We live in an age where personal choice is paramount, even in medical matters. But sometimes the balance of choice goes too far.
It is fairly common for patients to request medical interventions that have questionable benefits, and are completely unnecessary.
We all have heard of women who are ‘too posh to push’. They opt for unnecessary Caesarean deliveries rather than going through vaginal deliveries.
Cosmetic vaginal surgery, hysterectomies, preterm deliveries and many other types of interventions are all too commonly requested in gynaecology settings. The question then is, are clinicians duty-bound to accede to such requests?
From the patient’s viewpoint, their choice must be respected. Those with specific medical requests will usually have gone to great lengths to justify their wishes. Often this is based on sound reasoning, preference and values.
But it is not unusual for some to request unreasonable interventions based on a fad, especially after so-called celebrities undergo certain surgical procedures, which then catch on as the fancy thing to do.
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Physicians have the right to decline your request, especially if the justification is difficult to defend. The tenet of medicine is to avoid harm, offer cost-effective interventions and be aware of the impact of medical interventions on the wider healthcare system.
You should therefore not expect your doctor to simply accept any request. They will go to reasonable lengths to explore the reasons behind your request and offer you alternatives.
The key to a consensus is open communication, with shared decision-making between you and your doctor, with all factors considered.
The risks and benefits of the requested intervention must be discussed, as other prevailing factors. Such factors may be in direct conflict with accepted medical practice.
Depending on the context, acceding to a request for an intervention that hasn’t been medically recommended can be ethically acceptable.
Decisions should always be guided by individual circumstances and counselling. But insurance and hospital regulations may come in the way of certain requests. When this happens, your doctor should explain that your medical request cannot be accepted.
Physicians may plainly decline your request based on a scientific basis. This is especially so if acceding to such requests would be detrimental to your overall health and welfare. In such situations, physicians are not obliged to refer you to a willing provider. But you can take your request elsewhere.
Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.