Balancing respect for autonomy/ best interests of adults Flashcards
What is the relationship between autonomy and capacity?
Capacity is a legal concept that describes something discrete and decision specific –> lacking capacity for one thing therefore does not mean lacking capacity across the board
Autonomy –> is an ethical concept describing a continuum, if someone lacks capacity for a specific decision this does not mean they totally lack autonomy. Autonomy should still be respected.
What is autonomy?
Autonomy = self governing
Freedom from bodily inviolability, constraint/ interference
- Self determination –> freedom to purse goals according to one’s desires, medicine tends to highlight this.
- Wish to be own master
- life and decisions depending on themselves, in charge of own future. self directed
Is autonomy always possible?
Is autonomy unanimous across all cultures?
Is it always a good thing?
- Idea that all our decisions currently depend on 1) who we are as a person, innate nature 2) previous experience. We have no control over this, therefore can we say we are autonomous?
- Not the case that autonomy is granted to all people, culturally specific. E.g. societies were women arent given autonomy
- Autonomy as a justification for selfish actions? Where autonomy is used as an excuse
What are the different concepts of autonomy?
- Principled/ moral autonomy
- having authority over your own actions, according to your own will and ability to reason or impose your own moral laws
- Relies on ability to reason, limited in medical situation.
- First and second order desires:
- first order –> to want something (craving cigarette)
- second order –> to want to want something (smoker wanting to quit)
- Both are in conflict, second order desire represents real will, first order represents less significant desire.
- Relational autonomy (allows for more degrees of autonomy)
- embeds agency (capacity to act) and autonomy (self rule) within social context
- rejects overly idealised aspects of autonomy
What counts as an autonomous choice?
- Anything a person chooses to do if they are deemed competent and there is no coercion
- Have decent information to make the decision
What is the legal stance on autonomy?
- Treatment w/out consent = battery (common law)
- Do what you can to facilitate autonomy, by facilitating capacity (if lacking, e.g. pain relief, finding better routes of communication).
- Person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
- Need to provide sufficient information for that person to make the decision - standard of care for provision of info (if not done this is negligent).
What are the 3 main factors in duty of care?
- To respect autonomy
- to act in a patients best interests
- to protect a patient from harm
What actions can be taken to ensure duty of care?
- Treat patients as individuals and respect their dignity.
- Listen to, and respond to, their concerns and preferences.
- Give patients the information they want or need in a way they can understand.
- Respect patients’ right to reach decisions with you about their treatment and care.
- Support patients in caring for themselves to improve and maintain their health.
What does respecting autonomy and duty of care mean for you as a Dr?
- If an adult has capacity their autonomous decision must be respected
- This is the case even if this results in harm to that person - e.g. refusal of life sustaining treatment
- If a person lacks capacity, a doctor must treat them according to the principle of best interests and must protect them from harm
If an adult patient refuses treatment thought to be in their best interests what might you consider?
- Do they have capacity?
- understand, retain, weigh up and make decision, communicate that decision
- Is their decision fully informed?
- Are they under coercion?
- To what extent can you detain or restrain them to treat in their best interests?
What are different conceptions of best interests?
- Mental state of happiness –> what brings the most happiness for this person
- Desire fufilment –> best interests tied to the person’s autonomous choices
- Objective list –> set of agreed criteria for achieving wellbeing e.g. independence, ability to have meaningful relationships, knowledge
What is the definition of best interests in the MCA (2005)?
- Person making decision in best interests must consider:
- past and present wishes and feelings -> in particular any relevant written statement made when they had capacity
- beliefs and value that would be likely to influence their decision if they had capacity
- other factors that would be considered if they were able
What do we need to consider before restaining someone for a treatment?
- The harm that will occur to the person if you do not restrain and treat them
- The harm of restraining them (physical and psychological)
- the minimus level of restraint required
- the proportionality of the restraint to the benefit of the treatment
What does restraint and treating in best interests conflict with?
Direct conflict with respecting the persons autonomy and duty to protect them from harm
What are the legal frameworks for restraint and deprivation of liberty?
- Restraint in the short term under the MCA
- Restraint or detaining a person so they are not at liberty to leave is under the Deprivation of Liberty Safeguards (DOLS) , formal process at organisational level with independent oversight
