HPPA 514 Biomedical Ethics: Moral Argument Essay #1

When determining whether or not to prescribed any controlled substance to a patient, the PA has a moral obligation to evaluate their actions as they relate to the principles of beneficence while also recognizing and respecting their patient’s autonomy. Despite the low-risk nature of Viagra and the apparent stability of Mr. S’s health, I would rather not write the prescription with only the current amount of information available. I’d like to call attention to a few key issues I take with this situation, as they pertain to beneficence and autonomy, that ultimately steer me away from satisfying Mr. S’s request.

In our previous reading, Yeo, Moorhouse, and Khan state that, “Good intentions constitute an important aspect of beneficence, but so too does the ability to produce good outcomes.” In a clinical setting, this refers to both the PA’s desire and ability to effect a positive outcome for their patients. According to Yeo, it is equally important to discuss and determine what constitutes as positive outcome. The onus is on the PA to respectfully elicit and explore any discrepancies between the patient’s values, priorities, and concerns versus the PA’s and to work towards a set of treatment options that will satisfy both parties’ values. Assuming that Mr. S has been honest in denying any erectile dysfunction, and that he is seeking a Viagra prescription based on the advice of a gym buddy and to feel like “more of a man,” I’m concerned that Viagra will not address Mr. S’s underlying issues. As a PA, the desire to provide Mr. S with an immediately positive outcome is outweighed by the possibility of latent negative consequences, such as a chemical or psychological dependency on Viagra for sexual arousal, which would be a stark violation of beneficence towards my patient.

Autonomy, synonymous with liberty, is agency over one’s own thoughts and actions, and I have no desire to impinge on Mr. S’s sense of autonomy. Yeo, Moorhouse, and Dalziel make the distinction between autonomy as free action, effective deliberation, authenticity, and moral reflection. Mr. S is a cognizant adult, not operating under any obvious duress or impairment. I trust that he has a basic sense of morality and self-awareness, but I am still concerned when he says that he’d like to feel like “more of a man.” This makes me question the extent to which he has reflected on the subject of his sexuality and masculinity. I’d like to ask him, in an emotionally neutral and non-judgmental manner, what “more of a man” means to him. I would not dismiss whatever response he offers, and I would encourage him to feel free to explore and verbalize his own feelings about masculinity. I would also gain a better sense of Mr. S’s authenticity and moral reflection. On the other hand, maybe there are no significant underlying emotional, social, or psychological issues at play, and Mr. S admits that it is a physical issue. In that case I would feel much better about prescribing the Viagra, but at present Mr. S has denied erectile dysfunction and I am weary of moving forward with the new medications for this patient. Just as patients have the ability to request or refuse treatment, I must also exercise my autonomy as a practitioner by withholding treatments or prescriptions until I am satisfied that I have done my due diligence with regards my patient’s physical, emotional, and psychological condition.

Beneficence and autonomy are two principles that might appear to be at odds with one another at times, such as patients like Mr. S desiring to exercise their autonomy in a way that conflicts with my sense of long-term beneficence. It is usually possible to resolve such discrepancies through further discussion with patients while demonstrating empathy and a desire to understand their perspective. This will elicit a more thorough and honest history, contextualized by the patient’s personal concerns and moral values. In turn, the patient will be more receptive to medical advice that they are given, advice that they might have initially disagreed with or dismissed altogether. This kind of rapport and trust between clinician and patient will often facilitate the best foreseeable outcomes for the patient that are in accord with the principles of beneficence and both parties’ senses of autonomy.

WORKS CITED

Yeo, M., Moorhouse, A., and Dalziel, J. “Autonomy”. Concepts and Cases in Nursing Ethics. pp. 91-97, 103-109, and 130-135.

Yeo, M., Moorhouse, A., and Khan, P. “Beneficence”. Concepts and Cases in Nursing Ethics. 3rd Ed. Broadview Press. pp. 103-117 and 135-139.

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