2. Client
Autonomy
´ Client Autonomy suggests that the professional’s
right to decide is qualified by the client’s responsibility to him/herself. The
right of the professional is decided by the responsibility of the client. Jack Kevorkian (medical pathologist,
euthanasia activist & author) admonished that “the patient’s autonomy always, always should be respected, even if it
is absolutely contrary- the decision is contrary to best medical advice and
what the physician wants”. Do you agree with him?
´ It is often a difficult ethical issue to navigate when
the client autonomous decision (his/her
intentional act) conflicts with the professional’s beneficent duty (action done
to benefit the client’s best interest without his/her knowledge). Thom
Mayne teaches; “I’ve learned that in
order to achieve what I wanted, it made more sense to negotiate than to defend
the autonomy of my work by pounding my first on the table”.
Case Study
A 74-year-old man with multiple
chronic medical problems was hospitalized for respiratory distress. He
experienced recurrent aspiration and required frequent suctioning and
endotracheal intubation on several occasions. The patient was deemed competent
and steadfastly refused feeding tube
placement. The patient demanded that he should be allowed to eat a normal diet
despite being told that it could lead to his death. The patient wanted to go
home, but there was no one there to care for him. Additionally, neither a
nursing home nor hospice would accept him in his present condition.
The case is especially interesting
because of the symbolic value of food and the plight of the patient who has no
alternative to hospitalization. The hospital staff experienced considerable
stress at having to care for him. They were uncertain whether their obligation
was to respect his autonomy and continue to provide food or to protect his
health by avoiding aspiration, pneumonia, and possible death by denying him
food. This ethical dilemma posed by the physician’s duty to do what is in the
patient's best interest versus the patient's right to decide treatment serves
as the focus for this case study.
What should the physician do in this situation?
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Food for Thought
“Professional-
Client relationship at its best is to be regarded as a partnership in which decision-making authority is shared.
Professionals are not dictators but enablers”. 
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