Take special care when treating patients with special needs

How should a doctor of optometry treat patients with special needs when they may be unable to give subjective responses to questions about their own health, or when their physical and mental disabilities may present challenges in their treatment?

Extra care is often called for due to multiple chronic, systemic, eye and visual conditions, says the author of a new AOA case study.

"As the global population grows and becomes more diverse, our understanding of disability is enhanced both by new social and medical models," says Thomas Wong, O.D., director of new technologies and clinical externships at State University of New York College of Optometry and past member of the AOA Ethics and Values Committee.

"Critical thinking processes and the understanding of modern bioethical principles are both essential to the proper optometric care of this patient population," Dr. Wong adds. "Moreover, case studies for complex, disabled patients represent new paradigms for the ethical care of all patients."

In this case study on the AOA Ethics Forum, Dr. Wong talks specifics. The forum provides an opportunity to review and discuss anonymously a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based on the AOA Standards of Professional Conduct and Code of Ethics.

Aside from drawing from their education, experience and expertise, doctors of optometry must keep in mind certain ethical principles, Dr. Wong says. Among the principles in the Standards of Professional Conduct:

• Respect for patient autonomy (self-determination): "The optometrist has the duty to involve the patient in care and treatment decisions in a meaningful way, with due consideration of the patient's needs, desires, abilities and understanding, while safeguarding the patient's privacy."
• Beneficence (do good): "The optometrist has the duty to proactively serve the needs of the patient and the public at large regarding eye, vision and general health."
• Non-maleficence (do not harm): "The optometrist has the duty to avoid acts of omission or commission that would harm the patient."

Dr. Wong also makes special note of the passage of a new amendment to the Optometric Oath by the House of Delegates at AOA's 2017 Optometry's Meeting^® in Washington, D.C. The top pledge of the oath now reads, "I AFFIRM that the health of my patient will be my first consideration." When examining patients who are disabled, have limited autonomy and competence to make decisions, doctors should keep this statement front of mind, Dr. Wong says.