Case One: Patient Interests and Medical Paternalism

Extract

A 16-year-old Hodgkin lymphoma patient refuses to have his blood specimen drawn, thus canceling his scheduled oncologic treatment. As a 16-year-old, he has no legal standing as an adult. His parents are split over his decision. One supports his right to choose; the other wishes the specimen to be drawn and the chemotherapy reinstated. The physicians at the hospital are seeking legal redress to have the court order the blood specimens to be taken.

The most fundamental question presented by this case is, “Who is in position to judge what is in the patient's best interest?” To many, the answer seems clear. Respect for the autonomy of the patient requires that he have the power to make decisions regarding his medical treatment. That is, there is a presumptive case in favor of allowing patients the right to determine for themselves the course their lives will take, and this includes the course their medical treatment or non-treatment will take. This rests on the assumption that patients are capable of exercising autonomy. But, what is required for a person to be in a position to exercise genuine autonomy?

In order to make autonomous decisions two conditions must be satisfied. First, the agent must be minimally rationally capable. In other words, a patient must be capable of recognizing and weighing differences between diverse treatment options, and then be able to reach a reasoned conclusion. In this case, the issue is complicated by the fact that the patient is a minor. Nevertheless, that we…