Talia Bardash

Reflection Paper for Biomedical Ethics

Professor Kirk

            After becoming a certified physician assistant, in the first five years of clinical practice,  I hope to incorporate the discussions on healthcare ethics that we have had this semester. I chose to become a physician assistant due to the rewarding nature of the job, the flexibility that it offers, and the ability to help educate those who are lacking in healthcare literacy. As a physician assistant, I will be able to develop meaningful relationships with my patients and I will help them through difficult times as well as celebrate with them in exciting ones. The profession also provides me with both lateral and vertical movement and an ability to amass a great breadth of knowledge in addition to detailed knowledge in any specialty I choose. An exciting aspect of the profession is that the specialty of choice can be changed and a new detailed amount of knowledge can be gained. This knowledge, both general and specific, will then help provide me with greater confidence to treat patients.

            The aspects of clinical practice that will be most important to me will be the aspects of effective patient teaching, patient centered care and developing meaningful relationships with patients. I feel that as a PA I have a great responsibility to educate patients about their case in a non-judgmental fashion. The desire to want to imbue the knowledge of their own healthcare came when I worked in a women’s health clinic where the women did not understand what was occurring to their own bodies, the consequences to certain choices and basic anatomy of their bodies. It fueled my passion to want to share the knowledge that I will learn so that the patient can feel like an equal partner in their care. I will work to ensure that each patient is able to make autonomous decisions regardless of their social status. Additionally, the patient deserves to have their care centered around them and I hope to be able to provide an environment of patient-centered care. Lastly, even if a patient is completely illiterate in healthcare, identifies with a minority group, or is of a low social class, I hope to connect with them on a human level and educate them like any other patient. Through developing a relationship with them I will learn about different psychosocial aspects of their life that are affecting their health, which will help me improve the quality of care that I will be able to offer.

            Three ethical principles that will play a major role in my ethical-decision making in clinical practice are autonomy, beneficence and non-maleficence. Autonomy is the “right to make decisions concerning one’s own life and well-being” (Yeo, 2010). The main meanings of autonomy are free action, effective deliberation, authenticity and moral reflection. Free action requires that a person be able to choose what they do and do not want with no person or thing posing as an obstacle to their decision. Effective deliberation is ensuring that a person has all of the correct information and conditions to properly make decisions. Authenticity is verifying that the choice of the patient is consistent with their values and character. Lastly, is moral reflection which involves the patient constantly engaging in thoughtful deliberation about their choices and relating them to their values. The second ethical principle that will play a major role is beneficence, which is “promoting someone’s good or welfare” and acting towards the goals of the patient (Yeo, 2010).  Non-maleficence is ensuring that all preventable harm is prevented (Yeo, 2010).

            These principles will help support the practices that will be the most important to me in clinical practice. The values of autonomy will help me educate, beneficence will help me make care patient-centered, and non-maleficence will help me develop meaningful relationships with patients. I want to ensure that my patient’s are able to make autonomous decisions about their healthcare. The first aspect of autonomy is free action and in my clinical practice I will work to see that no person or thing is creating an obstacle for the patient to make their own decisions. Often patients may make choices based on someone else’s opinion, but through educating them they can begin to develop their own opinions. The second aspect of autonomy is effective deliberation. Educating the patient and teaching them about their bodies and their health is very important to me. The patient won’t be able to properly deliberate on the options and the information if they aren’t provided with the full breadth of  knowledge and especially if they don’t understand the information. I hope that I am able to educate each and every one of my patients and raise their level of  health literacy.  This will help ensure that they are able to effectively deliberate and make an autonomous decision.

            Authenticity, the third category within autonomy, can also help to promote education. It is difficult to characterize someone’s values and beliefs in relation to medicine if they haven’t been given the space to share their feelings and thoughts with the provider. Additionally, if the patient is illiterate in healthcare then they may not have fully developed thoughts about how they would like their care to be implemented. In order for me to provide the patient with the ability to develop a value system for healthcare I need to present to them an honest and clear explanation of the basic aspects of healthcare, basic anatomy, risk and benefits of the chosen treatment, other treatment options, and lastly the risks and benefits of the other options (Ripley, 2015). This desire, of wanting my patients to be able to make autonomous decisions, will help drive my passion for education.

            Patient centered care is another practice that I hope to include in my clinical future. Beneficence will help me further this goal. Beneficence ensures that the goals of the patient will be treated as benefits and anything that strays from or counters the patient’s goals will be treated as harms. As I work to provide patient-centered care I will learn about the patient’s preferences through discussions that will be open-ended and directed by the patient. The principles that I had learned about from beneficence will help ensure that my patient’s values and preferences are held to the highest importance. Additionally, beneficence must be enforced in all situations, even when it is difficult or if there is conflict. In these tough or conflicting situations, because of beneficence, I will continue to focus on the patient’s goals and center the care around the patient’s wishes.

            Lastly, by engaging in non-maleficence I will be able to highlight my practice of trying to create positive relationships with the patients. I will constantly be trying to prevent preventable harm by engaging in education and making the care patient-centered. I will work to be organized, speak up in times of disparity, and have proper hygiene, which will help prevent any harm from befalling the patient.  These three examples are only some of the ways that I hope the patient will be able to see this devotion and recognize that it is because of my desire to genuinely help and protect them. Hopefully this passion will help the patient feel comfortable, trust in me as the provider and form another facet to the relationship I will have with them.

Through the ethical principles of autonomy and beneficence I will be able to create a clinical practice that strives on effective patient teaching, creating patient-centered care and throughout it all develop meaningful relationships with the patients.

References

Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

Yeo, M et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.

Ripley, A. et al. (2015). Improving the informed consent conversation: A standardized checklist that Is patient centered, quality driven, and legally sound . Journal of Vascular & Interventional Radiology, 26(11),1639-46.