autonomy

Question 1

what is autonomy *

Answer 1

being in control of your life
deciding the direction in which ones life should go
being free to make choices in ones life eg friends, career, relationships, money, children

Question 2

should someone’s parents decide if they study music or medicine *

Answer 2

no - the person is best placed to know what will make her happy
no - the student has the freedom to make choices and determine the mistakes they make
no - ability to make mistakes is a value

Question 3

what are the 2 values of autonomy *

Answer 3

instrumental value - I know what is best for me

intrinsic value - it is my life

Question 4

what is instrumental value *

Answer 4

we know what makes us tick
so are in the best position to make decisions of higher instrumental value
we can act in our best interest

Question 5

what is intrinsic value *

Answer 5

more important than instrumental
making meaningful choices is part of what it is to be human
how we exercise free will - without free will we don’t have moral responsibility
want to be true - even if everything falls apart you want to know the truth - making mistakes os important to flourishing as a person

Question 6

why is autonomy important in clinical practice *

Answer 6

people need to know the truth to make their own decisions
honesty respects the autonomy of the pt
honesty is important for instrumental value to allow people to make the right decision
and for intrinsic value - so they can be true to themselves

Question 7

why should you tell someone the truth if you know they are being cheated on *

Answer 7

CONSEQUENCES - stop them marrying the wrong person
VIRTUE - because that is what a loyal friend would do
DUTY - to tell truth
AUTONOMY - to respect this

Question 8

summarise health V wellbeing

Answer 8

there is more to well-being than medical well-being
best med interests are not the same as best interests
even if pts are wrong about their best interests - being able to choose what happens to their body is central to their autonomy eg if it is going to effect their way of life

Question 9

why is bodily autonomy important in healthcare *

Answer 9

most choices in healthcare have a direct impact on the individual’s body
got to recognise people are worried
what we do to people’s body is an invasion if we do it wrong
need to respect people as individuals

Question 10

how do we respect autonomy in practice *

Answer 10

it doesn’t mean handing over decision making to pt

it means respecting autonomous choices - not all choices are autonomous

Question 11

what are autonomous choices *

Answer 11

where people have a reasonable range of choices
adequate info 
clear explanation
no undue pressure or coercion 
non-judgemental
time
focus on goals not technical options

Question 12

other than value for the pt, what are the benefits of autonomy in medical care *

Answer 12

help drs to give better advice because autonomy means listening to pts so know what matters to pt
therefore inprove pt confidence and trust
therefore improved shared decision making
therefore improved adherence

Question 13

what are the limits to autonomy *

Answer 13

when autonomy is overruled to prevent harm to others

their own good, physical or moral, is not sufficient

Question 14

what is paternalism *

Answer 14

overriding or undermining an individual’s autonomy based on the belief that to do so is in their best interest
eg withholding bad news or playing down SE

Question 15

Does requiring a doctor to go against his/her own moral instinct constitute a sufficient harm to justify overriding a patient’s autonomy *

Answer 15

we shouldn’t withhold info from pts to stop them making bad decisions because we would be affected morally
we’re not there to live lives for people - have to support people in their decisions
perhaps our moral right or wrong is misguided anyway
better communication and a rich moral imagination might mean pt and dr understand each others agendas better

Question 16

what are reasons to justify paternalistic dishonesty *

Answer 16

technical info is difficult to put across - pts might not understand/put undue weight on rare complications
drs face uncertainty - life expectancy or outcome of treatment may be unpredictable
pt might not be able to handle info - might make them worse - what you don’t know cant hurt you

Question 17

why overall can we not justify paternalistic dishonesty *

Answer 17

CONSEQUENCES - people with serious illness suspect diagnosis so uncertainty causes anxiety, also pts might not trust dr if they feel they are hiding truth
DUTY DUE TO AUTONOMY - knowing their diagnosis is important for people to make life decisions eg finance, also most pts want to be told even if just because they want to know
VIRTUE - honesty is an essential virtue

Question 18

when are we bad at facilitating autonomy *

Answer 18

when very distressiong situations - pretend in pts best interest to not make them stressed, but actually we just need to learn to have these conversations better

Question 19

what is best interests

Answer 19

more than just medical interests

ie if detrimental to health, doesn’t necessarily mean detrimental to best interests

Question 20

are drs good at assessing pts best interests

Answer 20

no

Question 21

why do we place value on autonomy *

Answer 21

a competent individual is best placed to know what the right decision is for them

Question 22

how do best interests and autonomy relate *

Answer 22

people value being able to make their own decisions even if they are wrong
a key part of respecting people is allowing them to make their own decisions
therefore respecting people’s autonomy is fundamental to their best interests

Question 23

example of where autonomy is overruled *

Answer 23

smoking in the workplace because it causes harm to others

Question 24

what is maternalism *

Answer 24

soft paternalism
eg emphasising risks of not having treatment and playing down SE of treatment to persuade pt to have the treatment you think is in their best interests

Question 25

what is the problem with paternalism *

Answer 25

it is hard to know whether we even know a pts best interests better than them, and is it ever in someones best interest to restrict their autonomy
inappropriate biases are made on sex, race and socioeconomic status

Question 26

when might a dr be in a position to determine best interests *

Answer 26

when pt is refusing surgery out of fear but don’t really know what they are saying no to, and the dr has seen the operation many times and is confident it is in their best interests

Question 27

when can being paternalistic be respecting autoomy *

Answer 27

when pt wants yiu to be paternalistic

Question 28

how do you resolve conflict between what a pt thinks and a dr thinks *

Answer 28

good communication
you need to have intense discussions to understand the rationale of the pts choice and make sure they understand your view rather than completely leaving the decision to them
need to explore both pt and dr values
relationship centred
drs should label their biases rather than let them accidently slip out - this is enhanced autonomy
drs should use their power to guide pts not to control them - pts should have drs recommendations and the ability to accept or reject them
drs should investigate and ensure pts wants match with their context and story - otherwise just giving them the wrong treatment is arguably abandonment

Question 29

when might it be beneficial to be paternalistic *

Answer 29

when saying there will be no pain when youre about to inject a needle to stop the pt being scared

Question 30

what is the independent choice model

Answer 30

where the dr should giove the pt the facts but no opinions and only answer qns objectively
the problem is whether pts should be allowed to continue futile treatment
this model suggests that the independent choice is best made without any external guidance - the problem is that autonomous decisions are enhanced by the support of a dr

Question 31

how does the principle of autonomy help with people making decisions

Answer 31

the point of autonomy is to respect the patient as a person
it is not respectful to not give advice because you want to maintain neutrality. it is also not respectful to treat people with rigid protocols.

Question 32

moral considerations that make autonomy difficult

Answer 32

competence

availability of beds and resources