Biomedical Ethics: Reflection Paper

In this essay, I will demonstrate that Beneficence, Autonomy, and Truthfulness are central to my decision to become a Physician Assistant and will play the greatest role in my ethical decision-making in clinical practice.

My choice to become a PA stems from my desire to help people, especially when they are vulnerable. I am fascinated by the ever-growing wealth of medical knowledge, having a general interest in the biological sciences and medicine specifically. There is nothing more gratifying than involvement in this problem-solving puzzle that is patient care. Equally important is the fact that not all ailments can be treated such that symptom resolution is achieved or that the patient is cured. In these instances, simply caring for these patients while sharing positive interactions, smiles, and making them comfortable and unafraid is most important to me. My choice to become a PA sees the intersection of desire, duty, and honor; the PA career parallels my passion, and in the near future, I hope to be grateful for every patient I care for.

Competent delivery of evidence-based medicine, and thus keeping up with changing treatment modalities, is very important to me. This is also true of practicing patient-centered medicine and shared decision-making. I wish for my patient interactions to be such that we are on a dynamic team. Therefore, having an informed patient population and ensuring informed consent is upheld is paramount. The importance lies in producing better healthcare experiences and outcomes. Relationship building and engaging in supportive conversations with my patients is also important. In the instances I described above in which treatment may not render the patient asymptomatic or “cured,” I wish to understand and aid in the choices my patients wish to make.

Beneficence, Autonomy, and Truthfulness will play the greatest role in my ethical decision-making in clinical practice. Beneficence means acting to maximize good or minimize harm. (Yeo et al., 2010, p. 103) Autonomy is an individual’s right to make choices related to their life. (Yeo et al., 2010, p. 91) Truthfulness is a dynamic exchange that does not involve withholding information; where appropriate, what is known is shared. (Surbone, 2006, p. 944)

Beneficence is demonstrated regarding my desire to deliver evidence-based medicine. As a future PA, I am looking forward to keeping up with medical literature to learn about ever-changing treatment modalities that may afford my patients maximal benefits while minimizing harms. Autonomy supports practicing patient-centered medicine and shared decision-making. In order to inform my patients and allow them to participate in informed consent or other treatment decisions, disclosure of the totality of information related to their diagnosis and treatment options (risks, benefits, and alternatives) is important. This process refers to the ethical principal of Truthfulness. Thus, Truthfulness fosters an informed patient population which in turn fosters Autonomy. Once the patient has received all of the necessary information, we should respect their right to make decisions about matters that significantly impact themselves. It is important to note that practicing patient-centered medicine can sometimes raise the question of “What is Beneficial?” and “To Whom?” This may produce tension between Autonomy and Beneficence. Consider an example in which a patient is newly-diagnosed with late-stage cancer. Perhaps treatment via surgery is possible, but due to the location of the tumor, it would result in paralysis. After appreciating the risks, benefits, and alternatives to the surgical procedure, the patient elects not to have the surgery and chooses palliative care. The team thinks that removing the tumor would produce the greatest benefit for the patient. The patient, on the other hand, has no interest in life if he/she were paralyzed. In this example, the teams view of benefit differs from that of the patient. In considering Autonomy, the patient’s right to make decisions about matters that significantly impact himself/herself should be respected. Meanwhile, the team must expand their perspective to understand that what they view as beneficial is not what the patient views as beneficial. In expanding their understanding, the tension between Autonomy and Beneficence resolves; after disclosure of the necessary information, the patient is making the choice, and this choice is consistent with what they perceive as producing maximal benefit. As a patient-provider team, information will be disclosed and the patient will reciprocally disclose their treatment goals, their values, and other critical factors that guide medical care. This is involved in individualized, patient-centered care. It is my philosophy, and the literature has also demonstrated, that positive interactions can be beneficial for patients. This can maximize good for the patient as it produces the most beneficial psychosocial outcome which can influence the course of their disease and how they deal with it. Additionally, I wish to reduce feelings of fear in the face of illness. These two notions parallel Beneficence.

This essay successfully demonstrated that Beneficence, Autonomy, and Truthfulness are core principles regarding, both, my decision to become a PA and the aspects of clinical practice I feel to be most important.

Reference List

Surbone, A. (2006). Telling the truth to patients with cancer: what is the truth? Lancet

            Oncology. [7th edition], pp. 944-950.

Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in

            Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.

Yeo, M et al. (2010). Beneficence. In M Yeo et al. (eds.). Concepts and Cases in Nursing         

            Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.