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autonomy

- delivery of care based upon the patient's values & preferences, i.e. respecting a patient's right to determine his/her destiny & pursuit of his/her beliefs & happiness - it implies that the patient is capable of making reasonable decisions, including the right to refuse therapy (even at the risk of death). (see competence) - advance directives are widely believed to be a safeguard the autonomy of patients who lose decision-making capacity. [6] *From the Greek for 'self rule' - 0ne exception to the rule of autonomy is emergency treatment. - if emergency treatment for a critically ill & incapacitated patient is likely to produce substantial benefit & if delaying treatment is likely to lead to irreversible harm, emergency treatment without consent is widely accepted - however, this exception is limited when the patient has previously expressed a desire not to undergo the proposed medical intervention - a do not resuscitate (DNR) order is acceptable when the patient has clearly stated in advance this desire - a 2nd major exception to the rule of autonomy is called 'therapeutic privilage'. - in this case, a physician or the patient's family may believe that fully informing a patient about his/her medical condition may do more harm than good - some patients may prefer not to know if they are terminally ill & ask that family members or other caregivers receive all diagnostic information & make treatment decisions - this practice is not widely accepted in the United States, but is widely accepted in most other cultures Management: - ask the patient about their preference for disclosure & participation in medicial decisions (preferable as a part of advance directives) - if the family requests a patient should not be informed of a serious or terminal diagnosis, ask the family their reason for withholding the diagnosis [5]

Related

advance directives competence do not resuscitate (DNR); do not attempt rescuscitation (DNAR)

General

medical ethics

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 582
  2. Kapp M & Finucane T. Decision Making, In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 589
  3. Krakauer EL, Billings JA. On patient autonomy and physician responsibility in end-of-life care. Arch Intern Med 2011; 171(9):849-853 PMID: 21555664 - Goldberg GR, Meier DE. A swinging pendulum: Comment on "On Patient Autonomy and Physician Responsibility in End-of-Life Care". Arch Intern Med 2011; 171(9):854. PMID: 21555665
  4. Sudore RL, Fried TR. Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Ann Intern Med 2010; 153(4):256-261. PMID: 20713793
  5. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Vogelstein E Autonomy and the Moral Authority of Advance Directives. J Med Philos. 2016 Oct;41(5):500-20 PMID: 27465774