Tuesday, December 20, 2011

Self Destruction: When medical professionals find it difficult to keep their oath

Every month, we receive at least one question from a parent or professional that has to do with a patient or loved one making self-destructive decisions. Certainly this is one of the most frustrating situations for a medical professional. When a client or patient insists on making unhealthy decisions that definitely shorten life or decrease functioning, a medical professional feels unable to complete the oath to preserve life. But, we don’t take an oath to preserve life…. We take an oath to do our best and do no harm!

Every physician deals with this issue of self-destruction and it has two aspects.

First we must deal with our own feelings, and recognize that it is our job to provide the best medical care available. And, in metaphor, just because mankind has clean water, great open spaces, and a beautiful world, it doesn’t mean folks will take care of nature’s gifts or not be destructive to the environment. The old Hippocratic Oath can always be followed…. Do no harm!

Over the years, there has been an infrequent person that I really had trouble reaching, and in those few situations, after trying everything I could think of, including getting second opinions and unsuccessfully attempting to refer to other professionals, I caringly decided with some regret, that I must respect my patient’s decision and let nature take its course. This is always a difficult course to follow psychologically, but may be the only option left operationally. Naturally, faith filled professionals might have a little easier time with this because of their belief that God’s miracles may play a role in how nature takes its course.

However, regardless of how little we may approve of a decision that appears to be self destructive, we still demonstrate love and acceptance for the patient, other professionals and the family. That certainly doesn't mean we approve of self-destructive choices but simply that we accept an adult patient's right to make his or her own decisions about life and death.

And I want to emphasize, too, that age has made me increasingly aware that my view that an individual’s decision is self destructive or incorrect just isn’t always correct. Over the years, I’ve seen patients make decisions that I believed to be not in their best interest, and the decision turned out to work well.

For instance, in our DVD, we talk about a mother’s and physician’s decision not to hassle a young adult about poor self-care decisions that could have shortened his life by months. And the mother noted, “Those last months of life contained so many times of real discussion, openness and closeness that we would have missed if I had been focused on pushing decisions that could have extended life by no more than a few months yet would have been filled with conflict."
Of course all patients who are self-destructive or self –abusive, must be given the option of working with a competent professional, who is knowledgeable about drugs which are often helpful if hopelessness or an underlying depression is present.

Another example of writing on this difficult issue can be found on our website at:  http://pcwhi.blogspot.com/2011/10/once-parent-always-parent-when-adult.html

Dr. Foster Cline is a child psychiatrist and co-founder of Love and Logic. He is also the co-author with Lisa Greene of the award-winning Love and Logic® book “Parenting Children with Health Issues.” For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com

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