AUTONOMY

Autonomy
Means – Right or condition of self-government
Two aspects

Moral Autonomy is the philosophy which is self-governing or self-determining, i.e.,

acting independently without the influence or distortion of others. The moral
autonomy relates to the individual ideas whether right or wrong conduct which is
independent of ethical issues.

Psychological Autonomy is the competency to make one’s own decisions and the ability
to reason and act rationally.
Autonomous persons have the capacity to guide their lives according to their own
desires, beliefs, and intentions. Infants and persons with advanced Alzheimer’s disease
lack autonomy in this sense.
Medical Paternalism
Medical paternalism is a set of attitudes and practices in medicine in which a physician
determines that a patient's wishes or choices should not be honored.
2 examples of weak paternalism
2 examples of strong paternalism
CONSENT
Informed Consent
Health professionals must respect the informed consent (and refusal) of their patients
concerning a course of therapy.
The principle of consent is an important part of medical ethics and international human
rights law.
Informed consent is an ongoing process and not something that is finalized with a
signature on an intake form.
At every treatment point in time, the patient has a right to know and a right to refuse.
How consent is given
Consent can be given:

verbally – a person saying they’re for the therapy

in writing – signing a consent form for surgery
Someone could also give non-verbal consent, as long as they understand the treatment
or examination about to take place –holding out an arm for a blood test.
Consent
For patients to give informed consent, three conditions must be met:
Information
Voluntariness
competence.
Information
Relevant Information
The first condition for informed consent is that patients be given relevant information
concerning their condition and treatment options in a manner they can understand so
that they can make an informed decision.
“Relevant information” includes facts about what is involved in the proposed therapy
and alternative therapies, risks and benefits of the proposed therapy and of alternative
therapies, financial costs, and whatever additional information the patient requests
concerning therapy.
Giving information only on the treatment option preferred by the therapist does not
meet the standard for informed consent.
In a practical sense, patients cannot be given all information concerning medical
procedures, nor could most understand that information anyway (without a relevant
health-care degree).
Which information is relevant?
How an information is given?
What if patients state that they do
not want certain information,
or perhaps any information, about
their medical condition?
What if the patient don’t want
Information
Voluntariness
Voluntariness
Second condition for informed consent, means that patients must be free to make
decisions without being coerced (forced or threats) or otherwise manipulated.
Forcing therapy on patients against their explicit desires is the most flagrant violation
of this condition.
Deception
Deception is intentionally misleading a person,
By lying (intentionally stating a falsehood designed to create a false belief)
Withholding important information
Exaggerating
Understating
Using pretense. ( an attempt to make something that is not the case appear true )
Deception typically violates both the information and voluntariness conditions, and to
that extent those conditions can be viewed as overlapping.
Competence
Competence
Third condition for informed consent, means that patients must be sufficiently rational
or competent to understand and make health-care decisions.
Competent, autonomous adults can authorize someone to make decisions for them in
the event they become incompetent to make their own decisions.
Legal Competency
Although the psychological capacities and abilities that define autonomy come in many
different quantities, a person must attain some threshold of substantial decision-
making capacity to be allowed to make health-care decisions.
Standards for Determining Competency
There are three primary legal standards by which guardians might be asked by the
government to render decisions on behalf of the patient.
The first is the pure autonomy standard, and it relies on prior written or verbal
statements made by the person to friends, providers, or family.
Under the second standard, guardians may be asked to render a substituted judgment
for the patient. In this case, they use their knowledge of the patient and the patient’s
history of decision making to imagine what the patient would want under the
circumstances. Of course, this requires that guardians have an intimate knowledge of
the patient.
Under the third standard, guardians base their decisions on what they think is in the
best interest of the patient. In theory, the best interest standard can produce very
different decisions from what the patient might actually have chosen to do.
That’s all for today
Thank you