A. Write an essay describing what you think autonomy means in the context of health care.

Give three
examples of times autonomy might be a significant issue facing a patient or medical provider.

To respect a patient's autonomy is one of the foundations of medical ethics. It recognizes an adult
patient's competence in making decisions with regards to his or her medical treatment. In medical
practice, autonomy expresses the right to make informed decisions about a patient's medical concerns.
The principle holds the obligation to seek the patient's consent or informed consent before any
investigation or treatment occurs. In his judgment on a famous case concerning an adult refusal of
treatment, Lord Donaldson of Lymington made the following observations, and he stated, "An adult
patient who suffers from no mental incapacity has an absolute right to choose whether to consent to
medical treatment. This right of choice is not limited to decisions that others might regard as sensible. It
exists notwithstanding that the reasons for making a choice are rational, irrational, unknown, or even non-
existent." Generally, for a decision to be regarded as autonomous, there are two conditions required. First,
the individual must have the appropriate bodily capacities for self-government and be free from external
constraints. Secondly, if the individual can make relevant decisions, have sufficient knowledge to decide,
and voluntarily does the procedure, a decision is autonomous in a medical setting. If adults cannot make
decisions, the health care provider will be in overall charge of their care or appoint someone to make
decisions on their behalf. It rarely happens in our country because their family, friends, or relative mostly
accompany patients. In the case of incapacitated patients, law regulation is essential in making decisions,
and further information is given later in the toolkit. Communication is essential to maintain autonomy
between the patient and the health care provider. The medical practitioner should make the patient
comfortable with the kind of attention it needs as it is one way to implement autonomy. There will always
be blips along the way. The patient or an individual responsible should understand the implementation of
treatment as it reflects responsibility towards one's health. It also exercises comfort with the right to get
the right answers so that the health care provider meets both needs. How the treating relationship works is
an essential part of the treatment. Everything is enhanced if it works, but one's health care will suffer if
autonomy is not respected.

Reference:
Dworkin, G. (n.d.). Autonomy or self-determination as a medical student - Ethics toolkit for medical
students - BMA. Retrieved from https://www.bma.org.uk/advice-and-support/ethics/medical-
students/ethics-toolkit-for-medical-students/autonomy-or-self-determination#:%7E:text=What
%20do%20we%20mean%20by,investigation%20or%20treatment%20takes%20place.
B. How would you define the limits of a person’s autonomy in health care? For instance, can you identify
times when a person does not actually have the capacity to make his or her own medical decisions, and
how do you think these situations ought to be ethically handed?

There are certain circumstances where autonomy is lacking. For example, the adult's decision is
in opposition to the proposed treatment, except for compulsory treatment under mental health legislation.
The decisions will now depend on why the conditions are lacking. If someone forces someone into
making a decision, it cannot be theirs and should not be respected. In reality, coercion is not always easy
to detect. If a doctor had concerns about coercion, good practice would involve spending some time alone
with the patient to confirm that the decision is genuinely hers. If the patient cannot decide independently,
a decision on their behalf will still follow necessarily. Let us take the young children, for example, as
most of the decisions regarding their health are made by the parents or an adult assisting them. For adults
who cannot make decisions, they could appoint someone to decide on their behalf, or in some cases, it is
the health care provider who decides. For incapacitated patients, a family member or relative is necessary
to make a decision. Ethically, the physicians want most of their patient's understanding of their
conditions, be educated on wellness goals, and be active participants in their healthcare. For years,
physicians study to become doctors and bring their scientific knowledge and clinical intelligence to the
office and the bedside. However, it gets tricky because patients may not have those skills, but they know
their bodies, tolerance for treatment, and their way of comfortably receiving care.

References:

Dworkin, G. (n.d.). Autonomy or self-determination as a medical student - Ethics toolkit for medical
students - BMA. Retrieved from https://www.bma.org.uk/advice-and-support/ethics/medical-
students/ethics-toolkit-for-medical-students/autonomy-or-self-determination#:%7E:text=What
%20do%20we%20mean%20by,investigation%20or%20treatment%20takes%20place.

Bernstein, C. A. (2018, May 6). Take control of your health care (exert your patient autonomy). Retrieved
from https://www.health.harvard.edu/blog/take-control-of-your-health-care-exert-your-patient-
autonomy-2018050713784