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MDDUS: Patient decision-making vital

26 September 2014

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The Medical and Dental Union of Scotland (MDDUS) say doctors must respect patients’ right to decide upon their own treatment.

Stories in the press have underlined the subject of consent and decision-making of patients.

In situations where doctors dispute the decision made by a parent on behalf of the child, they have a “duty to raise concerns” according to MDDUS medical adviser, Dr Naeem Nazem.

On the other hand, Dr Nazem believes that when the argument is regarding the best course of medical treatment of a competent individual, they “must respect a patient’s autonomy”.

Doctors are faced with an ethical dilemma between their duty of care and allowing patients their right to autonomy.

Dr Nazem pointed out the patients’ “greater access to health information” means that they are playing a “more active role in decisions” with regards to their care.

Dr Nazem said: “In the vast majority of cases, doctors and patients work together in a partnership based on mutual respect. A shared decision, complete with a full and frank discussion of risks and benefits, is more likely to ensure a positive patient experience and outcome. Where an agreement can’t be reached, doctors need to consider whether a competent patient is making a choice about their own care or an adult is making the decision on behalf of a child or under a power of attorney.

“Doctors have a duty to raise concerns if they believe a parent is not acting in a child’s best interests. However, when it comes to a decision made by a competent patient, doctors must respect a patient’s autonomy and right to decide, even if they disagree

“While doctors cannot force a patient to follow their advice, they are entitled not to provide treatment requested by a patient that they do not believe is in their best interests. In these situations, doctors must explain their reasons to the patient and the other options available – including the right to seek a second opinion.

“MDDUS has dealt with many cases in which patients have requested unlicensed or specialist medicines from their doctors, following their own research on the internet. Doctors are reminded of their ethical duty to work within the field of their own knowledge and expertise. While patients are entitled to request medicines from their doctors, it is ultimately a doctor’s decision to consider whether any treatment or intervention is in the best interests of their patient.”