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Friday, January 3, 2020

Patient Autonomy; Legal and Ethical Issues?

Image result for patients autonomyMedicine has been recognized over the years as an ethical based practice. Ethical foundation serves as a backbone for setting out a legal policy. Initially, medicine was more of a paternalistic norm which was practiced in the doctor-patient relationship-“a profession where physicians decides what treatment a patient should receive based on their experience and knowledge”; however, recently, the advancement in medicine has changed its concept to a “patient centered care”. This simply means that the healthcare provider only advises and informs the patient on the possible treatment, but the patient makes the decision. This shift from paternalism to patient-oriented care is merely a reflection on the changes of ethical principle in medicine (Brooks & Sullivan, 2002). Therefore, Patient Autonomy is defined as the patient’s right to make their own healthcare decisions without the interference of the physician. Through the aid of patient autonomy, healthcare providers are permitted to educate patients; yet, are not authorized to undermine the decision of the patient (Entwistle, Carter, Cribb, & McCaffery, 2010).  

Patient autonomy is the foundation of professional ethics in medicine. It is significant that a healthcare professional develops the ability to recognize and practice patient autonomy in its different ways (Murgic, Hébert, Sovic, & Pavlekovic, 2015). The respect for patient autonomy in the healthcare sector is a focus on situations where decisions are made based on medical interventions. The goal of autonomy is to provide the patient the right to make their own choices on their respective healthcare services; this is associated with the principle of confidentiality, fidelity, privacy and honesty that are invoked in decisions based on the principle of autonomy (Entwistle et al., 2010). Furthermore, to respect a patient’s autonomy is to yield to their judgement and ensure that they have the absolute freedom to choose without any objection. Therefore, the core values of autonomy is the appreciation for a person, which integrates two moral commitment to “honor autonomy and support those with developing; impaired or recede autonomy”(Nurmsoo, 2014) .

For the past decades, it has been emphasized that patients have had the right to self-determination in healthcare even though the healthcare providers concentrated on the promotion of clinical benefits for their respective patients. Medical benefits as a mandatory service, and the respect for autonomy have increased the tension between patient-physician relationship. The concept of autonomy compels general physicians (GPs) to respect the right of a patient; nonetheless, this makes it challenging for physicians to mitigate and prevent their patients from suffering. While on the other hand, the beneficence principle supports the physician to act according to the medical practice; yet, they refrain from being accused of “Big Brotherism”(Tore Nilstun And, 2000). The concept of autonomous inpatient decision making is centralized by the concept of providing an informed consent (IC) to the patient-to outline the legislative laws and other healthcare policies. To issue an informed consent to the patient, the decision made by them has to be based on the fact that the patient had the ability to make the decision, the physician provided adequate and relevant information to the decision maker, and finally, the decision made by the patient or the patient’s representative was not acted as a result threat or coercion (Kevin W. Coughlin, 2018)

Recent studies have indicated that patient autonomy is important to medical ethics. The findings of the study done by “Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientist Johan Ng”, demonstrated that patient autonomy can lead positive changes in healthcare. The results states that supporting the psychological needs of a patient is fundamental for physicians to help patients sustain their health and wellbeing (Ng, 2012).
The thesis statement, “patient autonomy is considered as a standard in the modern medicine and ethics; and patients are entitled to their healthcare rights from their respective physicians; however, patient autonomy can be biased from a physician’s point of view because  at the moment of treatment, the patient maybe impaired to make the right decisions for themselves”.

The beliefs, desires, and decisions of an individual are autonomous when a certain criterion has been met. For instance, if the person’s behavior was a result of weak will or compulsion, then this is known as “Heteronomous” and not “Autonomous”. If the individual has had external factors such as unreflect of socialization, manipulation, coercion; the decision of the person was not autonomous. Furthermore, if the beliefs of a person regarding a subject were false, inconsistent with each other, or the person had little or no information of the subject without their realization, then this is not considered as autonomy (Varelius, J., 2006).

