In the Patient’s Best Interest: But Within What Limits?

It is said that the physician has a fiduciary responsibility to the patient. This means that the doctor must keep the trust of the patient. In that regard, the patient retains a trust that the doctor will always be making decisions and caring for the patient in the “patient’s best interest”. This would meet the ethical requirement that the physician’s acts be consistent with beneficence to the patient. But what does “patient’s best interest” really include and should, indeed, there be limits to the extent of those professional actions?



One question might be: under what conditions, if any, should a physician consider a responsibility to the patient’s family, to other parties including society in general? Should the physician’s concern at the bedside be only for that ill person lying in the bed? How does the “patient’s best interest” actions conflict with professional standards of medical treatment, established laws, responsibilities of shepherding common resources especially if they are scarce in order to enable the ethical principle of justice in the distribution of those resources?



Is “patient’s best interest” to placate the patient to prevent unpleasant or even unhealthy emotional turmoil? Or is it an expression to emphasize the exclusion of actions of self-interest by the physician for his or her actions? Many questions—but, in practice, these issues abound. Take these common examples and decide for yourself how the physician should respond or act. The patient wants an antibiotic for a viral respiratory illness that has been shown not to be improved by antibiotic treatment. The patient wants a medical excuse from jury duty or wants the physician to authorize a disabled parking permit when none is medically indicated. The patient, surrogate or family request a test, treatment or life-support, perhaps to produce a miracle response, when any of these requests would be a medically futile action for the patient’s condition based on known scientific knowledge and standards of practice Would it be right to deny all these requests? Would “best interest” be satisfied by educating the patient about scientific facts, the law, about ethical behavior, about social demands and requirements?



How do physicians know what is in the patient’s “best interest” if they never did or were unable to ask the patient what were the patient’s own view about needs and goals? Or is “best interest” only something the physicians know? And if the physician knows and acts, should there be limits to that action? ..Maurice.