Family or the Individual: Who Do We Work with?

Dani Romero Dr. Mack Cherry PHIL 3311 3/1/2013 Family or the individual: Who do we work with? Just as culture and individuals, medical ethics varies around the world. In the Western world medical ethics regarding consent is almost driven by the idea of separating the patient from the family. As discussed in class and readings, Western bio-ethics, compared to other countries, goes to the extent in dehumanizing the family figure when it comes to medical ethics, unless the patient is incapable to make their own decisions on their care.

This idea is applied to most cases, even to those pertaining to minors. In other countries, for example China, family is the first source a physician goes to in order to to discuss the patients care and state before talking to the patient. The main question is, which approach should be used when it comes to consent? Is it better to glorify the patients independence by getting rid of the family figure or is it better for the physician to go to the family first before bombarding a patient with overwhelming information?

Of course, both sides of the argument have valid ideas defending their reasoning; however, trying to approach this as unbiased standard would be useless. In addition to making an insight to both arguments I will also apply what I have experienced with regards to a family vs. individual approach in my culture. First of all, we must understand that each approach is based on a statistical analysis, meaning that it’s a summation of the most common outcomes of each individual case.

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We approach each case like this because it would be impossible to remember every single outcome for each individual case that is relevant. This doesn’t mean that every single family is evil and tries to exclude the patient from their own choices; however, it also doesn’t mean that every family is a depiction of the Brady Bunch where everyone is happy, understanding and embraces each others flaws and quirks. In addition, we must also fully understand what the term family really means.

According to the Oxford Dictionary a family means “ a group consisting of parents and children living together in a household”. If you approach this through a biological point of view it means “a principal taxonomic category that ranks above genus and below order” (Oxford Dictionary). In both descriptions a family is basically a group that shares similar qualities and characteristics, but unlike friends that share same interests, family members are joined by a blood line that holds together by, not only interest, but also biological need to survive (e. . Propagation of their genes to future generations) In Western culture there has been a desire to separate the patient from the family. It almost feels as if society sees the family figure as a source of unfair control or a dictatorship that silences the individuals voice. In our modern society, bio ethics is driven by working for whats the best interest of the patient and what they, as an individual, say is better fit for them.

In this approach, the family plays a only a “by default” sense, meaning that the patient is incapable of acting on their own behalf and has failed to appoint another individual to serve in their behalf and make decisions in the patients best interest (Boisaubin, 2004; Cherry and Engelhardt, 2004) Through the passing of the years, we as American’s have built up a mind set that families are evil and should not be trusted since we believe that no one knows better than what the individual wants but the individual himself.

The ideas behind isolating the individual from the family is to protect their “best interest”. By having the patient as the “go to figure” we are enforcing the authority the patient has over themselves thus assuring that they are the only one that have control on what should happen to them. The idea of liberty plays a great part in Western culture, thus by isolating the patient we are playing by what every American is entitled to, which in this case, is the liberty to either accept or deny treatments offered by physicians.

Also, as mentioned before, the main reason why an a patient is treated as an individual is in order to protect their best interest. As it can be easily seen, the family figure plays no role in this approach. The families main role is to play a historian in order to help the physician fill any gaps left by the patient. In this case families are suppose to be trusted, unless they show signs that they are incapable of being trusted. As mentioned in Ruiping Fan’s and Julia Tao’s “Consent to Medical Treatment: The Complex Interplay of Patients, Families, and Physicians,Western ioethics began as a fight against paternalism in order for the patient to gain autonomy over themselves (Engelhardt, 2002). Bioethics was build up on the pillars of individualism and autonomy over ones own body and decisions. Knowing this it doesn’t seem strange that Western bioethics drive a wedge between the family and the individual. Most would believe that the wedge driven between patient and family wouldn’t affect pediatrics since children aren’t seen as a someone who is responsible and aware of their actions and their repercussions.

However, in Western society the same idea is being applied to pediatric care. In today’s society, under the “Convention on the Rights of Children” by the United nations “minor children ought to be treated as self-possessed moral agents, who are to undertake their own moral and life-style decision making as soon as possible and as far as feasible” (Parental Authority and Pediatric Bioethical, pg. 553). An example would be acceptance of allowing children as young as 14 years-old to get birth control and abortion with out parental consent.

Even if, according to Englehardt, some isn’t considered a responsible person in the sense that they are rational and are able to understand their actions till the age of 18 (). It almost seems strange that children at such young age have the mental and moral capacity to make such drastic decisions with out parental consent. This all falls under the same idea of the individual being independent and free to make their own choice, even if the individual doesn’t have full control over their impulses.

Granted that parents and guardians are suppose to act in behalf of their child’s best interest; however, how is possible for Western bioethics to try to drive a wedge between the bond of child and parent at such an early age? On the other hand when we look at other countries such as China, we see that there is there is a more family oriented approach to medical ethics. According to Yali Cong’s article “Doctor-Family-Patient Relationship: The Chinese Paradigm of Informed Consent” a “family member” can either be the patients family or the representative of the patient’s entire family, usually meaning the grandfather, father or elder son (pg. 52). The individual makes part of the family, thus whatever causes harm to the individual causes harm to the family ( e. c emotionally, mentally, economically) therefore the family should be with the individual in order to support them through the process. In most cases in China, the physician discusses the patients health with the family first and then they decide how much the patient should be told or if they should be told at all.

Even if this approach is family oriented, it doesn’t mean that the individuals voice is ignored and all the decisions are made by the family and don’t consider the individual. It means that if the individual isn’t able to communicate or the family decides not fully disclose all the information to the patient, family members will act in the patients behalf and follow what the patient best interest is. This bioethical approach revolves around one central idea: why should we separate the patient from the people they are there to support them?

