Painful Decisions

The recent news of the birth of octuplets has raised a variety of issues about medical ethics. One article raises a central point in making healthcare decisions. As hard as patients try to make good decisions, sometimes the circumstances are against them.

In this specific example, about how to proceed with the pregnancy: "Rosenthal, on the other hand, questions the woman's capacity to make a good decision under the circumstances. Some neonatologists believe that when pregnant women are told about dangers of prematurity or have great expectations about giving birth, their judgment can be impaired, she said."

The article continues in the more general way: "Although the health care system in America gives patients autonomy in making decisions about their own bodies, when emotionally distraught, some people decide poorly, she said."

We see people every day who are in pain, frustrated, scared, or otherwise emotional about their health problems. These feelings are completely acceptable and normal and no one should deny you your experience. You are a whole person with thoughts, feelings, and a physical problem. All those feelings can build a vicious cycle, though, in which your pain feeds your emotions and your emotions feed your pain. Some people even need a specialist to help them work through those feelings.

That's why your doctor should aim to guide you through the whole situation. Appropriate reassurance, information, education, and options should be discussed. Once you have a better understanding of the situation, a lot of fear tends to just melt away.  You should ask questions and bring up your concerns. If you make a choice that isn't helpful or may even be dangerous to you, your doctor should explain what could happen and how the risks outweigh the benefits. All this goes to finding treatment options that will help your health problem and fit with your values and needs.

Sometimes, you're just not ready to make big decisions. First, remember that although you may feel alone and the weight of the world is on you, you are not the first person to be in this situation (and get through it successfully) and your doctor is there to help.  You and your doctor can break the problem down into smaller chunks that you can get a better handle on. Working this way, the big decision may end up making itself.

Remember, you are the most important person in you healthcare team. The rest of your team really, really wants to help you make good decisions and see you at your best.

If all the guidance and help still doesn't make you confident about your decisions, ask your doctor: "If I were your mom, what would you do for me?" Personally, this thought goes into how I try to help each and every patient.