1 Monash Centre for Human Bioethics, Menzies Building, 20 Chancellors Walk, Monash University VIC 3800, Australia.
As a doctor, I have cared for patients who choose futile care over effective care, and die. Just as doctors ought to assist patients attain substantial understanding, so doctors ought to attempt to guide patients from unwise choices due to implicit biases, including cultural bias. A patient may counter that they have a right to believe what they want and make health choices as they want. However I debate that patients always have a right to health care when their desire for this is based on false beliefs. Many core aspects of healthcare are unique goal-orientated activities, unlike consumer transactions or cultural activity. Tolerance has limits, and in health care, society ought to allow for a reasonable amount of pluralism. In a liberal pluralistic society, we agree to abide by moral principles that others may not reasonably reject. Where a patient chooses lethal alternative medicine, despite protestations from health carers and family that such a path is futile, if the patient agrees to be part of a community of co-deliberators, the patient ought to engage in dialogue with expert health carers. Evidence based medicine (E.B.M.) embraces dialogical consensus as a means by which outlying beliefs may be debated by society as being reasonable or unreasonable. Dogmatic belief that restricts a patient’s freedom of choice and leads to a patient’s death, not only is antithetical to a longitudinal notion of patient autonomy, as it kills the patient, but such dogma precludes co-deliberation. If a patient seeks care of an E.B.M. carer, the patient may not reasonably reject that a carer will seek to dissuade the patient from lethal implausible health beliefs. A patient who considers that their beliefs are immutable and refuses any co-deliberation, should respect that a doctor has a professional obligation to care, and in such circumstances the patient ought to listen to the doctor
Dr John Gruner has been a G.P in the Dandenong Ranges near Melbourne since 1995. He has had long term interests in the ethical interface of complimentary medicine and evidence based medicine. In 1996 after a one year acupuncture course he commenced a Master of bioethics course that he completed in 1999 with a publication examining informed consent in complimentary medicine. More recently he has resumed research in the same area, looking at fallibism, hope,trust and cultural relativity in complimentary medicine.