The Question of Autonomy in the "student Doctor" and a Wary Patient

The Question of Autonomy in The "Student Doctor" and a Wary

Patient

The "Student Doctor" and a Wary Patient brings to light an

interesting dilemma in the medical field, which is: "How do

we introduce young doctors to hands-on experience without

sacrificing the quality of practice in hospitals?" This is a

problem whose intricacies are exposed when James Denton, the

young student doctor in our case, is confronted with the need

to put his patient at ease and act with confidence, while at

the same time not sacrificing the patient's autonomy by

misinforming him (which, unfortunately, Denton fails to

protect). The ultimate question is, "At what point and by

what method can Denton achieve balance between autonomy and

beneficence?" Most would agree honesty is a staple in ethics,

and I maintain that holds true here. James Denton is verily

bound to be honest, and by doing so he may very well account

for the patient's well being, as well as his right to know

what is being done to his body.

As part of Denton's training, we assume that he must

gain experience dealing with his patients one-on-one and

project confidence, and his attempt succeeds perhaps too

well. He introduces himself as a "student doctor," which is

certainly honest, but whether the patient does not catch

this, or simply only hears "doctor," before you know it he's

calling Denton "doctor" and asking questions that assume a

certain degree of experience. Furthermore, he clearly brings

up his distrust for the student doctor population, which

makes Denton even more uncomfortable. This is clearly an

unfortunate situation, as the patients' fear is probably

weakly founded and more than slightly unreasonable, and

Denton (and the student doctor population) needs to gain

experience in a "live" scenario, is most likely very

qualified, and on top of that will, indeed, be under the

supportive gaze of the resident doctor. Just the same,

Denton is being asked point blank how experienced he is, and

he knowingly avoids offering the information he is plainly

being asked to reveal.

Calling Denton a dishonest person seems unfair, and

as far as we know, he is a decent human being. But it seems

nearly impossible to make a case that Denton has his

patient's autonomy in mind when he chooses to not clarify

what experience he actually has when he obviously knows that

the patient is concerned about this. Now, as far as

beneficence, he is certainly concerned for the patient's well

being, and even selected the operation in question because he

felt it would be more effective. So in this way, we can be

sure that Denton wishes the best for his patient, and

undoubtedly will perform his task to the best of his

ability. So why not? The patient's nerves are put to rest

by Denton's slightly misleading answers, Denton seems to feel

like he knows what he's doingÐ'...so what's the harm? Well,

trust is pretty much obliterated.

Regardless of Denton's goodwill, he has deceived his

patient. He has allowed this man to believe that he is

someone he is not, and while this may work out here in

practice, we must think in terms of precedent, and about what

we would be "letting in" if we ascertain that what Denton has

done is ethically sound. Kant would roll over in his grave

if he knew we were using the categorical imperative to

establish that deceit "on the patient's behalf" could be

universally applicable; and for good reason we should be

hesitant to do so.

Even with precedent and imperative aside, withholding

information presupposes that one knows that the "deceived"

party, once holding this information, would disagree with

one's decision otherwise being made on their behalf.

Further, this would imply that the issue could be concluded

in one of two plausible ways, as the information would not

need to be withheld if this was not the case.

So is the question now, "How can the medical student

community gain the trust of their patients, while at the same

time maintaining honesty?" Of course not. To me, Denton's

route is clearÐ'...and