In the case of Mrs K, the care team’s initial concerns were with the patient’s autonomy in relation to informed consent and what would most benefit Mrs K, as well as the patient’s ability to make “well-informed, well-considered, and voluntary decisions.”
The authors noted that in cases where respect for autonomy trumps other obligations or principles, the principles-based approach is preferred; however, after applying the principle-based approach to Mrs K, the care team continued to feel uneasy, primarily because Mrs K’s main motive for discontinuing treatment was her belief that she was a burden.
As a whole, the team thought it could do more to provide for Mrs K. In cases like this one, a care ethics approach may be more effective in examining the questions presented by the patient. This alternative approach focuses on “being attentive and responsive to the needs for care of those involved in the care process,” which, the authors noted, can be much more specific than receiving — or not receiving — treatment.
In describing the 4 pillars of a principles-based approach — respect for autonomy, beneficence, nonmaleficence, and justice — the authors concluded that this approach does not adequately address the major motive that is affecting Mrs K: her belief that she is a burden. Alternatively, the care ethics approach prioritizes a holistic approach to medical care; the 5 key elements are attentiveness, responsibility, competence, responsiveness, and cooperation.
“[I]n this approach, respecting autonomy is not so much about informed consent but about supporting the patient to deal with her present physical and mental condition and to repair and retrieve her life together with that of her partner,” the authors wrote.
The care ethics approach requires that physicians ask and answer the following question: What does the patient need in order to deal with the changes in her life, both in her own body and in the relationship with her partner?
“A care ethics perspective focuses on supporting the patient and those who are involved in care for the patient,” the authors concluded, “acknowledging the relational context of the patient’s life and experience.”
Metselaar S, Widdershoven G. Moral dilemmas in (not) treating patients who feel they are a burden [published online April 23, 2019]. Bioethics. 2019;33(4):431-438.