Medical Ethics: Autonomy

In medicine, autonomy is the right of ‘competent’ adults to make informed choices about their treatment.

A good example of autonomy in medicine is when patients exert their right to refuse what might be deemed to be life-enhancing or life-lengthening treatments.

For example, a patient who has terminal cancer, but is finding his or her treatment to be painful or overly intrusive, might decide to refuse further treatment. It is this patient’s autonomous right to decide to have what they believe to be a better quality of life, even if it means they will not live as long, rather than having a longer life, blighted by what they have deemed, for example, to be the unacceptable side effects of chemotherapy.

The law and autonomy

• The law in the majority of countries states that any adult person who is of sound mind has the right to choose whether they receive medical treatment or not.
• They are deemed to be competent to consent to their treatment.
• They are also deemed to be competent to refuse any treatment offered, even if that choice may not seem to be rational or sensible to other people.

There are two prerequisites for autonomy

• The first prerequisite is the ability to make relevant decisions within the context of being given sufficient information. This requires the patient to have ‘capacity’ or ‘competency’. Having capacity or competency means that, given the required information, the patient has the mental capability of weighing up the pros and cons of a treatment in order to reach a reasoned decision.
• As well as having the necessary mental capacity, the person must be free from external constraint, including coercion.

Conditions where autonomy is lacking
Adult patients are generally assumed to have autonomy.

• In certain circumstances, however, autonomous rights can be removed, and treatment can be enforced against the will of the patient. Under Mental Health legislation, for example, patients whose minds are deemed to be unbalanced can be ‘sectioned’, with their care passed to others – often the courts – who assume responsibility for their medical needs until they are deemed mentally fit to make their own care decisions once again.
• If a health professional feels that a patient is being coerced into a treatment or procedure, then they must attempt to find out whether the decision is genuinely that of the patient. This can be encountered in procedures such as termination of pregnancy. It is also one of the reasons that is presented and argued very strongly by those who oppose assisted suicide – the fact that elderly and infirm people may be pressured into ending their lives by family members, or by society more generally.