BigBlue wrote:GoodDoctor wrote:This is true, and we are very cognizant of the practice of obtaining informed consent before proceeding. But physicians in general have a philosophical problem with un-informed non-consent. When we seek informed consent, we provide the medical reasons for proceeding, the available medical alternatives, associated risk/benefit for proceeding, and associated risk/benefit for not proceeding. What physicians have is a philosophical problem with non-consent due to a patient's non-medical decision tree. Physicians are not out to deny folks their freedoms or restrict their behavior, we have seen all of the ugly sides of disease processes, study pathophysiology for our entire lifetimes, advance our understanding of these conditions and try to come up with better ways of treating disease, preventing disease. We just hope and expect, probably incorrectly, that patients ought to make medically informed decisions in their refusals.
Not everyone's decisions on medical issues are based entirely on health, nor are they always un-informed when non-consent is occurring. Perhaps what you may not be seeing is that some people's decision tree involves factors that don't relate directly to health. You're a doctor and apparently your ultimate goal is keeping people healthy. Some may prioritize other things in their life or even the state of their country over their own health. To minimize that and label it as uninformed is unfair to them and at odds with our nation's foundation of liberty. Their priorities may not be your priorities.
Would you similarly fault a person with what is likely a terminal cancer if they chose to stay home and die around their family instead of be hospitalized with a treatment that might help them but they stand a chance of dying there? From your statements I'd suspect you would be disappointed with that "ill-informed" decision. But I would see their point.
My comment had nothing to do with me or any other physicians finding fault with a person who refused treatment because they followed a non-medical decision tree. I was only trying to enlighten the philosophical difficulty physicians have when encountering such decision trees. We are not finding fault with any patient, we are not angry with such decisions, we understand where they are coming from, BUT . . . such decisions are difficult for us to evaluate in light of what we know about what ever we are trying to treat, which is based on our knowledge and experience and why we offer that treatment and provide the accompanying informed consent. Physicians work under conditions that are,
in the broadest sense, demanding decisions dealing with life and death and all untoward conditions in-between on a daily basis. We have all seen good outcomes and bad outcomes, and a lot of all of the in-between outcomes. So, philosophically, when a physician offers a medical treatment based on their knowledge and experience, explains that to the patient by providing informed consent, and the patient declines based on a non-medical decision tree, the physician is not angry with the refusal, not dumbfounded by the refusal, and is not blaming or finding fault with the decision because a decision based on non-medically related factors is just plain outside the scope of the physician's medical knowledge, experience and focus.
Your example concerning a terminal cancer patient's choice to stay home and die and whether I or any physician would fault that decision only shows how extraordinarily un-informed you are. Ever heard of hospice?