Philosophy Bioethics Terrence F. Ackerman

Ackerman, Terrence. "Why Doctors Should Intervene." Hastings Center Report. August 1982. Terrence F.

Ackerman's article "Why Doctors Should Intervene?" asks the central question not only when doctors should intervene in patient decision making, but also what is the appropriate relationship between a physician and his or her patient? Is the physician simply the provider of medical assistance? Or is there a parental role that the doctor must occasionally take on, when he or she believes the patient's needs are not being met because of a lack of patient information or understanding of the patient's medical condition? When should doctors intervene under such circumstances, Ackerman asks, as well as stating why intervention is occasionally necessary as well as feasible for physicians.

In his article, Ackerman suggests that case of physician potentially having to treat a patient, without the patient fully understanding his or her medical circumstances, can occur under numerous circumstances. These circumstances include, but are not limited to, the patient's unwillingness to accept treatment for personal, psychological, or religious reasons and the patient's family's desire to withhold or limit treatment or the patient's knowledge of his or her condition.

Patient or familial guilt, depression, or even delusions can all result in the doctor's legitimate fear that the patient's treatment is being compromised by a lack of knowledge on the part of the patient's self or those responsible making decisions for the patient. Of course, doctors, just like patients, live in the real world, not simply in the world of medical textbooks. Ackerman notes, "patient autonomy has become a watchword of the medical profession," in recent years. (14).

In other words, doctors are more and more unwilling to exercise their own wills upon patient's decisions to accept treatment or to live or to die. Rather than 'playing God' doctors are encouraged to see doctors as facilitators of their patients' differently expressed wills, rather than possessing the ability to withhold or administer treatment based upon their own will. However, critical to a patient's ability to accept or reject treatment is his or her ability to have full cognizance of his or her condition.

Ackerman also states "knowledge of the patient's psychological and social situation are also necessary to help the patient act as a fully autonomous person." (14). In other words, certain conditions may impede a patient's ability to fully understand what he or she is suffering. A schizophrenic, to suggest one hypothetical example, whom is convinced of his or her own immortality while in a delusional state, may not be able to fully comprehend the immediacy of a medical condition that impedes his or her physical life.

On the other hand, a Christian Scientist whom wishes to not be medically treated, but understands that with the help of prayer alone he or she may die, can reject treatment according to Ackerman's paradigm of intervention. Ackerman's modality of care, in other words, presents the idea that doctors should intervene when patients cannot or will not be fully cognizant of their actions, because of their psychological condition. The physician must always take into consideration the social context and religious beliefs of the patient.

The religious milieu from which the patient springs from may make aggressive treatment untenable. The age, social situation, and condition of the patient thus all affects the doctor's need to intervene and require more or less aggressive treatment for the patient, depending on the patient's will. Critical to know when and why a doctor should intervene is the doctor's assessment of the patient's ability to assess his or her condition, and the consequences of treatment or a lack thereof.

This suggests, at its crux, that a patient's family's desire to make a patient not fully aware of the seriousness of.