 It has been argued by many that autonomy in the western medical care is treated as a means of obligation than the act of beneficence. Patient autonomy stands for administering care in accordance to the values and believes of the patient; it can also permit them to utilize their freedom for self-realization. While patient autonomy still has its high grounds and morale in places like the United States and Canada (Murgic et al., 2015), some Latin American cultures and Asian Societies still practice paternalism within their healthcare system. In the Latin American society, there is still a great significance in the number of physicians and families who believe in paternalism. For the purpose of assuring the health of the patient, most physicians may have the tendency to withhold information on the diagnosis and prognosis of the patient’s health condition in the form of beneficence. This can or may interfere of overrule the will of the patient (Karime K. Machado, 2012).  Also, in some cases, most of the physician does not participate in the decision making of the patient; however, it is the family of the patient who plays the role of a decision maker because the family’s autonomy and well-being is observed as more significant(Cheng-Tek Tai, 2003). Therefore, it can be considered that patient autonomy does not meet the cultural values of certain countries.
In patient autonomy, there is a constant risk of disconnection between the concept of self-determination and the need for a social medical system (Graber & Tansey, 2005). Patient autonomy involves a person to have the right of authorizing an informed decision about their medical treatment plan which simply means that they can set a limit for any medical intervention rendered to them. Moreover, this brings attention to the fact that patient autonomy can act as a threat to the duties of the healthcare professionals. This implies that physicians would have to go against their knowledge and believes to “save the lives of their patients” to ensure that their patients were well informed of the consequences or inconsequence of their healthcare decision (Evanthia Sakellari, 2003). The more the patient is autonomous over their own decisions, the more the physicians will suffer its consequences. Physicians request for a mental evaluation of a patient if the refusal to treatment was not based on a religion belief. For instance, patients who are cognitive impaired are usually incapable of determining their medical treatment in the context of their best interest. “A hospitalized patient of a medical history of schizophrenia   with a life-threatening; yet, a curable condition, who rejects any medical treatment because the voices in their heads are instructing them to decline the medication given to them by their physicians are likely to receive the necessary treatment for their recovery”(DT, 2019). To summarize, patient autonomy acts a challenge for healthcare providers to have a more professional conduct towards their patients.

Patient autonomy has influenced the doctor-patient relationship over the years. Doctor-patient relationship is crucial in the healthcare system; once it as been established, there must be a consistent commitment to provide an ongoing care to patients  which means that decision making has to be shared between the patient and physician throughout the incubation period of the disease. Furthermore, physicians are mandated by law and ethics to ensure that their patients receive the necessary care throughout the course of their medical condition, no matter the outcome or the challenge. On the other hand, patient autonomy brings about conflict of interest between the physician and the patient as it becomes medical and moral problem. To illustrate more, a cancer patient may decide not to follow-up with their medical intervention if they believe it may not be beneficial to their current health status; however, the physician may be obligated to provide that specific care to their respective patient because they have taken the oath of “do no harm”(Wancata & Hinshaw, 2016). The concept of patient autonomy becomes unsatisfactory in the terms of chronic diseases and primary medical due to the fact that there is a difference in the communication level between the physician and the patient, and that certain decisions may be insignificant compared to the maintenance of the relationship. Although patient autonomy should be respected in a strict manner, the healthcare system should pay a great amount of attention to the particularities of the patients or those who need medical services (Arrieta Valero, 2019).   

In conclusion, patient autonomy is seen as the ethical principle in medical practices. It plays an important role in the improvement and advancement of the quality of healthcare services that a patient receives. While ethics remains the backbone of legal policy, medicine which was initially a paternalistic norm is now transformed to a more patient-centered care. Even though physicians are required to understand and apply patient autonomy in its own various aspect, patient autonomy has proven to have a more negative impact towards the healthcare system. 

