Angelika Dabu
Biomedical Ethics 
Professor Kirk

Reflection Essay Assignment

Given my acquired knowledge of health care ethics and the complexities that may present within the field of medicine, I am able to form a moral framework that will guide my clinical practice in my first few years as a certified, licensed physician assistant. This framework is in alignment with my personal values as they relate to my decision to become a PA and support the aspects of practice I anticipate will be the most important to me (Kirk, 2019).

I have chosen to become a physician assistant because caring for and helping people in vulnerable circumstances is something that is very important to me. My personal challenges and the challenges of people who are close to me have informed my understanding that life is often complicated. These experiences have instilled in me the importance of moving through life with an awareness and sensitivity of the parts of life that are unpredictable. I feel that it is a privilege to provide direct patient care and to have the opportunity to make someone else’s life better in both measurable and immeasurable ways. Thus, it is my intention to stay grounded in the ideas that drew me to the PA profession and for those ideas to guide my ethical framework throughout my career.

In foresight, I believe that patient-centered care and shared decision making will be the most important aspects of practice to me, as I have directly and indirectly experienced the effects of both. I can appreciate how they benefit the quality of care a patient receives. Though patients may present with common illness and diseases, each patient is unique, and his/her/their course of treatment will be most effective if determined on an individualized basis. Active engagement on the patient’s part is thus essential as patient care should not be a passive process, and receiving care can be a vulnerable experience for patients and their families. I believe that a health care provider can only sufficiently treat a patient to the extent that they know him/her/them. Therefore, shared decision making is also crucial. Having a genuine interest in knowing a patient’s values and what is important to him/her/them can build trust and ultimately lead to positive desired outcomes and patient satisfaction.

Three principles of significance to patient-centered care and shared decision-making are beneficence, nonmaleficence, and patient autonomy. Beneficence involves doing good and producing benefit. It involves not only caring for patients but also caring about them (Yeo, et al., Beneficence, 2010). Related to beneficence in terms of benefit is nonmaleficence, which involves doing no harm, or preventing, removing or minimizing harm (Yeo, et al., Beneficence, 2010). Lastly, patient autonomy involves respecting a patient’s right to choose the direction and extent of his/her/their well-being regardless of others’ personal opinion of what they believe to be the most appropriate course of action (Yeo and Moorhouse, Autonomy, 2010). With respect to patient-centered care and shared decision making, patient autonomy can effect beneficence and nonmaleficence in cases that present with challenges in health care.

Beneficence, nonmaleficence and patient autonomy are the best principles to support patient-centered care and shared decision-making, as they support a holistic approach to providing high quality patient care. In more complex, sensitive cases that do not present with clear, easy decisions to make, such principles ethically inform significant decisions that must be made between patients and health care providers. Through shared decision making, a health care provider actively listens and learns about a patient’s values, and in collaboration with the patient, makes a decision about how to best move forward in his/her/their treatment, considering all alternatives with the end result inevitably being one of challenging determination (Chow et al, Shared decision making: Helping the system and patients make quality health care decisions, 2009). In the process, the patient is able to verbally and perhaps emotionally communicate his/her/their goals, and the health care provider is able to respond more effectively in maximizing the patient’s level of care.

For instance, in the case of a high-risk pregnancy, shared decision making is vital between a patient and her/their health care provider, as the outcome of the pregnancy proves to be highly consequential. The act of the patient being actively involved and participating in her/their care is important as it relates to beneficence. The patient, who is in a vulnerable position, may feel therapeutic value in expressing her wishes and knowing that her health care provider cares, in effect producing a psychological benefit (Yeo, et al., Beneficence, 2010). An additional benefit produced through the shared decision making process would be trust in the relationship between the patient and the health care provider. With this trust, the patient is able to exercise her right to self-determination, or autonomy, in that, given full knowledge of her condition, she is able to carefully and effectively deliberate whether or not to conceive her child considering the harm, benefits and risks in doing so. As stated by Yeo et al., “Respect for autonomy in health care settings may be expressed both in terms of the ideals of information-sharing and client involvement in health care planning” (Yeo et al., Autonomy, 2010). This supports the notion that shared decision making furthers patient autonomy as the health care provider provides the knowledge necessary for the patient to make a fully informed decision and thus offer informed consent.

Moreover, a patient who chooses to proceed with a high risk pregnancy may benefit in the possibility of successfully surviving the pregnancy and birthing a healthy child who, with her, will live a quality life as a result of the patient’s goals of care being heard and honored. As such, beneficence through patient-centered care will be achieved in the case that the mother, along with the health care provider, share in this decision, and no harm is produced as a result. Nonmaleficence is thus achieved as the mother, who takes the informed risk of proceeding with the pregnancy, together with her child, is healthy and does not have to wonder “what if” had she chosen not to proceed with the pregnancy. She also does no harm to the fetus in deciding to proceed with the pregnancy, ultimately respecting the child’s right to live. In this way, shared decision making essentially speaks to patient-centered care in that it works to produce desired patient outcomes with the patient’s values driving the direction of treatment considering beneficence, nonmaleficence and autonomy.

Thus, while there are a multitude of important aspects pertaining to clinical practice, patient-centered care and shared decision-making are of particular significance in terms of beneficence, nonmaleficence and patient autonomy. These aspects of care speak to the core value of treating patients through a complete lens of who they are as human beings and thus form a strong foundation for the ethical framework that will guide my first few years in the PA profession.

References

Chow, S., Teare, G, and Basky, G. (2009). Shared decision making: Helping the system and patients make quality health care decisions. Saskatoon: Health Quality Council, pp. 1-51.

Kirk, Timothy. 2019. HPPA 514 Reflection Essay Instructions and Writing Guidelines. 

Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

Yeo, Michael et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.