Gabriel Angelo M.

Montemayor Bioethics 1 Reflection Paper

2014-28336
1. How should doctors and those in training do hospital rounds?
Hospital rounds should be done in a way that is person-centered. As stated in the Alma-Ata
Declaration, health is a state of complete physical, mental, and social well-being and not merely
the absence of disease and infirmity. Thus, doctors should not focus only on the pathologies
and conditions that these patients have because each patient experience is unique and
therefore must be individualized. Doctors must not treat the patient as the disease entity (i.e.,
referring to the patient as someone who has Tuberculosis) because the patient is more than
that. Being person-centered implies treating patients as partners in the management of their
own health, which involves disclosing to them information about their condition,
communicating with them, and consulting them throughout the process. This way, they will feel
more involved and their opinions will be valued.

2. Should the sleeping hours of patients be respected? in rounds – teaching and clinical? in
monitoring?
Respecting the sleeping hours of patients is generally the right approach when conducting
rounds, whether it is for teaching purposes in a clinical setting or during monitoring. We as
physicians have to remember, as simple as it sounds, that patients are human as well. Thus,
even though we may think that we have their best interests at mind, we have to act accordingly
in a manner that respects the autonomy and dignity of our patients since they are the biggest
stakeholders in terms of their own health. This also means that we must respect their right to
privacy. Therefore, their time, including sleep, is protected unless it is necessary. The key,
however, is to engage and talk to the patient. For example, we can let them know when a
procedure is absolutely necessary and must not be delayed.
The best way to practice respect in this scenario is to do hospital rounds while the patient is
awake, which also comes with the added benefit of the patient being more alert, oriented,
conversant, and engaged. Doing so while the patient is asleep is a disservice for both the
patient and those who are being taught because the end result would be suboptimal—for the
patient, sleep is disturbed and no significant progress would have been done while for the
student, the clinical picture may not be fully grasped.

3. Are patients allowed to refuse procedures and interventions even if they are deemed
necessary?
First, it is important to establish that respect for autonomy is only applicable when the patient
has the capacity to act intentionally, with understanding, and without external or controlling
factors (i.e., influence of drugs, abuse) that would otherwise influence decision-making and,
thus, take away the premise of voluntary act. These patients are deemed competent and
therefore have the ability to express preferences, understand the situation at hand,
contemplate and rationalize relevant information, and ultimately reach a reasonable decision
on their own. A person’s autonomy is also not absolute and can be restricted if 1) the patient is
incompetent and 2) if the decision of the patient can impose harm or violate the autonomy of
others or society.
On to the subject matter of refusal of necessary procedures and interventions, this poses an
ethical dilemma since there are 2 principles clashing in this case—respect for autonomy and the
principle of beneficence. An autonomous person has the right to have a say especially when
Gabriel Angelo M. Montemayor Bioethics 1 Reflection Paper
2014-28336
talking about medical treatment options and the physicians, subsequently, are obligated to
respect the preferences of the patient. Respecting autonomy is to acknowledge, at the very
least, a person’s right to hold views, to make choices, and to take actions based on personal
values and beliefs (Beauchamp and Childress, 2001). Thus, theoretically speaking, respecting
the autonomy of the patient to the extreme in this scenario is to allow refusal of the necessary
treatment. On the other hand, the principle of beneficence is catered towards promoting the
welfare of the patient and acting for the benefit of the patient, which means preventing harm
and removing conditions that will cause harm to the patient, among other things. Thus, if we
are to apply the principle of beneficence to its extreme in this scenario, it implies that the
physician does the best treatment for the patient despite refusal and therefore disrespecting
the patient’s right to self-determination.
With these two options, the question is: “which option is the right one?”. In my opinion, the
ultimate cop-out answer of “it depends” is the only logical position I would take. For me,
upholding respect for autonomy does not mean relying solely on the patient for decision-
making. Promoting autonomy also involves helping the patient to deliberate by disclosing
information to the patient, listening to the patient’s thoughts and feelings about the situation,
and then educating the patient on the best treatment as well as the other options available.
Thus, as a physician, I have included the patient in the decision-making process and vice-versa.
Ultimately, the end result should be a shared decision from the patient and the physician (and
to a certain extent from the relatives).

4. Assuming a competent adult patient, do the opinion of blood relatives matter?

For a competent adult patient, the opinion of blood relatives matter only to a certain extent. As I
indicated earlier, promoting autonomy also involves helping the patient to deliberate by
disclosing information to the patient, listening to the patient’s thoughts and feelings about the
situation, and then educating the patient on the best treatment as well as the other options
available. This can also be applicable to blood relatives since they are, to an extent,
stakeholders in this scenario. However, the ultimate decision still rests on the patient. As long
as no controlling factors are at play that would otherwise strip the patient of autonomy, then
the influence of blood relatives can still be valued.