As explained, Chinese physicians would never directly tell the patient that they are suffering from a terminal illness. On the other hand they would approach the family and educate them about what’s going on and what could happen and then the family can decide what to do in regards of letting the patient know. Families usually tell their loved ones the diagnosis gradually in order for them to take in the news and learn to accept it little-by-little and allowing them to adjust to their state (Doctor-Family-Patient Relationship, pg. 155)

Another similar approach to the family oriented consent is that of Confucian moral balance where not only is family integrity important but also pursuits a harmonious ambiance where family members can cooperate and work harmoniously with one another in order to work for the patients best interest (The Family and Harmonious Medical Decision Making, pg. 580). In the case of Tankai and her unfortunate death due a strike to the head in an accident her parents had to become the figure of authority since Tankai couldn’t possible act in her behalf.

After her death, Tankai’s father decided to donate her organs in the hope that “their daughters life could at least partially be continued in someone [else]” (HEC Forum 2008, pg. 191). In this case, the family stepped in and acted on their daughters behalf and did what they knew Tankai would have decided on if she where to be of sound and mind before her passing. As shown by this case, the families job is to act in the behalf of the individual and do what they would have considered their best interest.

In addition, it is understood that when the term “best interest” is used in this context it doesn’t mean the what the family may benefit from but what a the individual of the family will ultimately benefit from. After understanding both sides of the argument, I can see that I lean more towards the family oriented approach. I was brought up in a traditional Catholic home, in addition I come from a Mexican background meaning that I come from a very conservative household.

Family plays a big role in the morals that have been taught to me through both my religion and culture. As I grew older I started to deviate from some of the ideas that had been drilled into my head by my culture. However, I don’t understand the Western obsession with separating the individual from the family as if they where to ignore the individuals voice and carry out their beliefs on them. Family is seen as the core of social and economic activity and therefore the locust of moral activity.

I’m not saying that individuals choices should be manipulated by the families interest but the family shouldn’t be removed from the picture since they are the source of the individuals moral and ethical reasoning. The individual’s reasoning usually comes from elder family members that have been passed down from one generation to another, which makes the idea of cutting off the family seem even more irrational. As I grew up, I was taught that with out family you don’t have anything. I was taught that family is the glue that holds all your life together and without it life would be hard and eventually fall apart.

Of course, not all families are the same and there may be a reason why Western medical ethics have decided to remove the family figure, but for the most part family members tend to care more for the people they have a stronger connection to thus making them one of the most reliable choice rather than a “by default” choice. However, if the family doesn’t seem to be trust worthy (due to their actions, behavior, and decisions of care for the patient) or the patient has expressed that they don’t wish to have to do anything with them, I believe that the family oriented approach is the better one.

I trust that my parents, siblings or any other family member, can responsibly act on my behalf if I’m not able to do so. Why wouldn’t I trust the people that have been there for me through thick and thin, and have molded me to become the person I am today? It seems bizarre to think that some people can’t trust their own family members; however, I do understand that not everyone has the same luck with family members and experience. In my own personal view of the situation I would prefer for my parents to be informed first about by condition, that is if it’s a horrble diagnosis.

I would prefer for my parents to have their breakdown and cry out their feelings prior to me knowing the diagnoses. I believe this because when I am informed by the physician I would have my moment and would be able to look at my parents and have them be the shoulder for me to cry on, rather than them having a meltdown and me not have anyone to look up to and reassure me “everything would be ok”. Generally, it’s the families duty to comfort the ill family member, and having them cry and have a meltdown would be more stressful rather than comforting.

I also agree with the Chinese ethical belief that when it comes to medical context it should com down to three different parties: the patient, family and physician (The Family and Harmonious Medical Decision Making, pg. 580) Another thing to think about when it comes to family oriented approach is the role parental and guardian supervision take place in pediatric care. Due to my upbringing in a catholic home it’s really hard for me to stomach the idea that children as young as 14 years-old can receive abortions and birth-control without parental consent.

Yes, I understand the idea that it’s better for them to be sexually active with protection rather than having them have unprotected intimate relationship. However, this comes back to the idea of moral pluralism, that everyone is a secular individual and necessarily share the same beliefs. However, maybe it’s because it got beaten into my head that it wasn’t acceptable to be intimate till marriage, but to me it seems that we are giving children the easy way out.

Technically, Western culture is enforcing children to go behind their parents back and engage in such activities that they [the child] could lead to consequences that they can easily be protected from or taken out of. My question is; when is protecting the child’s “best interest” gone too far? Western culture is attempting to take apart the family figure by allowing children to be “ self-possessed moral agents” (Parental Authority... pg. 553). Overall, there is a definite connection between Chinese morals with hose that I have been exposed to, making it harder for me to understand the reasoning behind Western fight for the separation of the patient from the family. Family oriented and individual oriented approaches to medical cases have one thing in common; that they both strive for the patients best interest; however, how you arrive at that is a long path that has been twisted and turned by modern Western society. This makes is impossible for physicians to choose a default approach to all cases.

Unless you live in a family and tradition driven society like China, one can’t assume that everyone is comfortable with a family approach. However, since America is a melting-pot or cultures there really isn’t a right answer for which approach should be the default one. Most individuals, and physicians, prefer the individual approach since it’s just easier to talk to the individual with out having 10 different people screaming at you giving different opinions.

Regardless of what’s easier, I believe that if the patient is to say that they prefer a family oriented approach as that the one used in China, their wishes should be respected and carried out since it is considered the patients best interest. As a prospective medical student I know I will have to understand and keep an open mind and do what the patients best interest is. Overall, I find that the family approach may be more relaxing to the patient; however, if the patients family doesn’t seem trustworthy or doesn’t seem interested on the patients best interest

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