Medical School Interview [UK] - Medical Ethics - Autonomy

[@theMSAG]

Here's a question to practice with:
"A patient who was on the organ donor register dies. However, their family do not wish to donate their organs. Do you think that the patient has overriding autonomy in this scenario? What are the issues here?"
Tell us your ideas for points or even your answer structure below in the comments. We will give you feedback and help to polish so that you're interview-ready!

[@gigazaeem9542]

Here is what I would say. please give feedback as soon as possible please so I can act upon it:
"Since the patient was on the organ donation register, you could assume that perhaps they did want their organs to be donated and you could take this into account when making the decision. However, it could also be the case that, because of an opt-out law that might be in effect that the patient wasn't aware of, they might not have known to opt-out during their life. Because of this, I would then ask the family if they knew or if the patient was aware of this. I would also ask them why they don't want their relative to donate their organs. It could be the case that they object on religious grounds, which is something I can't discriminate against, even if I am don't believe in it but it could be something else as well. In any case, I would explain the huge impact his donations could have on people's lives and explain how important this would be to them. Most importantly, I would look to see if there was an advanced directive or a lasting power of attorney that could make the decision on the patient's behalf as that would be the most appropriate thing to do. These 2 things will be sufficient to make a decision because even though the patient is deceased, they agreed to this when they were alive so you basically treat that as what they would have done if they were here right now. If that isn't there, I would respect the family's decisions and not remove the organs because I would understand if, for example, they want their relative to be 'whole' as a lot of religious people say against removing organs after death. Because they are the family, you assume that they make the decisions that the patient would have wanted, basically meaning that they act in their best interest. Of course, it wouldn't just be me talking to them. The whole multidisciplinary team could work together to find out exactly why the family objects and by doing this, we can have a better outcome since it involves a lot of opinions from medical professionals and also the family that most likely care for their relative who has passed away."
Please let me know what you think about this and where I can improve.

[@GoogleAccount-hy4it]

As a doctor, I have a responsibility towards the patient to respect their autonomy as well as one towards their family to inform them of their member's advance directive. The issues that can arise with such a situation can be classified as social and legal.
Immediately, informing the family of their member's choice may cause unrest and stern opposition - to which it is vital to pay heed to and convey to them that their beliefs and reasoning are understood by the doctor addressing them. This can involve using phrases such as "Can you tell me what is going through mind," or "what do you make of your relative's (patient's) decision?" This will enable them to present their point of view in a thorough manner as well as help the doctor to gain an insight as to where the family's standpoint comes from.
As a doctor, I understand that anything the family proposes is most likely in the best interest of the patient and making this known to them will further smoothen the meeting. Then, it is vital to systematically inform them about the concept of patient autonomy and how I hold a legal responsibility to comply to patient's advance directive given that they made it competently. I would make sure to tell them that in the event I decide to go against the patient's autonomous decision, I would be held legally accountable, hence a legal issue. If the disagreement is solely based on their feelings and emotions, it wouldn't provide me with a reason to override the patient's autonomy as the patient's feelings and opinions towards organ donation may not match with their family's.
Furthermore, during our conversation, I may gain an insight into the late patient's life and it may be the case that the patient may have been pressured to sign such an advance directive. For example, I may find out that the patient had always been a religious person who believed in the notion that the human organs are not meant to be shared as it may not only involve the transfer of a physical object, but also one's deeds and that they had only signed such a document because their friends shared a different opinion. In that case, the pillars of benevolence and non-malevolence would weigh more than the pillar of patient autonomy and it would be reasonable to act in the interest of the family as it may be in the patient's best interest.
In summary, as a doctor, I look forward to act in the patient's best interest and to investigate and obtain "hidden" information through effective communication is crucial as it would lead me to ultimately respect the patient's best interest.
Please let me know if I haven't accounted for other important issues and what I am missing in my answer and how I could improve it :)