The case study involves a 24-year-old woman, Paige Howitt, who is in a constant pain resulting from a nerve condition (Mail Online, 2018). She wishes to undergo an operation meant to amputate her leg as she believes that it will help end her agony. She recounts that she had developed the condition seven years ago during a surgery to align her kneecap. Howitt narrates that she has been battling with pain ever since, describing her knee to be on fire. According to Mail Online (2018), the operation is estimated to cost $9,000, and she has taken initiative to raise the amount by organizing funds drive. However, she admits that her partner, Tom, is against the amputation, a situation that makes her hesitant to have the amputation procedure. Clearly, from this case study, there is a tension between personal autonomy and paternalism. It is worthy to note that paternalism is the practice of people to restrict freedom of other people. On the other hand, personal autonomy is the ability to make a personal decision regarding things that directly affect the individual. Typically, personal autonomy is vital over paternalism, and it helps a patient in many ways.
Advocates of personal autonomy have cited various reasons why they believe that it is good for patients. For instance, Oshana (2014) elucidates that personal autonomy allows a patient to grow psychologically, a situation that makes the patient to feel cared for and even respond positively to medication. Imperatively, coercing a patient not to take a particular medical procedure is detrimental to his or her health as the patient may feel unappreciated which may deteriorate his or her health. This situation, therefore, implies that a patient may not positively respond to alternative medication, leading to severe health complications and even death. From the aforementioned case study, Howitt has made up her mind to amputate her leg as evident through the fact that she has organized funds drive to help her raise the required amount for amputation. Mail Online (2018) also note that Howitt's stance on amputating her leg is also evident by the fact that she admitted that she could not cope up with her knee pain anymore. Thus, even if Tom is to influence her decision successfully, she would find it hard to respond to other treatments such as medications, rehabilitation therapy, and so on.
Another reason for personal autonomy is that it gives patients, just like other human beings, the freedom of choice. It, therefore, enables them to choose medical care that they believe will relieve themselves of the excruciating medical problems they encounter. As Hunsaker and Mann (2013) explain, a patient needs to have self-determination of which treatment to undertake and it should be free from duress, manipulation, coercion, and undue influence. It is imperative to note that an adult person by nature is qualified to make their own decision that best serves their interest. In the above case, Howitt's partner, Tom, is against her decision to carry out amputation of her leg even though she experiences unbearable pain that cripples her happiness and daily life activities. Tom was to advise Howitt on other options regarding her medical condition that she should explore rather than opposing her move to have amputation operation. By so doing, Howitt can easily change her mind and explore other treatment options.
It is a medical and legal requirement that adult patients should have personal autonomy over their health (Young, 2017). It is important to note that at 24 years old, Howitt is an adult capable of making informed decisions regarding her health. Therefore, unbeknownst to Tom, his action of opposing Howitt's decision to undertake a surgical procedure meant to amputate her leg is considered medically illegal (Young, 2017). The law gives a patient absolute right to choose or to oppose a given medical treatment provided that the decision of the patient is rational and the patient is not incapacitated. Lindberg, Fagerstrom, Sivberg, and Willman (2014) further explain that a decision is considered autonomous if a patient has sufficient information required to make a voluntary decision. It is plausible to note that Howitt gave a rational reason for her action: the excruciating knee that she narrates that has been detrimental to her wellbeing and comfort over the past seven years. In addition, personal autonomy helps to avoid future regrets and blames. It relieves family members of any guilt that they may face later if their preferred medication for their patient goes wrong.