Arrieta Valero, I. (2019). Autonomies in Interaction: Dimensions of Patient Autonomy and Non-adherence to Treatment. Frontiers in Psychology, 10.
Brooks, H., & Sullivan, W. J. (2002). The importance of patient autonomy at birth. International Journal of Obstetric Anesthesia, Vol. 11, pp. 196–203.
Cheng-Tek Tai, M. (2003). The ethics of biobanking View project The St. Jude valve prosthesis. Evaluation and Followup View project. Retrieved from
DT, T. (2019). Jehovah’s Witnesses’ refusal of blood: obedience to scripture and religious conscience. J Med Ethics, 25(6), 469–472.
Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010, July). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine, Vol. 25, pp. 741–745.
Evanthia Sakellari. (2003). (PDF) Patient’s autonomy and informed consent. (13). Retrieved from’s_autonomy_and_informed_consent
Graber, M. A., & Tansey, J. F. (2005). Autonomy, consent, and limiting healthcare costs. Journal of Medical Ethics, 31(7), 424–426.
Karime K. Machado, M. P. M. H. M. F. (2012). Autonomy Versus Paternalism in Latin America.
Kevin W. Coughlin. (2018). Medical decision-making in paediatrics: Infancy to adolescenceMedical decision-making in paediatrics: Infancy to adolescence | Canadian Paediatric Society. Canadian Paediatric Society, 23(2), 138–146. Retrieved from
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: Views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics, 16(1).
Ng, J. (2012). Supporting Patient Autonomy Is Critical to Improving Health – Association for Psychological Science – APS. Journal of the Association for Psychological Science. Retrieved from
Nurmsoo, S. M. (2014, September 16). Incidental findings and patient autonomy. CMAJ, Vol. 186, p. 1017.
Tore Nilstun And, S. B. (2000). Patients’ autonomy and medical benefit: ethical reasoning among GPs | Family Practice | Oxford Academic. Family Practice, 17(2), 124–128.
Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, Health Care and Philosophy, 9(3), 377–388.

Wancata, L. M., & Hinshaw, D. B. (2016). Rethinking autonomy: decision making between patient and surgeon in advanced illnesses. Annals of Translational Medicine, 4(4).

Saturday, December 28, 2019

Healthcare Disparities in Rural and Remote Areas in America


The rural population in America is estimated to be 15-20% of the whole population. They face healthcare disparities that leads to worse healthcare as compared to urban and suburban regions. This inequities in healthcare is due to economic, social, racial, ethnic, geographic and health workforce factors (Kelleher & Gardner, 2017).

Increase in population and disparity in distance has been proven to be problematic in accessing medical and emergency healthcare services in first world countries such as Canada, United States of America and Australia. Inequities in healthcare accessibility and underutilization of emergency hospital services are a result of geographical distance among rural and remote areas. Meanwhile, there are pressures to downgrade hospital infrastructure, centralize more specialized medical functions to ensure that there is an appropriate level of procedures and quality of care and attempt moving hospitals services to rural areas. Small hospitals in rural and remote regions have struggled to sustain their financial status which has further become a major problem in terms of both capital expenditure and expenses; at the same, maintaining and attracting highly skilled healthcare professionals in remote locations is another challenge of its own. Hospital closure is often considered as a political charge that is restricted by the local population. This implies that primary healthcare is of great significance either by preventing unnecessary hospital admissions or providing the necessary emergency care, which can also be assisted by telemedicine (Rechel et al., 2016).


Kelleher, K. J., & Gardner, W. (2017, April 6). Out of sight, out of mind - behavioral and developmental care for rural children. New England Journal of Medicine, Vol. 376, pp. 1301–1303.

Rechel, B., Džakula, A., Duran, A., Fattore, G., Edwards, N., Grignon, M., … Smith, T. A. (2016). Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries. Health Policy, 120(7), 758–769.

Tuesday, September 3, 2019

Prevalence of Corporal Punishment among Nigerian Students Between the Age of 2-14 Years

Related imageChild abuse and neglect is known as a major public health problem diminishing the health and wellbeing of a child and an adolescent across the world. The Centers for Disease Control and Prevention uses the term child maltreatment in a general concept that includes “abuse”, and “neglect” even though the terms “maltreatment and abuse” are mutually used in the literature. According to CDC (2008) this is defined as any act or series of acts of commission1 or omission by a parent2 or other caregiver that results in harm, potential for harm, or threat of harm to a child (Leeb, Paulozzi, Melanson, Simon, & Arias, 2008). Furthermore, World Health Organization defines “Child Abuse and Neglect” as ‘Every kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust or power. Several studies have shown that children who have been abused or neglected tend to show signs of developmental issues, impaired cognition, eating and sleeping disorders, poor academic performance, poor relationship, PTSD, depression, suicidal behaviors and themselves may inherit the trait of abusiveness (Olatosi, Ogordi, Oredugba, & Sote, 2018).

