Based on the Article from the Journal of Ethics, AMA.........\"Explain your take

Question

Based on the Article from the Journal of Ethics, AMA........."Explain your take on Dr. Anderson's paternalism. Does she have a moral obligation to be paternalistic or to respect her patient's autonomy. Support your claim."

I know that this is supposed to be my thoughts, but what I need help with is understanding the details of the article and processing the information based on the bioethical principals. If someone could help me with this please.

*****I was unable to upload a PDF of the article I am referring to so I copied and pasted it below. Assistance is greatly appreciated. Thank you

Article:

AMA Journal of Ethics®
Illuminating the art of medicine
Virtual Mentor. February 2004, Volume 6, Number 2.
Clinical Cases
Paternalism
Commentary by Anne Drapkin Lyerly, MD, and Barbara Katz Rothman, PhD
Lisa Morgan arrives in the office of Dr. Karen Anderson, her obstetrician/gynecologist. Dr. Anderson, who is
going over her schedule for the day, hopes that Lisa is not pregnant again. Less than 2 years ago, Dr.
Anderson had performed a therapeutic abortion for Lisa, who is now 20 years old and unmarried. The
doctor's concerns are confirmed when her medical assistant, Elena, informs Dr. Anderson that Lisa is in the
office seeking another abortion.
From the beginning of the office visit, Dr. Anderson is frustrated with the interaction. Lisa seems to be
taking the situation lightly. Perhaps she is embarrassed, but her behavior is complicating a situation that is
already uncomfortable for the doctor. Dr. Anderson intensely dislikes performing abortions but will do one
when she thinks it is best for her patient, as with Lisa's first one. Dr. Anderson, who has a daughter about
Lisa's age, does not want Lisa to regard abortion as a form of birth control.
Before agreeing to perform an abortion, Dr. Anderson brings up the topic of birth control. At the time of
Lisa's first pregnancy, she had not been using any contraception. This time, she had been using birth
control pills prescribed by Dr. Anderson, but she was forgetful, missing scheduled pills frequently by her
own admission. Dr. Anderson suggests a longer-acting form of birth control, such as Depo-Provera (by
injection) or an intrauterine device. Lisa cringes at the thought of shots, even as infrequently as 4 times a
year, and says she knows women who have had bad cramping and even infections from IUDs. She wants
to stay on the pill.
Dr. Anderson tries to persuade Lisa, saying that she is likely to forget her pills again, just as she did during
the past few weeks. Dr. Anderson feels as though she is repeating the same words over and over again,
and she insists, somewhat angrily now, upon Depo-Provera. Lisa still shakes her head vigorously, saying
that she prefers pills to shots.
Dr. Anderson says "Wait here, Lisa, I'll be back in a minute," and abruptly leaves the room to regain her
composure. She vents to her assistant Elena, saying "I'm not making any headway with this girl. What else
can I do? I don't want her to just choose another clinic, but I don't think using abortion as a form of birth
control is healthy for this girl. I've got to try to educate my patients."
Commentary 1
by Anne Drapkin Lyerly, MD
In this scenario, Karen Anderson, an obstetrician/gynecologist, struggles about whether to perform an
abortion for her patient, Lisa Morgan. Because Lisa has had an abortion in the past, seems to be "taking
the situation lightly," and elects not to change her method of contraception, Dr. Anderson is uncomfortable
about performing the procedure for Lisa again.
Like many dilemmas regarding abortion, this scenario has several layers of moral complexity. At first
glance, the issue at stake is whether Dr. Anderson's potential refusal to perform the abortion constitutes
unjustified paternalism or if it instead represents justified concern for her patient's well-being. Closer
12/6/2017 VM -- Paternalism, Feb 04 ... Virtual Mentor
http://journalofethics.ama-assn.org/2004/02/ccas1-0402.html 2/4
inspection, however, suggests that the essence of the dilemma stems from the physician's personal moral
unease about this patient's reasons for requesting termination of pregnancy.
First, let us consider the question of paternalism. Paternalism has been defined as the "intentional
overriding of 1 person's known preferences or actions by another person, where the person who overrides
justifies the action by the goal of benefiting or avoiding harm to the person whose preferences or actions
are overridden" [1]. In this scenario, Dr. Anderson contemplates refusing to perform an abortion for what
she perceives to be Lisa's "own good"—an action that satisfies the definition of paternalism. She doesn't
want to send the wrong message by reinforcing a supposition that abortion is a "healthy" method of
contraception. According to this reasoning, refusing to provide an abortion would send a stronger message
that abortion is not a healthy method of contraception.
Dr. Anderson's attempted beneficence indicates unjustified paternalism for at least 2 reasons. First, if her
goal is to insure that Lisa is better educated about safe and reliable contraception, refusing to perform an
abortion is hardly the means to do so. Although she has offered the patient alternative forms of
contraception such as Depo-Provera and the IUD, she certainly has not exhausted the possibilities, such
as transdermal contraception, the contraceptive ring, or the diaphragm.
Even if Lisa continues to elect oral contraception, Dr. Anderson could advise her further on how to increase
