What Health Care Providers Know: A Taxonomy of Clinical Disagreements‪.‬

Some assume that respecting patient autonomy means clinicians should refrain from expressing opinions about what's in a patient's best interests. But depending on the kind of medical decision the patient is making, a clinician may have expertise vital to the patient's best interests--and even if she doesn't, she may still know what is best. Consider the following case: Horace Johnson is a forty-year-old, wheelchair-bound patient who has been suffering for the past ten years from type 2 diabetes mellitus. He has wet gangrene on his fifth toe. He doesn't visit the outpatient clinic for care of his diabetes and infection as he is scheduled to. The infection is so severe that his physician, Dr. Garcia, concludes that the toe cannot be saved and that if it is not amputated, Mr. Johnson could die. Mr. Johnson has been seen by a psychiatrist, who finds him eccentric but believes that he has no evidence of mental illness and must therefore be declared competent to make his own health care decisions. (1)