Pressured to Refuse Ventilator -- Persuasion vs. Coercion

Simon Fitzmaurice, an Irish man with motor neuron disease (MND), revealed to the Irish Times how health professionals pressured him to refuse the ventilator that is keeping him alive.  Shortly after being admitted, a doctor informed him it was rare and expensive for patients with his condition to have a ventilator at home.  Fitzmaurice said the doctor told him: “That it is time for me to make the hard choice.  He tells me that there have only been two cases of invasive home ventilation, but in both cases the people were extremely wealthy. . . .  This is it now for you.  It is time for you to make the hard choice, Simon.”

There is a growing consensus that patients ought not be abandoned to their autonomy.  Physicians should share their recommendation.  Indeed, if they feel strongly about it, they might even attempt to persuade the patient with evidence and argument.  But physicians must be careful not to stray from rational persuasion to badgering, manipulation, or coercion.  Unfortunately, some patients often experience mere persuasion as coercion.   Other patients feel that the physician does not share enough.