The Physician-Patient Relationship: The basis for moral clarity in clinical ethics

It is my
sense that the majority, perhaps the vast majority, of cases on which clinical
ethics consultants (CECs) are asked to consult and make an ethics
recommendation, there is, or would be, a general consensus on the part of the
CECs about what counts as the appropriate recommendation. However, the question
arises of how clinical ethics as a field should deal with issues that come up
about which there is not a clear consensus, such as in cases where a basic
right to have an autonomous choice respected by the patient is pitted over and
against the obligation of the physician to do no harm—the traditional tension
between respect for patient autonomy and beneficence/nonmaleficence. This
tension or conflict often occurs in cases of alleged medical futility where the
patient or the patient’s surrogate requests a treatment option the physician deems
will only cause harm and no benefit to the patient. For example, consider a
patient’s surrogate who insists that she will not consent to a DNR order and in
fact expects the physician to perform CPR if the patient arrests. For a patient
without capacity dying of metastatic disease, this directive by the surrogate
presents a stark dilemma to the physician—is it a violation of the physician’s
obligation to the patient to “do no harm” (nonmaleficence)? Or is respect for
the patient’s wishes or her representative’s wishes so sacrosanct that the
physician’s obligation to follow the patient’s wishes is paramount and
outweighs the obligation to do no harm?

Furthermore, it is my sense that those who view clinical
ethics cases from a distance, i.e.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.