Is it ever permissible to force medical treatment on a patient against their will? What if they are so emotionally distraught that they can’t think straight? What if they might die without the treatment?
What is it
In our healthcare system, parents normally make medical decisions for their kids because, we think, children are not competent to make such decisions for themselves. Similarly, we permit doctors to violate or defer consent for mentally incompetent adults. But where do we draw the line for what constitutes ‘incompetence’? Should severely depressed patients, for example, have the right to decide for themselves whether or not they want treatment? What makes a patient so incompetent, they should be precluded from making their own decisions? John and Ken consent to talk to Jodi Halpern from the UC Berkeley School of Public Health, author of From Detached Concern to Empathy: Humanizing Medical Practice.
Ken and Laura begin the show with the question: who gets to decide your medical decisions other than you? That is, when should patients’ medical decisions be made for them? Children and the physically incapacitated (e.g. the comatose, the unconscious) are perhaps the easy cases—we are comfortable when others make decisions for them. But what about adults who are depressed, grief-stricken, or otherwise psychologically incapacitated? What does ‘psychologically incapacitated’ even mean?
The philosophers invite Jodi Halpern, professor of bioethics at the University of Berkeley, to the show. Ken asks Halpern to flesh out what medical consent is and why the medical field is committed to it. They explore the importance of consent as a method of clarifying a patient’s values. But Halpern suggests that certain emotional and mental attitudes can get in the way of understanding one’s own principles. Still, Laura wonders why we think that any mental state could hinder a person's autonomy. For example, shouldn't we equally respect the decisions that a person who has undergone trauma and a patient who is a bad decision maker make?
In the last segment, Ken and Laura ask Halpern how she thinks that our current medical practices should change. The philosophers discuss “advanced directives" -- questionnaires that are meant to discern a patient’s values. Finally, Halpern argues that doctors should be more empathetic to and engaged with their patients. She explains how this practice would mitigate the ethical challenges of medical consent.
- Roving Philosophical Reporter (Seek to 7:28): Liza Veale documents the story of a doctor who receives a significant number of requests from emotionally troubled people who want to end their lives. The rights of patients and doctors are considered.
- Sixty Second Philosopher (Seek to 45:18): Ian Shoales discusses the advent of advertisements for prescription drugs on television and how patients are now empowered to choose the drugs they use.