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Respect patient autonomy and share decision-making, doctors reminded

Reminder comes in wake of recent high profile disputes between doctors and patients about care

Caroline White

Tuesday, 23 September 2014

Doctors are reminded to respect patient autonomy and share decision- making where possible, including fully explaining the pros and cons of particular treatments, medical defence organisation MDDUS has said.

The reminder comes in the wake of a spate of recent high profile media stories where patients have disagreed with doctors over the best course of medical care.  

MDDUS has dealt with cases in which doctors have disagreed with a decision made by the parents of a child regarding their care or where there has been disagreement with the decision made by a competent patient regarding their own care.

Whenever these situations arise, doctors are faced with an ethical dilemma of balancing their duty of care with the patient’s right to autonomy, says MDDUS.

Last month, the parents of 5-year-old Ashya King removed him from Southampton General Hospital after doctors turned down their request to treat his brain tumour with proton beam therapy on the NHS in England.

MDDUS medical adviser Dr Naeem Nazem believes the risks of conflicts in healthcare decisions can be minimised by, wherever possible, working in partnership with patients to enable them to make informed decisions about their care.

“Nowadays, patients and their relatives have greater access to health information and seek to play a more active role in decisions about their care,” he said.

“In the vast majority of cases, doctors and patients work together in a partnership based on mutual respect. A shared decision, complete with a full and frank discussion of risks and benefits, is more likely to ensure a positive patient experience and outcome,” he continued.

“Where an agreement can’t be reached, doctors need to consider whether a competent patient is making a choice about their own care or an adult is making the decision on behalf of a child or under a power of attorney, he said.

Doctors have a duty to raise concerns if they believe a parent is not acting in a child’s best interests, he insisted. “However, when it comes to a decision made by a competent patient, doctors must respect a patient’s autonomy and right to decide, even if they disagree.” 

MDDUS has dealt with cases where the relationship between doctor and patient has broken down due to a disagreement over treatment.

“While doctors cannot force a patient to follow their advice, they are entitled not to provide treatment requested by a patient that they do not believe is in their best interests,” added Dr Nazem.

But they must explain their reasons carefully and advise the patient that s/he is entitled to a second opinion.

“In these situations, doctors must explain their reasons to the patient and the other options available—including the right to seek a second opinion,” he said.

“MDDUS has dealt with many cases in which patients have requested unlicensed or specialist medicines from their doctors, following their own research on the internet. Doctors are reminded of their ethical duty to work within the field of their own knowledge and expertise,” he said.

“While patients are entitled to request medicines from their doctors, it is ultimately a doctor’s decision to consider whether any treatment or intervention is in the best interests of their patient.”

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