Question

Autonomy

Autonomy essentially means "self rule," and it is a patient's most basic right. As such, it is a health care worker's responsibility to respect the autonomy of her patients. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals. The following two cases address patient autonomy. The case involves the rights of a parent to care for her child in the manner that she sees fit.

Case 2:

You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.

Questions for Case 2:

Should we completely discount this treatment as useless, or could there be something gained from it?

When should a physician step in to stop a cultural practice? (If someone answers "when it harms the child" remind that person that there is some pain in many of our medical procedures, for example, having one's tonsils removed)

Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?

Do you think that the physician should report the mother?

Answer 1

Ans. Cao gio is a dermabrasion therapy called as coining which is belived to stipulate meridian points of the body however health care professionals do not accept this practice and claims it to be a form.of child abuse.

A physician must stop such practices if he feels that it leads to child abuse rather than the cure of the patient and that it causes more harm than good and can eventually be life threatening.

The physician should explain the mother regarding the effectiveness of modern medicine without humiliating her of her traditional medicinal practices. She should be made to understand that such customs can cause more damage to their loved ones and that the time has changed so does the treatment protocols.

Before reporting the mother, the physician must talk it out to the mother regarding the pros and cons of her ethinic treatment and if she still continues to do such practices, then it must be reported.