Sedated patients require dignity and respect
All behavior is public
Occasionally, reports of physician misconduct while a patient is sedated make headlines —sometimes locally, sometimes nationally, and sometimes internationally.
But regardless of the details of any particular case, what are the standards of thought, approach, and behavior to which physicians and surgeons should adhere when treating a patient who is sedated?
Medical Ethics Advisor interviewed bioethicist Laurie Zoloth, PhD, professor of medical humanities and bioethics, and director of the Center for Bioethics, Science and Society at Northwestern University's Feinberg School of Medicine in Evanston, IL, in mid-August on this issue.
"Well, a patient, when they're sedated, does not lose their status and their dignity, as a human being whose body cannot be touched without permission," she says.
Zoloth describes the relationship between patients and physicians/surgeons as a "contractual" one, whereby the patient seeks help, and the surgeon then agrees to help and advises the patient of "certain risks and benefits and burdens."
"Anything outside of that, any other touch of the body that's not needed for the medical procedure is clearly in violation of that contract," she says. "Your relationship when you [sign on for care] has to be one of complete and utter trust that your body will always be regarded with care an dignity during any kind of surgery. And it should be that no one would touch you when you are unconscious [in] any way that they wouldn't touch you if you were awake or consenting."
Zoloth says there "clearly is a long history of bad behavior." As possible explanation for why "mischief" can occur with a sedated patient, she attributes some of it to the "unrelieved tension" that is often present in health care settings.
Temptation is there
John Banja, PhD, a clinical ethicist at Emory University in Atlanta, says, "The point is that professionals must never succumb to the temptation to be frivolous or disrespect someone."
But "temptation" does exist, often with an attempt toward humor, perhaps to alleviate the stress of this particular type of workplace.
Another component of the temptation occurs "when the person's face is not able to engage with you," and with the patient unable to communicate or respond, it can lead to an attitude of "objectivication of the body."
"An operating room isn't a locker room," Zoloth says, "and patients have the right to understand that their bodies won't become figures of fun. And that their suffering . . . isn't just a subject for amusement or joking around."
For example, in a surgical suite, the patient's life "hangs in [the surgical team's] hands."
Zoloth's professional research focuses on "getting people to tell the truth — and never to lie."
The type of behavior whereby a patient's body might be disrespected ". . . would be a violation of the promises made to patients . . .," Zoloth says.
"Any violation of that promise would be a lie, in essence, to be assuring patient's of one thing and then . . . doing something else," Zoloth says.
Professional life is public
One of the truths of all professions is that people "sometimes act differently [in private] than they would ever act in public," says Zoloth, citing as one example the recent case whereby former presidential candidate John Edwards admitted to an extramarital affair after denying it for several months.
And anyone acting in a professional role is always acting "in public."
"Your work is always public. It's always observed. It's always witnessed. It's always done in the name of a larger goal . . .," Zoloth says."So, even if you think there is no one watching you and there's just your buddies in the operating room, people are watching at all times," Zoloth says. "And if you're a person of faith, you could say that all of this behavior is witnessed by a higher moral force in the universe."
Trend is toward culture of respect
While the temptation may exist in the health care setting to behave inappropriately toward a patient, that culture of "bad behavior, a history of jocularity," the arrival of bioethics standards from the '60s onward is changing what many have viewed as a "paternalistic system" in health care, Zoloth says.
One concept that has entered the curricula of medical schools in teaching bioethics, has been the "autonomy and dignity of the patient."
The requirement in health care to have respect for a patient's autonomy "not only extends beyond the patient's ability to make a choice, but the ability of the patient's body to be regarded always as an actual, individual, important person in the world . . . "
"We're not a television show. It's not 'House' . . . and I think most physicians understand that and adhere to that standard," Zoloth says.
Sources
For more information, contact:
- John Banja, PhD, Clinical Ethicist, Emory University, Atlanta, GA. E-mail: [email protected].
- Laurie Zoloth, PhD, professor of medical humanities and bioethics, Northwestern University Feinberg School of Medicine, and director of the Center for Bioethics, Science and Society at the Feinberg School, Evanston, IL.
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