Autonomy, Consent And The Patient's Best Interests

Question 1

What is the basis of Autonomy

Answer 1

An individual has the right to determine their own actions
Respect for autonomy accepts that individuals have their own values and preferences
In clinical practice; patient centred care and patient’s choice

Question 2

What are the requirements for Autonomy

Answer 2

1. The capacity to think freely and independently. Having a following your own beliefs and making moral assessments
2. The capacity to decide to do things freely and independently- which involves having the capacity to make and follow through on a decision being made.
3. Having the ability to act freely- being able to physically carry out the actions which we decide we want to follow

Question 3

What are the problems achieving autonomy?

Answer 3

People and things can interfere with our ability to think, decide what we believe, what we want to do etc etc.

Question 4

Examples of challenges to patient’s autonomy

Answer 4

Psychological problems 
Poor information 
Lack of understanding from healthcare staff
Paternalism 
Social/institutional rules

Question 5

What is informed consent?

Answer 5

A voluntary, un-coerced decision made by a sufficiently competent or autonomous person on the bases of adequate information

It is a legal requirement

Question 6

What is capacity

Answer 6

Someone must be able to understand and retain pertinent information
They must be able to assess this information in terms of benefits and risks to themselves
Capacity to consent does not imply always making the “right” decision

Question 7

What is Voluntariness?

Answer 7

The person must be free to choose without pressure from healthcare staff, family or friends

Good practice might necessitate talking to the patient themselves

Question 8

What does it mean for information to be sufficient information?

Answer 8

Clearly presented
Describe what the process will involve
Explain why it is necessary
Outline the risks of the intervention
Identify the benefits of the treatment
Indicate any alternatives

Question 9

If a competent patient makes it clear that they do not wish to receive treatment which is, objectively, in their medical best interests what should the doctor do?

Answer 9

It is unlawful for the doctor to administer that treatment due to a persons autonomy to the right of self-determination.

(A patient has the right to refuse treatment but there is no automatic right to receive a particular treatment just because the patient demands it)