For over a century, according to the Nigerian culture, children are perceived to be an instrument or property that has no rights of its own. The belief states that children should be seen on occasions, but not heard; they are not permitted to listen to the discussions of that of an adult or make contributions to their conversation. Not only was the situation prevalent in the Nigerian society, it continued its way into the educational system of the country. Unfortunately, children were only authorized to contribute in a class activity when the teacher deems it as necessary. The educational curriculum in Nigeria is recognized as a means of establishing a free democratic and equal community that is strong, united and independent with a land full of opportunities and potentials for the citizens to grow and prosper (Umobong, 2015).

The African custom detects that the parents are the solely responsible for training their child, and a member of the community also has the right to discipline and correct a child who misbehaves or acted in a wrong way. The parents are to teach their children in a suitable and acceptable way according to the standard of the society. However, in recent times, as a result of the introduction of nursery and pre-schools, parents pushed the responsibilities such as directing, guiding, counselling and role modeling to the academic institution; hence, contributing to the demands of the curricular of the school. Children at the age of two years, who are supposed to be at home to receive the warmth and nurture of a mother are enrolled into schools. The school is therefore faced with managerial challenges on how to manage the children and train them. This eventually leads to the lack of provision of human rights for the children; children are further subjected to physical abuse and neglection; emotional abuse from the teacher and other inhuman treatments (Umobong, 2015).

Academic institutions go beyond gathering children to enroll them for learning sessions; it is a way of addressing behavioral problems among students. Schools are challenged with numerous acts of misconduct from students. Although it has been argued by a lot of teachers that punishment is an answer to misconduct, others tend to enact discipline among the students. Therefore, teachers and academic administrators inflict corporal punishments on students for several reasons. Pupils are beaten for receiving a poor grade in an exam, for talking in the class etc. A considerable number of teachers, administrative staff and parents have the belief that these punishments are essential in the upbringing of a child; to teach the child a lesson or discourage misbehaviors in the future(Yemi, 2018) .

According to a survey conducted by UNICEF which focused on violence on children by caregivers or family members, authority figures, peers and strangers, showed that over 60% of adults in Nigeria agree with the method of physical punishment as an act of discipline towards children to raise and educate them. 91% of children between the age of 2-14 years have experienced violent discipline such as psychological aggression/physical punishment by a parent or a teacher. Over 30% of Nigerian children have been subjected to severe case of physical punishment from hitting the child on the head, ear or face to hitting the child with objects such as canes or sticks(UNICEF, 2014).
Another survey that studies eye injuries caused from corporal punishments in Nigerian academic settings that involved 172 primary school teachers in Ilorin, Kwara state, Nigeria, indicates that 80% of participants had witnessed students undergo punishments by the teachers with a cane, 46% students were subjected to horse-whip and 30% were slapped by the teacher’s hand; 61% of the students were flogged on their buttocks, while 49% of them on their backs, 52% on the palms of the their hands, 20% on the head and 16% received beatings on their face (Mahmoud, Ayanniyi, & Salman, 2011).


Leeb, R. T., Paulozzi, L. J., Melanson, C., Simon, T. R., & Arias, I. (2008). CHILD MALTREATMENT SURVEILLANCE Uniform Definitions for Public Health and Recommended Data Elements Version 1.0.
Mahmoud, A. O., Ayanniyi, A. A., & Salman, M. F. (2011). Observations of teachers in llorin, Nigeria on their practices of corporal punishment that are potentially injurious to their pupils eyes. Annals of African Medicine, 10(2), 150–154.
Olatosi, O. O., Ogordi, P. U., Oredugba, F. A., & Sote, E. O. (2018). Experience and knowledge of child abuse and neglect: A survey among a group of resident doctors in Nigeria. The Nigerian Postgraduate Medical Journal, 25(4), 225–233.
UNICEF. (2014). HIDDEN IN PLAIN SIGHT A statistical analysis of violence against children. New York, NY.
Yemi, F. (2018). Journal of Education and Practice ISSN (Vol. 9). Retrieved from Online website:

