From the Editor

FROM THE EDITOR My Body, My Choice

By Louis L. Constan, MD

Iwas lulled into drowsiness by the almost pastoral setting; peaceful music playing, the darkened room, both Mrs. Jones and her husband strangely cheerful between contractions. Why wouldn’t they be happy? They were having the baby ‘their way’ which is to say ‘naturally,’ although in the labor room with a fetal monitor on and me standing by. Suddenly I was alerted by a sharp drop in the fetal heart rate. “Nurse! Table flat! Lights up! Forceps!” “Doc, what are you doing? I want a natural delivery. Put me back where I was, immediately!” I ignored her. There was simply no time to have the argument she so clearly wanted to have. The baby was delivered in short order and was fine. The Jones’ were fuming. Clearly, they were not used to being told “no” by a physician. In the ordinary course of care, patients expect to be involved in the decisionmaking process for their treatment plans; sometimes referred to as “their body, their choice.” The Jones’ found out to their displeasure though, such ‘rights’ to make decisions, to ‘choose,’ has never been and will never be, absolute. For sure, there was the difficulty of making a quick decision in an emergency; but there was also the problem of other persons in the room with competing interests. One of the persons was the child, who didn’t much care for the ‘natural’ experience but did have an interest in being born alive. The other person was myself. If a ‘bad baby’ resulted from this situation, I likely would have been sued, and that lawsuit would have negatively impacted my ability to practice medicine. I made a moral decision for the benefit of the child, and a self-serving decision …very quickly…and justified it just as quickly as ‘good medicine.’ But, who’s to say for sure. There are other, less dramatic situations in which patients put us in situations of moral, ethical or social ambiguity. We don’t always see these conundrums coming at us when patients: • Ask us to tell that little white lie on an insurance form so they can get coverage • Request a post-dated excuse for work absence • Ask for a letter supporting their disability claim that back pain is caused by their work and not their obesity • Ask for a Viagra script and demand you recognize their confidentiality by not telling their wife • Refuse to even try to stop smoking, drinking, overeating, under exercising • Decline the COVID vaccine but expect you to take care of them anyway When they make the conscious choices to defraud their employer, defraud their insurance company, cheat on their spouse, eat and drink to excess and refuse a life-saving vaccine, they have made seriously questionable choices which, perhaps, could be treated no differently than how I treated the Jones’ choice for a ‘natural’ delivery. That is, refused. In fact, the ability to make choices about one’s healthcare is more of a privilege than a right, and is dependent on the patient getting serious about his responsibility to step up and start making responsible choices. And oh, the irresponsible choices I’ve seen! Will they ever stop? Not if we don’t ask they won’t. So what exactly should we ask of patients? This is fairly simple. First of all, that they start thinking more seriously about the choices they make. Weighty choices of life and health should be made with sober judgment. Accepting the advice of friends and neighbors is not enough. Aping the ‘talking heads’ is not enough. They need to start paying attention to reliable sources of information from university, government or major hospital websites. Second, consider the effects of their decision on others, describe those effects,

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In fact, the ability to make choices about one’s healthcare is more of a privilege than a right, and is dependent on the patient getting serious about his responsibility to step up and start making responsible choices.

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understand them. Explain why their own benefit warrants potential harm to others. We understand that sick patients often neglect others’ needs while they are ill; it’s natural. However, with the increasing prevalence of chronic disease, there has been an increase in narcissistic behavior by sick patients, in which they neglect ALL the needs of those around them. This is not right and we as doctors should not stand by and accept such behavior. Finally, accept the reality that they may not get what they want, no matter how much they want it, no matter how much research they have done; no matter how supportive their family is in this. Choice is never, never absolute. At best a privilege. The important thing is good patient care and the physician has the final say in that.

Reader, If you’ve enjoyed my columns over the years, you may enjoy my book,” Two Minds, Your Body” available at Amazon Books: https://www.amazon.com/Two-Minds-Your-Body-

knowledge-ebook/dp/B08R5W4PSH

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