When Should A Doctor Have The Authority To Override The Will Of His Patient?

There should be only two instances where a doctor’s judgment may override the will of his patient. The first is obviously when his patient has been declared incompetent, say, in the case of advanced Alzheimer’s or if his patient is obviously psychotic to the point of being declared insane.

The other exception should be when a doctor’s patient insists on doing something that threatens society in general, like when a patient says he believes that vaccines are dangerous when there is a mountain of scientific evidence is to the contrary. Such people might claim it is there Constitutional right of freedom to refuse. But in this instance freedom without responsibility is not an exercise of freedom. I mean, someone might just as easily claim to have the right to disregard traffic lights because they impinge upon their freedom of movement.

To move slightly off topic for a second, nature has programed its creatures, especially humankind, to seek advantage at every opportunity as part of a survival mechanism. Thus society has tried to come up with a system of laws that protect the rights of individuals as well as society as a whole. Or at least that’s the way the rule of law should be structured in well-run democracies — a way to modify nature’s over aggressive impulse for the good of everyone.

Getting back on point, what was it that inspired me to write about the unlimited power of doctors? You see I’m 81 years old and in need of a left knee replacement. Unfortunately, I experienced some months back a minor TIA, a mini stroke, caused by an SVT, an uncontrollable heart flutter in laymen’s terms, and because of that my cardiologist said he would not allow major surgery within six months of any such occurrence.

Now my cardiologist is a fine doctor who only has my best interest at heart, I know this. But as my grandmother used to say, “circumstances alter cases.”

As I said I’m 81 thus my window of opportunity for a knee replacement is on shaky ground as a rash of diseases might soon rain down upon me making such an operation permanently out of the question, leaving me with difficult movement on top of whatever other aliments might hit me.

So here are the facts and where my cardiologist and I degree, I was once told that because of my SVT bouts there was a strong possibility that without one of those high priced blood thinners there was for me a high probability of a stroke. But who wants to be held hostage to those super high priced drug companies.

In any event, after my minor stroke that only garbled my speech for 15 minute or so, I decided to go for the big fix of my heart — an ablation. You see an SVT is where there is a periotic short circuit of the heart’s electrical system. An ablation is very high-tech procedure where they probe up through your leg vein and into the heart to find the area of the short circuit and burn it out.

The bottom line is that the procedure worked just fine — no more SVTs. So naturally having fixed the underlying cause of my mini stroke, I assumed that I was good to go ahead with my knee replacement, which I had already postponed once because of the TIA. But no! My cardiologist still insisted on having me wait six months.

Now from his perspective of wanting to be extra cautious I see the point, but from the perspective of my specific situation it made no rational or scientific sense. In fact postponement had the potential of further ruining my quality of life somewhere down the line. I can understand when someone suffers a stroke from an unknown cause that a wait-and-see approach before leaping into surgery makes perfect sense, but not when the underlying cause is 99.9 understood and fixed. That’s absurd.

Thus I maintain that doctors should be viewed as highly trained consultants who may also be specially qualified to undertake certain medical procedures, but except for the few first explained exceptions above they should not usurp the responsibility of deciding on treatment of what which should remain wholly with the patient. In other words whatever legal treatment is available the decision whether or not to go ahead with such a treatment does not belong with the doctor.

Now in practical terms most folks will almost automatically follow the recommendations of any doctor with whom they have great trust. Once again, however, when a patient with a sound analytical mind and upon much consideration of his or her special situation determines a certain course of action, a doctor should have no more say on the matter than giving his expert opinion. And if he adamantly disagrees with his patient’s decision, then he simply need have the patient sign a release form stating that the patient has decided to go against his professional judgment.

After all, doctors see a majority of their patients, maybe, a few hours a year at most. On the other hand patients have lived with the specifics of themselves over a lifetime. And while doctors are forced by time to often rely on cookie cutter treatments, patients may sometime understand their own special variations from the norm.

The bottom line: after all is said and done, it should be the doctor that advises and the patient that decides — outside of factors effecting society in general and the degree of one’s mental competence of course — when and what treatment they will receive — full stop.

As a postscript, after my doctor became a bit incensed at my attitude on the matter and blurted out, “I’m not going to let you tell me what do,” and I responded, “I wasn’t telling you what to do, you were telling me what to do, “ because he is a good guy we finally came to a minor compromise.

Jim Ridgway, Jr. military writer — author of the American Civil War classic, “Apprentice Killers: The War of Lincoln and Davis.” Christmas gift, yes!