In the iconic painting Broken Column, Kahlo represents her spine as a Greek column that is fractured and disintegrating. In this beautiful and tragic interpretation, the fractured column bespeaks Kahlo’s physical weakness and emotional instability.
Using the patient’s worldview to challenge his or her decision and establish a treatment plan—implying the view is shared by the physician when it is not—could be seen as manipulative and deceptive.
The growing number of web-savvy patients alters the power dynamic in the patient-physician relationship. In the older model of care, physicians served as unchallenged experts who alone devised therapeutic plans for patients.
People have a social obligation to conform to the general rules of sleeping: sleep at night, in a bed, in a private place away from public view, and in proper attire.
Physicians make patients aware of those interventions that they (the patients) may then refuse. In short, informed consent is less about patient decisions than it is about restraining physicians.
Tracy Shamas, MSN, APRN and Sarah Gillespie-Heyman, MSN, APRN
Veterans at the end of life have special needs due to posttraumatic stress disorder, environmental exposures, and the influence of military culture on their values. Those who die outside the Veterans Affairs health care system, however, can be at increased risk for receiving outpatient palliative care that is not sensitive to these factors.
AMA J Ethics. 2018;20(8):E787-792. doi:
10.1001/amajethics.2018.787.