Patient Autonomy: Where Should It Begin and End?

I have published threads here in the past for discussion of the ethical conflict between physician paternalism versus patient autonomy in medical decision-making.

Here is a brief vignette extracted from a book review article “Veatch Hates Hippocrates” by ethicist John D. Lantos in the January-February 2010 issue of the Hastings Center Report that sets the conflict rather clearly. Read it and then give us your view of the “good” and “bad” of this communication between a patient and her doctor. ..Maurice.

Doctor: “I notice that you are coughing, that you are using your intercostal muscles when you breathe and that you are breathing sixty times a minute. I don’t want to impose my values upon you. How do you value that state of being?”

Patient (gasping for air): “…can’t….breathe…”

Doctor: “Can’t breathe? Well for me that would be unpleasant, but I happen to value oxygenation. I wouldn’t want to impose those values on you. I could give you a little oxygen. Or I could give you morphine. Or I could give you a nebulizer treatment. Which would you prefer?”

Patient: “I just…want something that will make me feel …better…”

Doctor: “I want to help. Tell me… what does ‘better’ mean to you?”