compliance (ie, taking the pills after another daily activity, such as brushing her teeth or removing contact
lenses). Finally, her discussion should include counseling about the risks associated with pregnancy
termination so that Lisa can consider these in the context of her own short- and long-term reproductive
decision making. Lisa is a sexually active adult and should be educated not by example (or unjustified
paternalistic decision making on the part of her physician) but by clear, articulate verbal exchange.
Admittedly, the patient as described does not appear to be optimally receptive to counseling, which brings
us to the second flaw in the physician's rationale for paternalistic behavior. Even if further attempts at
communication fail, Dr. Anderson would not be justified in refusing to provide the abortion for the patient's
"own good." As a physician, she is not in a position to know better than Lisa what would be in Lisa's best
interest. It is likely that Lisa, like many women considering abortion, will not disclose all of the
considerations that led her to seek an abortion—particularly in light of what seems to be a judgmental and
emotionally charged reaction on the part of her physician. One scholar in the field of abortion research
reflected on a woman who:
…had three abortions in two years, butchose to keep usingthe
rhythm method. I recall feelingpuzzled by herinsistence on an
obviously ineffective method. Ayearlatershe came into my
private office forpsychotherapy; she wanted help in leavingher
batteringhusband. Itwas he who had forbidden herto use any
otherform ofbirthcontrol [2].
Women's stories are complex, contextualized, and often unavailable to the individuals who perform their
abortions. Assuming we can make conclusions about our patients' best interests during a short clinic visit—
particularly decisions about reproduction—is at best presumptuous, at worst an arrogant and maleficent
way to attend to patients as they work through difficult reproductive decision making.
Let us move, however, beyond the question of paternalism to what I perceive is at the heart of Dr.
Anderson's dilemma: an apparent conflict between her values and those of her patient. Suppose that Dr.
Anderson does in fact have a relatively detailed understanding of the patient's reasons for undergoing an
abortion and that these reasons seem unethical to her. Perhaps she thinks that Lisa is approaching the
decision to terminate her pregnancy with the wrong moral stance, and she (Dr. Anderson) simply does not
want to be complicit in an act that to her is ethically problematic. How can Dr. Anderson resolve this
dilemma?
On the one hand, a physician may, except in emergencies, choose whom to serve [3]. Thus, Dr. Anderson
is not obligated ethically to provide an abortion for Lisa and could refer this patient to another provider for
these services. Closer analysis suggests, though, that continuing to provide care—even an abortion—for
Lisa, would actually be an ethically preferable decision.
12/6/2017 VM -- Paternalism, Feb 04 ... Virtual Mentor
http://journalofethics.ama-assn.org/2004/02/ccas1-0402.html 3/4
One reason that continuing to care for Lisa would be ethically preferable is that, despite Dr. Anderson's
initial analysis, Lisa may in fact have reasons for pregnancy termination that the physician could
understand to be morally acceptable. Moreover, even if Lisa's reasons for pregnancy termination seem
shallow or patently wrong to Dr. Anderson, she cannot know her patient well enough to judge whether her
action is morally acceptable in the context of Lisa's life. As philosopher Maggie Little has eloquently
argued,
Decidingwhen itis morally decentto end apregnancy, itturns out,
is an admixture ofsettlingimpersonally oruniversally authoritative
moral requirements, and ofdiscoveringand arbitrating—
sometimes afteragonizingdeliberation, sometimes in adecision
no less deep forits immediacy—one's own commitments, identity,
and definingvirtues [4].
Note that Dr. Anderson's commitments, identity, and defining virtues are different from Lisa's, and
recognizing that difference is critical to her appreciating an acceptable discrepancy between her own
ethical decision making in a similar situation and that of her patient.
Secondly, as a physician who has decided to provide abortions, it is important for Dr. Anderson to consider
her services in light of the history of abortion in the United States. Restricted access to abortion has
historically been a serious public health problem for women. While a detailed discussion of this is beyond
the scope of this commentary, studies indicate that before the legalization of abortion in 1973, 17 percent of
pregnancy-related deaths were the result of illegal abortion. Presently, the risk of death from abortion is
significantly less than the risk of death associated with carrying a pregnancy to term [5]. Dr. Anderson may
find her role in improving access to abortion by providing abortion services in a private, safe, and
nonjudgmental clinical setting.
Physicians who are involved with patient decision making about reproduction interface with some of the
most private, personal, and important decisions of an individual's life. Facilitating patients' own reasoned
and reflective decisions about reproduction will almost always promote the best interests of our patients in
particular and the health of women in general.
Anne Drapkin Lyerly, MD, is an assistant professor in the Department of Obstetrics and Gynecology and
a faculty associate in the Center for the Study of Medical Ethics and Humanities at Duke University. She
