In healthcare, oftentimes ethics in considering treatments come into question. In this scenario, Mr. S asks for a prescription for Viagra despite an unremarkable physical exam and denial of sexual issues. Ultimately, the physician agreed to give the prescription. In this thesis I will use the principles of autonomy and beneficence to support my position in agreement with the provider.

Autonomy is defined as “the right [of the patient] to make independent decisions concerning one’s own life and well-being”⁽¹⁾ and “respect[ing] a patient’s moral personhood by honoring [their] carefully deliberated preferences”⁽²⁾. Essentially, it is to let a patient consider what they want for their own treatment. Yeo et al.’s description of autonomy as “free action” supports this thesis. The patient voluntarily made the decision that he wanted Viagra, which is an aspect that ties into the patient giving informed consent, and respects patient autonomy⁽¹⁾. The patient did not express distress from pressures from his wife nor friend, nor did the provider offer this option. The only possible sources of persuasion could be from his perception of societal standards or expectations from the adult-film industry; however, these possibilities do not directly coerce the patient. Refusing to prescribe the medication would disregard the right of the patient to make his choice. He had his own desire to feel more masculine, hence, seeking for Viagra. Although he denied sexual dysfunction, there is a possibility of him feeling uncomfortable to disclose this issue. “Effective deliberation” in autonomy is another description that supports the thesis. This explains how the patient was able to express his desired goal of getting Viagra, with reasoning to “feel ‘more of a man”.” “Competence” is a concept that went hand-in-hand with effective deliberation, where a patient would need the mental capacity to make choices. According to the physician’s exam, it showed normal findings and had no remarks indicating that the patient was unable to make decisions for himself. Examining the concepts of free action, voluntary choice, effective deliberation, and competence under autonomy helps to support the thesis. The principle of beneficence also works in conjunction with autonomy.

Beneficence in healthcare is an ideology that describes “caring about and for the wellbeing of” patients, and the “orientation toward the good of patients”⁽³⁾. In other words, it is a way of intentionally treating patients with actions that emphasize benefiting them and their outcomes. Even if some outcomes inevitably result in risk, beneficence will lean towards choices that produce more “good” than harm to the patient and/or others. In the case with our patient wanting Viagra, beneficence supports the physician. This is because the medication will not affect others negatively, and the physician predicted low-risk to the patient. One might argue that Viagra may harm the patient with side-effects, or mentally, if it does not meet his desired outcome, and therefore he should not be given the medication. This stance can be countered by the concept of “dignity of risk.” This idea explains that a person should have the dignity to be in command of assessing risks of what they desire, act on pursuing it, and be subject to consequences that may follow⁽²⁾. In other words, although the patient’s choice may have risks, their choice should be respected. Another facet of considering treatment with beneficence places importance on the quality and sanctity of life⁽³⁾. These ideas evaluate how a treatment is able to improve one’s life, and views that everyone’s needs and concerns should be given the same consideration and respect as everyone else’s. The patient wanted to improve his self image of masculinity, and believed that Viagra could help. The medication has the potential to improve his “quality of life” in this way. His concern is not far off from a patient wanting cosmetic surgery (e.g. breast augmentation), even though their condition is not life-threatening nor affects their physical health. This case shows how a procedure can be considered based on a patient’s desire for it, as well as for benefiting their mental-state and self-image. After all, the World Health Organization had defined health as “a state of complete physical, mental and social well-being,” which shows that the concept of “health” is multifaceted and all parts should be considered⁽⁴⁾. The ideas of producing more “good” than harm, dignity of risk, quality of life, and sanctity of life, and the broad definition of health support the physician in prescribing the medication.

With the principles of beneficence and autonomy, I have supported my argument in having the provider write the prescription for Mr. S.

References

• 1. Yeo et al., Autonomy
  2. Kirk, Timothy W. “Staying at Home: Risk, Accommodation, and Ethics in Hospice Care.” Journal of Hospice and Palliative Nursing. 16, no. 4 2014: 200-205.
  3. Yeo et al., Beneficence
  4. World Health Organization. Constitution of WHO: principles, 2018, http://www.who.int/about/mission/en/. Accessed 30 September, 2018.