Tuesday, July 16, 2019

Sickle Cell and Thalassemia Disease

Sickle cell disease and thalassemia are both genetic disorders that resulted from genetical errors for hemoglobin-a substance that is made up of protein and iron molecule responsible for carrying oxygen in the red blood cells. These orders can lead to fatigue, jaundice and episodes of pain ranging from mild to very severe. Sickle cell and thalassemia can be inherited especially from parents who pass an abnormal gene. When this occurs, both diseases can be severe or fatal.


Related imageSickle Cell Disease was discovered in the 1900s, formerly known as "peculiar, enlongated sickle-shaped erythrocytes (red blood cells)". Advancement in studies indicated that the pain sickle-cell patient go through is caused from a blockage of tiny blood vessels. Furthermore, several studies concluded that sickle cell disease is caused by an abnormality in the hemoglobin, referred to as "hemoglobin S". This is disease among other identified diseases was the first to be understood by scientists at the biochemical level due to the fact that researchers learned that the abnormal hemoglobin is actually changing form (called sickling) because of a single amino acid error in the hemoglobin S.

The underlying molecular cause of the disease has been understoond for over a century. Yet, progress in translating the knowledge to improvde patient care is slow; that is, reflects the challenges of treating the disease. In United States, health research and treated were neglected among the underserved population where they are more prone in developing the disease. In the early 1970s, just after the civil rights movements that it was recognized the fact that patients with sickle cell disease were an example of racial inequality in the healthcare. In addition to this, the Sickle Cell Disease Association of America was founded and eventually helped to establish the Sickle Cell Amemia Control Act of 1972. The government provided grants for screening research and treatment programs.

New treatment for the sickle cell disease were discovered as scientific progress and technology evolved. The Prophylactic Penicilin Study (PROPS) shows that administering penicilin (an antibiotic) to unsick patients could prevent death caused by serious infections in sickle cell disease. Also, the Multicenter Bone Marrow Transplant Study illustrated that 84% of children who were diganosed with the disease could be cured after receiving  a bone marrow transplant from a matched donor or family member. Mid 1990s, the U.S Food and Drug Administration authorized a new therap called Hydroxyurea as a form of treatment to reduce further complications of the disease. "Hydroxyurea works in part by stimulating the body to resume production of fetal hemoglobin (hemoglobin F), a normal hemoglobin in the fetus that prevents sickling".


This is an inherite blood disorder characterized by low hemoglobin and fewer red blood cells in the body compared to normal. In 1925, Thalassemia or Mediterranean Anemia was first described by a Detroit physician who studied Italian children with severe anemia (low levels of red blood cells), poor growth, huge abdominal organs and early childhood death. In 1946, the cause of thalassemia was discovered to be an abnormal structure in the hemoglobin. The body destroys the red blood cells, resulting to Anemia. The body tries to make red blood cells quicker than normal as a means of compensating for the loss; however, this can lead to other thalassemia complications such as bone abnormalities and spleen enlargement.

Related imageIn the year if 1960, doctors started transfusing fresh red blood cells to patients with thalassemia every month to treat the disease. This mitigated most of the symptoms in childhood and had a huge impact in the survival rate of thalassemia patients; this treatment is currently in practiced. Nonetheless, since blood contains a large amount of iron, most patients died during their teenage years from the damaged caused by too much iron. Moreover, researched discovered that surplus iron amount can be removed from the body through by a drug called desferoxamine. The drug has prevented iron-induced heart disease and has improved the life expectancy of patients. Recently, there is availability of two oral drugs that aid in removing iron, which has improved the quality of life of the patient with excess iron from blood transfusion for thalassemia. On the other hand, specialized imaging test can detect iron in the heart and also permit patient to be treated to prevent iron-related heart failure.


Tuesday, July 9, 2019

Violation Of Human Rights in Nigeria: What Is Going On Now!

