WHEN CONSENT IS NOT ENOUGH IN BIOETHICS
THE DILEMMA BETWEEN RESPECT FOR AUTONOMY AND PROTECTION OF LIFE
Ekemini William Etim (Rev. Fr.)
Introduction
It can be gleaned from various bioethical discussions that the place of autonomy occupies an important place in the formulation of the principles of Bioethics. Scholars envisage that autonomy respects one’s privacy and rights thereby fostering self determination and a sense of dignity. Meanwhile, such propositions and their purveyors are not entirely wrong. Nevertheless, a serious dilemma arises when respect for autonomy, self determination, privacy and rights are diametrically opposed to the protection and preservation of life for which medical interventions ought to be primarily concerned with.
Autonomy or Life: A critical Analysis
Cases abound where preservation of life is sacrificed for consent either from the patient or the patient’s family. More often than not, the medical practitioners are intimidated by possible litigation if the rights to privacy or consent are not respected despite their good will. It is at this point that the principle of bioethics especially in the Western world which prioritizes autonomy should be analysed and possibly reviewed to take into consideration the place of life which should hold a pride of place in the hierarchy of ethical values. This does not however mean that the place of autonomy should be relegated to the background but calls for a real practical resolution when both respect for autonomy and preservation of life are in contention.
As it were, the place of autonomy is important in Bioethics but should it override the preservation of life? In case of emergency where consent is almost impossible to obtain, to what extent can the medical practitioner go and to what extent is he or she protected by Law? Also, in a critical situation where a patient consciously refuses treatment out of erroneous cultural or religious belief or in a case where a family member refuses to consent to a surgical operation of the relative out of personal phobia, what can a medical practitioner do and to what extent is he protected by Law? Medical personnel should be in the best position due to their training to help one get an informed consent. However, one becomes incapacitated when such consent is refused. A real situation of life and death, for which a medical personnel has a remedy but consent is denied is a critical issue that Bioethics has to face especially when the good will of the practitioner is not protected by law.
On the other hand, one would not imagine that the patients are incapable of making some good judgements and in this case, contributing to their well-being through their consent. The patients who are capable of giving an informed consent should always be allowed and their consent respected as long as it is ethical. This statement presupposes the possibility of an unethical consent. I would imagine that such is a strong possibility. We cannot guarantee that a patient will always make a good judgement; there is a tendency to equally make a bad judgement. Thus, Bioethics should not shy away from delving into those practical situations where consent is just not enough.
Conclusion
It would be ethically wrong to allow a patient to die of an illness that is curable simply because there was no one to give consent or because the family member who should provide the consent is beclouded by erroneous cultural and even religious sentiments. Consent should not be an absolute without taking into consideration the entire well-being of the human person and his dignity. The Doctor should not be condemned to follow the medical preferences of the patient nor is the patient to be treated as if he had no self determination. There should be a proper therapeutic alliance. I would want to argue that therapeutic alliance in the first place involves openness and readiness to make use and accept the best medical treatment. Thus the prioritization of autonomy over life and other values affects also the social dimension of medicine. If autonomy does not consider human interdependence and mutual responsibility then the overall human good will continue to be violated.
Ekemini William Etim (Rev. Fr.)
- I am a Priest of the Catholic Diocese of Ikot Ekpene, Akwa Ibom State, Nigeria
- I am a Master Degree Student of Global Bioethics (Online)
- I have great interest in Bioethics