What is wrong with having different standards of care to accommodate all the different cultural backgrounds of potential patients? When Dr. Fife used that approach (p. 77), other doctors obviously did not respect him for it. But patients preferred him, and a good relationship between a patient and his or her physician is critical when it comes to compliance. Why stick to methods that patients do not understand, support, or believe in? Is that really what is best for people? Being forced into doing what is considered best for them, because that is the only option? It is their body. So why is respecting the patient's wishes above all else considered a "lower" standard of care? The "higher" and "lower" distinction gives the impression that other methods of treatment are lesser than Western medicine. And even if you, as a doctor, strongly believe that Western medicine is the end all be all, your patient might believe in something else entirely that is just as important to him or her. The suggestions from the conference on interacting with Hmong patients that we looked over in class yesterday was one example of an attempt at bridging that gap. Maybe they wouldn't work verbatim in practice, but any effort made by a doctor to better comprehend where a patient is coming from can't hurt. If it's good enough for McDreamy...
On p. 80, Fadiman mentions "the principle of autonomy" and "the principle of beneficence". I looked up those terms because I am absolutely torn about bioethical principles these days, and now I'm even more confused about where I stand. Despite the fact that I keep leaning heavily toward autonomy, the truth is that there simply isn't always time to gain an understanding of a patient's wishes. And since many Hmong patients only seek medical attention when it is an emergency, the principle of beneficence is especially relevant.
"One clear example exists in health care where the principle of beneficence is given priority over the principle of respect for patient autonomy. This example comes from Emergency Medicine. When the patient is incapacitated by the grave nature of accident or illness, we presume that the reasonable person would want to be treated aggressively, and we rush to provide beneficent intervention by stemming the bleeding, mending the broken or suturing the wounded.
In this culture, when the physician acts from a benevolent spirit in providing beneficent treatment that in the physician's opinion is in the best interests of the patient, without consulting the patient, or by overriding the patient's wishes, it is considered to be "paternalistic." The most clear cut case of justified paternalism is seen in the treatment of suicidal patients who are a clear and present danger to themselves. Here, the duty of beneficence requires that the physician intervene on behalf of saving the patient's life or placing the patient in a protective environment, in the belief that the patient is compromised and cannot act in his own best interest at the moment." (http://depts.washington.edu/bioethx/tools/prin3cs.html)
In the case of an attempted suicide, the discrepancy between autonomy and beneficence is at its most extreme. It is their body. But when a person does not respect their body and tries to destroy it, that is one situation when the doctor definitely does know better.
Subscribe to:
Post Comments (Atom)
3 comments:
I agree with your point that Dr. Fife was doing something right when he "compromised" with his Hmong patients on certain aspects of their medical care. One of Fadiman's main points in "The Spirit Catches You and You Fall Down" is that the Nao and Foua lost faith in their doctors and distrusted Western medicine due to the lack of compromise on the part of some of the doctors. Dr. Fife's method of compromise is a far better solution than simply asserting authority over other cultures who may not be oriented to our culture of biomedicine. I also like that you pointed out that there are some issues that the doctors can not compromise on--this is part of life and is a real issue that doctors may have to confront sometimes.
While I do agree that the idea of compromise is probably the best step to take in cross-cultural medicine, I disagree with your assessment of Dr. Fife. I think that rather than actively compromising with and adapting to the Hmong, Fife simply didn't care. Notice that he also doesn't know the reasoning behind their wish for no episiotomies or cesarean sections and did not wish to know. In class, we've been discussing the medical field's ignorance of different cultures, and Fife seems to have the same level of ignorance. Of course, a one-page description of a doctor cannot adequately describe his competence, but I thought I'd share my initial impression as well.
I, too, have always strugged with medical ethics in these issues. One specific example that I've struggled with is the idea of cutting off life support vs. allowing assisted suidide for terminally ill patients. I know the difference between the two, certainly, but I think that a number of terminally ill patients (specifically those in very late stage illnesses) would argue that their quality of life really isn't significantly better than that of a terminally ill patient. Is the medical community really in a place to decide this? Shouldn't the decision be left to decide his own quality of life? I know that if assisted suidide for late-term illnesses were allowed, it would make it significantly more difficult to draw the line between what is considered a poor enough quality of life to aid someone in dying and what isn't, but it is a question I consider often, and I have yet to find comfort in any answer available.
Post a Comment