ToughChoices

I had a strange moment of realization today.

All of my life I have been a "helper" and a "pleaser".
Living with an alcoholic turned up the volume on those characteristics.
I'm concerned that recovering from life with an alcoholic may have turned them off.

I am entering a medical profession.

While discussing a case in medical ethics today, I had, without a doubt, the most "hands off" approach of anyone in my group. We were presented with a case where one of our patients refused to adhere to his medication schedule (due to unavoidable side effects), and was, therefore, putting his life at risk. My group was united in favor of calling his family to intervene.

Except for me.

I thought (and still think, despite all the arguing) that the patient should be counseled on the potential harm to himself, given professional medical advice, and left alone, to proceed as he desires. His life, his choice.

Everyone in my discussion group thought that I was being cold.

It made me wonder if my experiences with alcoholism, and the "hands-off other people's lives" approach that I've adopted as a means of dealing with addiction has adversely affected my ability to effectively care for my patients.

I'm proud of myself for defining where my problems stop and other peoples' begin - but perhaps a health care profession isn't the best place to start enforcing those boundaries? I don't know.

Anyone have any input?
Thanks!
-TC

denny57

I would be extremely angry if my doctor called my family and discussed anything to do with my health - unless I had signed a form stating it was ok or the state had deemed me mentally incompetent. I am an adult and will make my own choices regarding my health.

I'd add that my doctor would never do that - and that's one of the reasons he's my physician of choice.

hadenoughnow

"The group" was incorrect, there is this thing called Dr/patient privilege. Interfering by discussing a patients medication compliance even with their family is unethical. My mother is frequently non compliant with her BP medication and my brother used to get angry with her dr's until I explained to him that I know for a fact that she is non compliant but that they are not allowed to discuss it with us that unless she is incapacitated.

respektingme

Your argument makes perfect sense. But I think it's one of those things that could be tough if you're really in the situation. For example, my dad had a heart attack and open heart surgery. The surgery recovery was painful. He said he'll never have it again. Well, he hasn't signed a living will, and if he's having another heart attack and out of it, he's going to have it again if I have anything to do with it. Likewise, my brother has emotional problems. He suffers from depression but hates taking the meds. He's stopped them abruptly and as a result, he's been suicidal twice. My mom flew out to get him over the hump both times. He's just frail emotionally. And he lulls himself into thinking he doesn't need the meds because he feels okay, and slips off into darkness. He gets better when he gets his meds stabilized. So if my mom wasn't there to help him, he could be dead. That's not something he'd want under normal circumstances. His head was just screwed up.

So I think it's cloudy. Definitely not in the same category of someone who is poisoning their body intentionally, day in and day out. If someone is determined to destroy their life, that's their choice. Family members can choose to detach if that's the case.

BTW, I made straight A's in college. All except for my Ethics class. I struggled and made a B. Seems odd because one would assume that would be easier than say, Microeconomics. Was probably the codie in me that made it so difficult.

ToughChoices

Dr./Patient privilege is very real. From a legal perspective, the patient's family should not be consulted - it would violate privacy policies.

We were discussing a provider's ethical responsibility to protect the patient and act in his/her best interest. Trying to decide if it was ethical to obey the law, when doing so might cause harm to our patient.

It's an interesting issue.
If the patient's noncompliance put others at significant risk I would be compelled to take action (although I'm not sure what that action would be), even if it wasn't technically legal to do so.

blessed4x

I am a nurse, and the medical profession is crawling with people that are codependent. As I learn more about me, I see why I was so drawn to a "helping" profession. I personally don't think you were cold at all.

Legally yes, there is HIPPA. I think if the person is of sound mind, and over the age of 18, has been presented with all the facts regarding the consequences of their choice, it is also ethical to leave the decision in their hands. Too bad I haven't been able to live that advice with my AH.....he is of sound mind (most of the time), over 18, and well aware of consequences of his choices. HMMM, you've really given me something to think about.

Barbara52

For me it kinda comes down to we all have the right to screw up our lives without outside interference. Who I am to tell someone else that they aren't capable of making a rational decision about what they want to do with their life and health? Who am I to say I know better than that other person whether the treatment must go on regardless of side effects? My standards are not universal standards. I will not impose my standards on another capable adult. I do not want that power over another adult either.