The following essay will give an initial ethical framework that will guide my first few years of clinical practice as a physician assistant, focusing on the aspects that I envision will be most important to me and my own personal values.

One thing that drives my personal choices is the interactions I have with the people around me. As a very extroverted personality, I have always looked for things that will allow me to spend time with others, get to know them personally, and build relationships. Academically, I love science and am drawn to the human body and the way medicine interacts with it. Combining those things led me to become a physician assistant, to build relationships with patients and help them feel comfortable, while also providing high quality care to them medically.

There are two aspects of clinical practice that are extremely important to me and that I foresee being important throughout my practice–patient education and culturally sensitive care. I spent two years before PA school teaching 7th grade science in a low-income area, and it led me to recognize the lack of health literacy and health education provided. Often, the small health information provided in various science classes was the only health information my students had received. I recognized the importance of educating patients, not only to improve their health but also because their understanding is necessary for patient-centered care. Cultural responsiveness has also been important to me as I’ve come to better understand how one’s culture impacts their perspective and actions. I have been surrounded by cultures completely different from my own, and I have learned better how important cultural responsiveness is in understanding and building relationships with others. The patients I see in the future will be from various backgrounds, most likely different from my own, and it’s important to provide culturally sensitive care to them.

Of the ethical principles we have learned, I anticipate autonomy, beneficence, and dignity will play the strongest role in my ethical decision-making when I am practicing as a physician assistant. Autonomy is the ability and the right to make independent decisions, and as mentioned by Yeo et. al, is founded on meanings of autonomy as it pertains to free action, effective deliberation, authenticity, and autonomy (Yeo 2010). Accepting the autonomy of my patients and doing whatever I can to promote that autonomy will be extremely important to me in my clinical practice. Beneficence is promoting and acting to do good as one cares for others, as well as preventing harm in the actions taken (Yeo 2010). It is rooted in providing the best care one can for the patient in a way that will benefit them. Beneficence is an ethical principle I know will drive the actions I take to care for my patients (Yeo 2010) Dignity is the feeling of worth someone has based on the way they are treated by others and impacts the way someone feels and behaves. Having dignity allows someone to feel confident in themselves and able to make decisions. It also provides protection for their inherent sense of self and gives them pride in that (Royal College of Nursing 2008).

In order to promote patient education, the principles of autonomy and dignity are a necessary guide. Patient education is needed in order to provide patients with full autonomy. One of the aspects of autonomy is effective deliberation. A patient will not be able to effectively deliberate if they do not have the full education they need, and therefore will be unable to truly be autonomous in their healthcare decisions. As Yeo et al mention, “someone trying to decide between various options would not be able to deliberate effectively if information relevant to an informed decision were lacking” (Yeo 2010). In the future, I want my patients to be able to be fully autonomous and providing adequate patient education will allow that to happen. Autonomy of my patients will help me know that I am providing the care my patients want that will help them reach the outcomes they desire, and this autonomy will be possible through proper patient education.

Dignity is another important ethical principle for patient education. Patient education will allow them to conserve their own dignity. For example, a patient with a worsening illness may feel that their health was part of what made them who they were, and now they are defined by their illness. Educating the patient on what is happening with their treatment and care and how to deal with it can help the patient feel a sense of control and acceptance that will allow them to retain their dignity. Treating patients with dignity will also create better opportunities to provide patient education. When someone is treated with dignity, it is respectful of who they are as a person. Treating patients with dignity will help develop my relationships with patients and provide a foundation of respect and understanding before I provide information. Recognizing the dignity of each patient will help me educate each patient fully. One question mentioned in the research is “what do I need to know about you as a person to give you the best care possible?” (Chochinov, 2002) Keeping this question in mind as I go through my practice is vital to provide the highest level of care I can to patients, especially in the realm of patient education.

To provide culturally sensitive care, it is essential to use beneficence and dignity as an ethical framework. Without a recognition of the dignity of each patient, I will not be culturally responsive to them. Cultural identification is often closely tied to one’s sense of self and worth, and recognizing and accepting someone else’s culture is essential to treat them with dignity. Chochinov et al mention that 87.1% of patients felt that “not being treated with respect or understanding” had the biggest impact on their sense of dignity (Chochinov 2006). That research also showed that demographic variables had an influence on a patient’s sense of dignity. By not treating patients with respect or attempting to understand their culture the best we can, we are not treating each patient with dignity. To provide culturally sensitive care, I must respect and promote patient’s dignity. Another ethical principle that has an impact on providing culturally sensitive care is beneficence. For me, this is directly tied to dignity. When we recognize a patient’s culture and inherent dignity, we are preventing any harm that the patient may have felt when these things were not recognized or accepted. For example, if I was biased and ethnocentric in my care, patients could be harmed mentally or even physically from these biases. The other aspect of beneficence is to promote good and benefit our patients.Yeo mentions that a caring relationship “sets up conditions of trust that enable the one cared for to… feel cared for” (Yeo 2010). If I do not develop a caring relationship based in an acceptance of my patient’s identity and culture, I will not be able to create a caring relationship that allows the patient to feel cared for. I may not, as Yeo et al mentions, be able to make a positive difference for my patient due to this lack of sensitivity to them (Yeo 2010).

In conclusion, to provide high quality care, specifically considering my commitment to provide culturally sensitive care and adequate patient education, I will use the ethical principles of autonomy, beneficence, and dignity to guide my practice as a physician assistant.

 

Sources

Chochinov, HM et al. (2006, June) Dignity in the Terminally Ill: Revisited. Journal of Palliative

Medicine, 9(3), 666-672.

Chochinov, HM. (2002, May) Dignity-Conserving Care—A New Model for Palliative Care:

Helping the Patient Feel Valued. JAMA 287(17): 2253-60.

Royal College of Nursing. (2008). Defending Dignity—Challenges and Opportunities for

Nursing. London: Royal College of Nursing. Yeo, M 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. 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.