The Golden Rule has been preached to those in healthcare for decades. As nurses we were taught that we should treat our patients as if they were our mother or grandfather. I have heard doctors concluding consults with, “if it were my sister I would tell her to do X procedure.” I know well meaning nurses whom call all their patients sweetie, because that is how they address family and they want to treat their patients like family. Empathy for our patients, care, and recommendations based on how we would like to be treated seems to be the ethical and correct behavior. It is not the right thing to do. To assume that we know what a person should choose or how they would like to be addressed is presumptuous at best and patriarchal at worst.
We should leave the Golden Rule concept in the past.
The Golden Rule, although a benevolent seeming concept, is fundamentally flawed. Not everyone wants to be treated the way that someone else thinks is right. This is concept is clearly evident in labor and delivery. Women that choose to pursue normal means of birth, such as waiting for spontaneous rupture of membranes, are commonly labeled as difficult. Women that decline an epidural or pain medications are often met with impatience and pressure to not suffer through the pain. Mothers that wish to give birth vaginally, after one cesarean birth, are discouraged, badgered and bullied into submitting to a repeat surgery. All this is done by health care providers that believe that they are treating the patient according to the Golden Rule. Pain is bad, so healthcare providers want to take pain away from mothers. Vaginal birth after cesarean comes with risks and they would not choose to try it. By attempting to apply the Golden Rule in these ways, we are actually doing more harm.
We need to think about the Golden Rule in a new way. It does not mean that we do for our patients what we would like done for ourselves or our loved ones. We do not decide for a woman, what she should choose to do, based on what we would want our sister to choose. A truer interpretation of the Golden Rule is respect for our patient’s wishes, requests and declinations. Ultimately I would want my healthcare providers to respect how I want to be treated. That is how I take care of my patients. If they don’t want to know the details of every intervention, then I won’t tell them. I know that education is important, but some patients do not want to hear how a urinary catheter works. Many patients want to know every detail, and I accommodate their requests. Personally, I prefer unmedicated labor and feel that moms miss out on something amazing when they get an epidural. I do not treat my patients how I like to give birth. I support them with what they prefer, whether it is an epidural, unmediated birth or somewhere in between.
I feel comfortable sharing my opinions when asked. I give advice, but I never assume that I know what is the golden answer for each woman.
The old Golden Rule does not apply in health care. Patient autonomy, as a priority in our nursing care, should become the new Golden Rule.
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