Chaplain's Corner

Do we take too much for granted?  Are we much too liberal in giving away our responsibilities?  Is our willingness to trust sometimes misplaced?  Sometimes, yes.  Back in June the Regional Health Authority through its Ethics Committee planned and presented a day long workshop for 100 of its employees to discuss the issue of “informed consent.”  It was a fascinating day and it was interesting to think very practically about the challenges and issues involved in seeking to insure that those we serve consent to the service which we provide as health care providers.

The issue of informed consent is an issue that is directly related to the fact that we live in a free society that values the right and responsibility of every capable person to make decisions about how his/her own needs will be met; in the language of ethics this is called respect for personal autonomy.  We live with this freedom and exercise it everyday, but seldom give much thought to how precious this freedom is and the responsibility having this freedom places upon each of our shoulders.

In health care, this means that when you come to your family physician or to the hospital for medical treatment, you should be provided with the kind of information that enables you to make a reasoned decision about whether or not you are willing to receive the treatment the doctor is recommending.

Surprisingly, in our society there are still people who don’t understand that this is a freedom and responsibility that is theirs: perhaps some grew up in days when this freedom was not as readily understood, or some come from countries where this freedom may not have been extended to its citizens or others have just not considered this freedom to be theirs who come and go from our clinics and heath care facilities believing that whatever the doctor orders, what ever the doctors says, they must just go along with.

Don’t get me wrong, I am not suggesting form a moment that our physicians are not interested in what is best for us.  I believe that the vast majority of the physicians in our province are sincere, well-trained people who want what is best for their patients.  But we would be seriously naïve to think that in the busy, rushed, climate of our current health care system where many doctors are servicing far more people than they can adequately manage that it isn’t common for doctors to make diagnosis, prescribe treatments all without their patients having an understanding of what is wrong and how the recommended treatment is supposed to help.
 
Little of this happens because of carelessness and the vast majority of it happens because a typical visit with the doctor is rushed and happens in an environment where the patient’s anxiety is already heightened, making it more difficult for the patient to truly understand what the doctor says.  In such a context, the encounter fails to provide the patient with the kind of information, in the kind of context that would generally result in consent being truly informed.

There is a spiritual dimension to this as well.  Pat Frain, the director of Spiritual Health Care Services at the Health Science Centre defines spirituality as “our longing to live meaningful and purposeful lives, our sense of relatedness and connection, our desire to live with trust and hope in an uncertain universe, our desire to experience a sense of belonging to something greater than ourselves – Ultimate Mystery, God, the Divine, Oneness, the Unlimited, Nature, Life.”  The relationship we have with our physician should have a spiritual component to it, for it is a relationship that can be extremely intimate requiring a high degree of trust and respect.  Trust and respect are best built and preserved in a context of mutuality, straight forwardness and communication.

When so much is at stake, our health, and ultimately our physical and mental wellbeing, it is not in the least unreasonable that the person we look to for help provide us with an explanation of what is happening and an explanation of what they are recommending to address the problem along with alternative treatments and information about what the consequences of both accepting and rejecting treatment might be.

I believe our physicians want to provide that information, but we need to want it.  My encouragement to you is to begin viewing your physician as a highly trained person who entered medicine because he or she had a deep desire to help people medically.  But also view your physician as a person who is harried, pressured to care for many, many people, often working long hours and many times having no one who really is considerate of the pressure that he/she feels. 

I would like to encourage you to begin taking more responsibility for asking your doctor for help in understanding your medical needs and the treatment that are available.  Don’t be afraid to say to your doctor, “I’m sorry, but I really didn’t understand what you just said, could you explain it a bit differently.”  Or “I appreciate your insights into this problem of mine, but we have been working together on this problem for some time and things really are not getting much better.  Is there something else we can try?”  Be kind, assertive and generous with your doctor, but don’t agree to a treatment until you understand what is wrong with you and what the treatment is hoped to do for that problem.

Doctors are intelligent, big hearted folks with years of training and experience, but they are just people with limitations.  There are times when their best efforts just fall short of your needs and it is no insult to your doctor for you to ask at that point, “Would you be so kind as to provide me with a referral to another doctor who might have fresh set of eyes and a different way of thinking, to see if there is something more that could be done about this problem we have been working on?”

Because informed consent is both your responsibility and your physicians, you must take equal responsibility for insuring that you understand your diagnosis and how the doctor is recommending that problem be addressed.  It is your right and you must bear part of the responsibility to insure that this information is provided to you so that you can make a truly informed decision about what the doctor is recommending be done for you.

If after consenting and being compliant with the approach your doctor has recommended, if there is little or no improvement, do not be content and conclude, “Oh well, I guess I just have to live with this.”  No!  Go back, explain your concern and ask your doctor if there might be another way of approaching the problem.  Your doctor can only help you if you give him/her clear information about how you are feeling, what is working and what isn’t working and if you after agreeing with a treatment actually comply with the treatment according to the physician’s directions.

You have a right to know what is wrong with you, to what course of action your doctor recommends, if there are alternative treatments or approaches and why the doctor believes this one is the best for you.  Know your right, participate fully in your care, once you agree to a treatment, follow the instructions of your doctor and if things are not working out, go back and ask your doctor to consider a different approach.  Health care is a relationship, participate fully in the relationship you have with your doctor, be involved, make sure you are informed and don’t allow the system to rob you of the right you have.  Insist, be gracious, but insist!