[What to do in case of disagreement between physician and patient: a few legal and ethical considerations].
A patient may not demand an intervention that is not medically indicated. Such situations put the physician in a conflictual position that may jeopardize the physician-patient relationship. Exploring the different viewpoints may help explaining the sources of disagreement and reach a consensus. When this fails, the final decision in Switzerland belongs to the physician, including in case of an incompetent patient. A project of a revision of the Swiss civil code would confer decision-making responsibilities in such cases to the person closest to the incompetent patient. This is cause for concern given the poor ability of surrogates to accurately predict patient preferences and the additional emotional burden to surrogates. Early discussion with a competent patient and establishment of advance directives is therefore extremely important.
Ray
Sylvie
S
Service de médecine interne générale, HUG, 1211 Genève 14. ray-sylvie@hcuge.ch
Hurst
Samia
S
Perrier
Arnaud
A
D024362:Advance Directive Adherence / Q000331:legislation & jurisprudence; D003657:Decision Making; D034462:Dissent and Disputes / Q000331:legislation & jurisprudence*; D006801:Humans; D007872:Legal Guardians / Q000331:legislation & jurisprudence; D008020:Life Support Care; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D010349:Patient Compliance; D010361:Patients / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000941:ethics / Q000331:legislation & jurisprudence; D013557:Switzerland