Infringement of human rightsIn Nigeria, human rights are being violated by the justice system such as the police. These days, the police have broken the code of conduct of human rights that includes unlawful killings, torture and other ill-treatment as well as enforced disappearances. The conflict in Niger Delta poses as a threat to the safety and lives of the Nigerian residents. Human right advocates and journalists are intimidated and harassed for expressing their voice. Women still face the violence, which is widespread across the country, and unfortunately the government has shown no interest so whatever to protect the rights of the children. Furthermore, millions of citizens face eviction in the country.  

Although the government has given its pledges to foresee the challenges in the criminal justice system of Nigeria, there is little or no progress to address the issue. The Nigerian Police Force (NPF) has no regard for human rights; people are subjected to illegal killings by the police either during or before arrest, or along the streets. A majority of the armed forces that perform such crimes are left unjustified by the legal system of Nigeria (the court).  


Saturday, February 2, 2019

Understanding The Aboriginal People

The residential schools were government owned and sponsored by a religious system established to assimilate the aboriginal children in the Euro-Canadian tradition. Despite the fact that the first residential facilities were in the New France, it was usually referred to as a custodial school that was introduced after the
1880s. Originally created by the Christian churches, the Canadian government attempted not just to educate them and convert their culture and adapt them into the Canadian society, but the residential schools also disrupted the lives of the native population and communities; thereby, resulting to a long-term problem among the indigenous persons.  

The institution forcefully separated children from their families for a long period of time and banned them to recognize their Aboriginal heritage and culture or speak their native languages. The children were critically sanctioned if they did not obey the strict rules enforced by the school. The children faced abuse from the staff of the residential school staff such as physical, sexual, emotional, and psychological abuse. They were taught with an inferior curricular structure, which is normally taught up to the 5th grade. These lessons were focused mainly on manual labor in agriculture, light industry (e.g woodworking), domestic work such as laundry and sewing. Furthermore, any studies indicated that a lot of children were beaten and strapped, shackled on their beds and the rest of the children were punished by having needles shoved on their tongues as a consequence of speaking their language. These abuses were also followed with overcrowding, poor sanitation and inadequate food and access to healthcare. The medical inspector PH Bryce reported 24% of death rate among the aboriginal population within the school around the year of 1907.  


Sunday, December 9, 2018

Lymphomas Cancer in Nigeria

Lymphomas are a heterogeneous group of neoplasms of lymphoid tissues, each with distinct clinicopathological features that varies to different response to treatment1 

The finding from the report of Ferlay showed that the cancer rate occurring in Sub-Saharan Africa, Hematolymphoid Malignancies has merged as a major cause of morbidity and mortality with lymphomas and other hemotologic malignancies such as leukemia and multiple myeloma together accounted for 8.7% of incident cancer diagnoses and 9.9% of cancer deaths in 2008. Annual incidence has estimated a rate as low as 30,000 and as high as 278,000 of Non-Hodgkin Lymphoma (NHL) in Sub-Saharan Africa. This has made it one of the most common cancers in the region. Other studies have indicated that in most Nigerian Tertiary Hospitals, Lymphomas, mostly NHL are ranked among the leading cancers2 

Between the year 1960 and 1975 an estimate of 100 patients with Non-Hodgkin's Lymphoma were admitted to the University College Hospital in Ibadan, Nigeria. The related cases were analysed in respective to the clinical findings, histological classification and response to therapy. Majority of the patients (87%) had reticulum cell sarcoma with a high ratio of men than women (2:1). The applied therapy consisted mainly of single-agent chemotherapy, but a few of the patients had either surgical excision combined with chemotherapy or multiple-agent chemotherapy. The derived results were poor as a result of high default rate, late presentation, inadequate supply of drugs and the lack of radiotherapeutic facilities3 

“The contemporary management of these neoplasms requires that they are accurately diagnosed, categorized by sub-typing according to the WHO system of classification”4. These classifications are multiparametric approach requiring clinical, morphological, immunological, cytogenetic and molecular techniques. The impact of this can be reflected in the resource-rich settings where treatment of those malignancies is increasingly related with unprecedented rates of long-term cure and control. Diagnosis of lymphomas cancer remains as a big challenge in Sub-Saharan Africa, because of inadequate facilities5