For the patient's good. Complex?

Rosemary Flanigan

September 4, 2009

I sometimes think our ethics committee at Carondelet Health must be one of the most knowledgeable groups in the area—sometimes our self-education takes almost the whole meeting!—but I wish that simultaneously with learning so much, we could be DOING equally much (and maybe we are and I’m just not aware of it).

Back in 1988 the Pellegrino/Thomasma twosome wrote For the Patient’s Good. The Restoration of Beneficence in Health Care, and we are going to discuss the different meaning of the “good” of the patient:

-- The ultimate good (that which constitutes the patient’s ultimate standard for his/her life’s choices, that which has the highest meaning for him/her

--Biomedical good (that which can be achieved by medical interventions

-- The patient’s perception of his/her own good at the particular time and circumstances of the clinical decision and how one prefers to advance one’s own life plan

-- The good of the patient as a human person capable of reasoned choices

The physician is bound to advance each of these four senses of good to the extent possible.

So let’s say the patient dying of cancer who had consistently refused resuscitation now during his/her last hours begs to be put on a respirator because of difficulty in breathing. Here is the place that people might fear their living wills or advance care plans will work against them.

But the physician may order the respirator—in order to make the patient comfortable—without negating the patient’s life plan entirely.

BUT, what if the patient is unable to speak and there is conflict between physician and proxy? Call in the ethics committee!!!! (hopefully, a well-educated one!)

The “patient’s good” is a highly complex concept!!! COMMENTS????