completed the Greenwall Fellowship in Bioethics and Health Policy and currently devotes her research and
writing efforts to ethical issues, women's health, and reproductive medicine.
References
1. Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 5th ed. New York: Oxford University
Press; 2001:178.
2. Anolick K. Foreword. In: Kushner E. Experiencing Abortion: A Weaving of Women's Words. New
York: Harrington Park Press; 1997: xii.
3. American Medical Association. Principles of Medical Ethics. Code of Medical Ethics, Current
Opinions, 2002-2003 edition.
4. Little M. The morality of abortion. In: Frey RG, Wellman CH, eds. A Companion to Applied Ethics.
Blackwell Publishing; 2003.
5. Gold RB. Lessons from before Roe: will past be prologue? New York: The Guttmacher Report on
Public Policy. March 2003. Available at: http://www.agi-usa.org/pubs/ib_5-03.html. Accessed
January 26, 2004.
Commentary 2
by Barbara Katz Rothman, PhD
12/6/2017 VM -- Paternalism, Feb 04 ... Virtual Mentor
http://journalofethics.ama-assn.org/2004/02/ccas1-0402.html 4/4
Abortion seems to be unique among procedures doctors perform, in that physicians' personal distaste for
performing them is considered reason enough not to do them. A physician who, for example, really hates to
attend the births of children with Down syndrome, cannot tell her patients, "You really must have prenatal
diagnosis and abort if Down syndrome is diagnosed, because I hate to do those births." Or, less morally
fraught, a doctor who finds setting bones distasteful, just does not like to do it, cannot say to a patient: "You
really must stop skiing because I hate to set bones."
But a physician who "intensely dislikes performing abortions" is allowed to have that influence her practice
and even her patient's treatment.
Karen dislikes performing abortions: no reason is given. No reason has to be given, it seems, if it is
abortion. Its "unlike-ability" is taken for granted.
Ms Morgan is a sexually active, fertile woman who has experienced her second pregnancy in less than 2
years. At the time of her first pregnancy, she was not using any contraception and is now somewhat
erratically taking birth control pills. Unless there was a long unexplained period of sexual abstinence
between the last pregnancy and this one, she has apparently been fairly successful in her contraception. A
20-year-old, demonstrably fertile woman who does not conceive for almost 2 years is almost by definition
fairly effective in her contraception.
We now are faced with a conflict between what Karen feels comfortable doing and what Ms Morgan feels
she needs to have done. We are being asked to think of Karen as maternal: she has a daughter Ms
Morgan's age, we are informed, and she tells her assistant that she is worried about the girl's health and
needs to "educate" her patients.
What if we were to provide Karen with convincing data that barrier contraception and early abortions every
2 or so years are physically safer for Ms Morgan than Depo-Provera or than an IUD? Would that ease
Karen's discomfort? Would she so educate her patients? If so, then we can ask whether Karen is behaving
paternalistically. Paternalism is not just about power: it is the power of the parent, a power used in the
perceived best interests of the other. If I force a child to have a vaccine, even though he or she really hates
having the shot, I am doing so in the best interests of the child, doing something I believe he or she will
"thank me for later." That, I believe, is what marks a particular use of power as "paternalistic."
I think that is not the case here though: it is not the safety of early abortion for her patients that troubles
Karen but the act of abortion itself. It is, then, rather disingenuous for her to say that using abortion as a
form of birth control is not healthy for this girl or for us to be asking whether this is paternalistic behavior on
her part. Karen does not like, intensely does not like, to perform abortions, and she does not want her
patients to have them. She would like Ms Morgan, and presumably her other patients, to do whatever it is
they have to do to avoid putting Karen in the difficult position of having to do something she dislikes doing.
I regard that as inappropriate and unprofessional and an attempt at abusing her power; I do not think it
rises to a standard of paternalism.
Barbara Katz Rothman, PhD, is professor of sociology, City University of New York. Her first book was In
Labor: Women And Power In The Birthplace. More recently, she published The Book Of Life, an ethical
guide to issues involved with the human gene map, race, and normality.
The people and events in this case are fictional. Resemblance to real events or to names of people, living
or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not
necessarily reflect the views and policies of the AMA.
© 2004 American Medical Association. All Rights Reserved.

Explanation / Answer

Does she have moral obligation and respect patient autonomy?

Yes, doctor Anderson had moral obligation.

Rational:

1.Moral obligation arising out of right or wrong.

2.Here patient is not getting awareness on how to use contraceptive.

3. Patient is careless.

4. Patient doesnot have co operation.

5.doctor had explained nicely, doctor made patient involvement on conversation.

6. Doctor gave decision making part to the patient

7. Thats why doctor Anderson had moral obligation.

8. Dr.Anderson gave respect to patient autonomy.

9. According to this article main decision gave to patient, by this way doctor is respecting patient autonomy.

Related Questions

Navigate

• Browse (All)
• Browse B
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.