Antagonists of personal autonomy, however, argue that it is contentious as a patient incapacitation is hard to evaluate. According to Pieterse et al. (2013), the health condition of a patient may cloud her judgment, a situation that may make him or her to make poor decisions as far as their medical treatment and care is concerned. It can be explained that the severe pain that Howitt faces influenced her action of amputating her leg. The ramification for this is that she could not make an informed decision regarding the medical procedure that she should undertake. Therefore, in this regard, Tom acted in the right manner by opposing his partner's move to amputate her leg as she could not make the informed decision. Even though Howitt was not incapacitated and was an adult to make decisions regarding her medical care on her own, chances are that she never explored all the options available for alleviating her condition. According to Harden et al. (2013), therapeutic ways of treating Complex Region Pain Syndrome (CRPS) include physical and rehabilitation therapy, psychotherapy, and medications. In this regard, it is essential to highlight that Tom might have been right in opposing the decision that Howitt is about to undertake of amputating her needs. Notably, Tom's staunch stand can help her explore other therapeutic ways that can be better than doing leg amputation
Utilitarianism theory stipulates that actions of individuals are considered either right or wrong based on the effects that they have on utility (Mill, 2016). It is imperative to note that utility refers to pleasure or ability to satisfy informed preferences. Vitally, two sovereign masters govern humanity: pain and pleasure. These two stimuli make a person to make decisions meant t either alleviate pain or increase pleasure. As earlier stated, Howitt suffers from excruciating knee that has been unbearable for more than half a decade. It is important to note that Howitt believes that the best way to eliminate her pain is to amputate her leg. She, therefore, has an informed preference regarding her action. The utility involved in Howitt's decision is that she will be able to alleviate her adverse medical condition that has denied her happiness. On the other hand, disutility regarding her decision is that she will lose her limb, a condition that will make her a person with disability. As Hayry (2013) elucidates, classical utilitarianism stipulates that an action is right if it maximizes on utility while limiting disutility. This, therefore, implies that a rightful action entails exclusive pleasure or satisfaction of a given preference. For Howitt, she wanted to eradicate her pain by amputating her leg that was the source of her suffering. By so doing, her actions are justified as she aims to achieve a long-lasting pleasure that she has longed for, ever since she had a knee surgery went wrong seven years ago.
In general, it is indeed true that personal autonomy for patients has more benefits to their health, unlike paternalism. Patients need to have the sole mandate to make personal decisions regarding which medical procedure to undertake. They can, however, receive pieces of advice from medical staff, family members, friends, and colleagues from work or school. Personal autonomy is beneficial to psychological well-being of patients and improves their mental and physical health. In contrast, paternalism is preferable for underage or incapacitated patients as it ensures that they undergo the best medical procedure that promotes their physical and mental wellbeing. Nonetheless, for adults who can make sound decisions, paternalism is detrimental to them as it contravenes their freedom of choice. Therefore, health professionals and family members need to understand when to guarantee a personal autonomy and when to decide for a medical procedure or care for the patient.
Harden, R. N., Oaklander, A. L., Burton, A. W., Perez, R. S., Richardson, K., Swan, M., ... & Bruehl, S. (2013). Complex regional pain syndrome: practical diagnostic and treatment guidelines. Pain Medicine, 14(2), 180-229.
Hayry, M. (2013). Liberal utilitarianism and applied ethics. Routledge.
Hunsaker, A. E., & Mann, A. (2013). An analysis of the patient self-determination act of 1990. Journal of Human Behavior in the Social Environment, 23(7), 841-848.
Lindberg, C., Fagerstrom, C., Sivberg, B., & Willman, A. (2014). Concept analysis: patient autonomy in a caring context. Journal of advanced nursing, 70(10), 2208-2221.
Mail Online (2018). Woman, 24, is considering paying PS9,000 to have her leg amputated. [online] Available at www.dailymail.co.uk/health/article-5912391/Women-24-suffers-constant-pain-considering-paying-9-000-leg-amputated.html [Accessed 7 Jul. 2018].
Mill, J. S. (2016). Utilitarianism. In Seven Masterpieces of Philosophy (pp. 337-383). Routledge.
Oshana, M. (Ed.). (2014). Personal Autonomy and Social Oppression: Philosophical Perspectives (Vol. 65). Routledge.
Pieterse, A. H., de Vries, M., Kunneman, M., Stiggelbout, A. M., & Feldman-Stewart, D. (2013). Theory-informed design of values clarification methods: A cognitive psychological perspective on patient health-related decision making. Social science & medicine, 77, 156-163.
Young, R. (2017). Personal autonomy: Beyond negative and positive liberty. Routledge.
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