When facing ethical dilemmas doctors should consider the patients autonomy. Alongside beneficence, justice and non-maleficence; autonomy is one of the 4 pillars of ethics.
Respect for autonomy means to respect the ability of a patient to make their own decisions, this means patients have the ability to “self-rule” and make decisions about their lives. When patients practice their autonomy, they are remaining involved in their healthcare. When patients engage in their healthcare there is increased patient satisfaction and better clinical outcomes.
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Autonomy is a relatively new principle and idea in medicine. In the past therapeutic relationships between doctors and patients were based upon paternalism. Paternalism is practiced when decisions are taken by the doctor only, reducing patient engagement in the decision-making process. Modern practice has adapted to ensure that the wants, needs and requirements of patients are respected. Decision making is now a collaborative process between the doctor and patient. An autonomous patient can request or refuse treatments and investigations. However, patients cannot demand a treatment and doctors must ensure that even when promoting autonomy their practice aligns with guidelines set out by the GMC and governing bodies such as NICE.
Many MMI stations involve talking to others in vulnerable positions in a role of responsibility or as a friend. You may have to discuss how to approach someone who has done something unethical. Good answers show an awareness of how you can give the individual autonomy by asking them how they would like to proceed with the issue and facilitating them to put their choices into action.
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We can show respect for a patient’s autonomy by gaining consent. This is fundamental to good medical practice and allowing patients to be autonomous. Patients must consent to any form of medical treatment, test or examination. This may be verbal or in writing. In order for individuals to make autonomous decisions they must provide consent based on a validity criteria. Valid consent must be voluntary, informed and the person consenting must have capacity.
If doctors fail to respect their patients’ autonomy, and harm is caused where consent isn’t provided, there can be serious detriment. Legally doctors who fail to provide all the necessary information to a patient can be charged for negligence. It is deemed more serious where harm is done to the patient where consent gained.
The principle of respect for autonomy underpins the requirement that doctors keep patient information confidential. Patients should have control over information about themselves. It is a privilege as a doctor to be trusted with your patient’s private information, and maintaining confidence is an intrinsic part of the process of developing trustful doctor-patient relationships. Doctors and medical students must ensure they are confident with what information they can and cannot share with family and other parties involved in the patient’s treatment.
