Medical Ethics Terrance Ackerman, in his article Why Doctors Should Intervene, presents some of the complicated affective influences that enter into the doctor -- patient relationship when a patient is facing a life threatening situation. Patient autonomy has been the watchword of the medical community. Serving as the Magna Charta by which doctors have operated in their associations with terminal patients, honoring patient autonomy has been the guidelines by which doctors set limits on their involvement in patients lives. However, Ackerman makes a significant argument regarding conditions under which patient autonomy and a policy of non-interference are not sufficiently broad enough to address the real needs of the patient. The effects of the illness, he says, can create distortions in the patient's ability to make autonomous decisions. In this case, according to Ackerman, the doctor should position himself to actively engage the patient, and influence a different course of action than what the patient requests.

Ackerman defines patient autonomy as a policy which has helped formulate a number of patient rights. The right to refuse treatment is one of the key choices which should lie in the patient's control. Patient autonomy has given rise to the right to give informed consent to the doctor / medical staff prior to receiving treatment, and the right to receive competition medical care. These rights have been used to form a larger understanding of the policy of non-interference by the doctor and staff once a patient has made his or her decision. Once a patient has expressed his or her desires, the medical staff, in order to honor the patient's autonomy, is required to take a step back, and allow the patient to have control over their own lives.

This dynamic and often ethically challenging situation can place the medical staff in a position in which they must relinquish their own control over a situation, even if they...

Just as one of the most serious and destructive issues of a serious medical condition is for the patient's loss of control over their own life, so is the doctors forced loss of control over his patient.
There is an assumed contract between the patient and doctor when the patient comes to the medical practitioner. That contract, in essence, says "I am a sick person, and you are a trained medical professional. Because you have the services I need, I am coming to you to allow you to perform your profession, which I expect will make me well." When a doctor first enters a patient's room, whether it is to conduct an annual physical exam, sew up a minor cut, or consult on the advancing stages of cancer, this assumed emotional and psychological contract guides and directs the doctors and patients choices and activities. However, when the patient's medical condition becomes life threatening, and the patient is faces with the prospect of long or painful treatment that does not have the guaranteed outcome of returning health, this contract no longer is in force. As a result both the practitioner and the patient are left in the awkward position of having to forge a new contract while at the same time wrestling with the questions of life altering treatment options.

Ackerman identifies a handful of issues which can obstruct the patient's ability to make objective decisions. For each of the situations, he cites painful examples of how these conditions have entered into his medical practice, and hindered his ability to proceed with treatment. Ackerman identifies that depression, denial, guilt, fear, or other social pressures can affect the patient's judgment, and impair his or her ability to make an informed decision.

Denial of the severity of a condition can affect the patient, and influence him or her to forestall treatment. When the condition…