I’m not implying every nurse or doctor does this, but couldn’t come up with a better title.
A cognizant patient is above all a free person. A free person is free to accept and to deny care, whatever may come. It’s his life, let him live his life as he sees fit. Explain, educate, inform and then ask: do you understand that if we don’t do this you may die / lose a limb / lose your liver / fall down and have a stroke and end up bed bound if we’re lucky enough to save your life?
I don’t understand the logic playing mental gymnastics to make a patient stay at a unit because the nurse or doctor in charge are convinced it’s in the patient’s best interest to do so, even when after education he wants to leave. I’m the odd one at my unit, as most of my coworkers do vehemently disagree with me, as they expect me to provide care AND to care. They feel they lost if a patient leaves against medical advice.
To me it looks like they don’t understand individual freedom and forget that a patient is still a free person. I wouldn’t want to be my coworkers’ patient.
You cannot stop grown ups from making stupid choices. The cognizant patient gets to decide his answer. Not a nurse or doctor convinced they get to decide for the patient.
Another problem I see: say you force a cognizant patient to stay at your unit because you are convinced you are doing the right thing. Why do you think he’s going to be a pleasant patient to work with? People lash out when they feel trapped and they insult and punch personnel. What’s the point?
Punched coworkers will call in sick and start looking for jobs elsewhere, some insulted ones too.
Wouldn’t it be better to inform, document, let him leave, move on?
I think thus just boils down to whether you think Kantian or Utilitarian ethics is more correct.
I think it’s not just ok, but morally obligatory to do your best to promote people’s well being, even via manipulation, regardless of if they are hellbent on fucking themselves over. Human beings are deeply, deeply imperfect, and we do not always make good rational decisions. With respect to medical care specifically, if someone refuses something that is objectively a clear benefit regardless of potential unknown context, then they are not doing so rationally, and there’s no good reason to just throw your hands up and give up on them for that.
This approach becomes extremely problematic once you leave the medical field, and it’s already problematic within.
The easy example is religion. Is it ok to manipulate them to save their souls? But let’s dial it back a notch. What about if someone doesn’t want kids, but you know they would be happier with them? What about giving up sex, drugs, and rock n roll? What about starting sex, drugs, and rock n roll?
Yes, people are stupid. And medicine is complicated and difficult to understand. And in systems like American healthcare, there’s a ton of bullshit on top of everything. But it’s very rare to be ok to deny them their agency to make a decision.
Of course, IME in the US, it won’t be the patient refusing treatment; it’ll be their insurance company that does so. And if not them, then finances in another form.
No, because souls don’t exist.
If I actually knew that for a fact then yeah, literally yes that would be ethical. The reason that feels wrong is because there’s literally 0 possible situation in real life where you can be certain about that, and in the vast, vast majority of situations the person saying that is correct about themselves. So in any real-world scenario, it wouldn’t be.
I’d like to clarify that I think the situations where it’s ethical to override a patients agency are not common. In practice I probably agree with you in 99.99% of cases.
But if I was literally omniscient so I knew?
Sure. If you had sufficient certainty that you can correctly, by reason alone, identify it as a truth that this would maximize their well being. Like the children example though, I don’t think there’s any real world scenario where you could be.
I’m not saying we should deny people agency as a rule. Doctors are also failable humans who would make bad decisions if we established as a rule that it’s ok for them to override patient agency.
I’m just saying that even though it’s immoral to establish a culture in the medical system of doing so, individual instances of doing so can absolutely be moral. Probably they should still be condemned anyway to prevent the establishment of such a culture, though.
If there’s one thing we can confidently conclude is immoral here I agree that it’s insurance companies lmao.