Is Patient Autonomy the Central Value in Making Medical Decisions? The introduction of patient autonomy was a progressive and beneficial improvement to the operation of the health care field. The concept of patient autonomy was designed to protect patients from making decisions that would harm them. This concept ensures that patients are not forced by medical professionals to make life altering decisions. This clause also protects healthcare professionals from mal practice if their recommended health care plan does not go as planned. Patient autonomy should be considered as the central value in medical decision making as it introduces and enforces the concepts pf competency, shared decision making, and patient compliancy with healthy lifestyle recommendations. While discussing patient autonomy in making decisions, it is important to discuss the concept of competency. While competency is typically associated with the patients, it also refers to the physicians. Competency establishes that the patient and healthcare provider are making rational decisions when accepting and creating healthcare plans. Many different factors establish whether or not a patient is competent enough to make possible life altering decisions. For instance, children, mentally ill patients, and comatose patients are not competent to make medical decisions. This is because these patients are more likely to make rash decisions, are unable to process fatal diagnoses, or are simply unable to speak. While
In his article “Whose Body Is It, Anyway?”—appearing in the New Yorker in October 1994—Dr. Atul Gawande highlights the complexities of the doctor-patient relationship vis-à-vis patient autonomy and decision-making. Dr. Gawande explains that a respect for patient autonomy (i.e., allowing patients to choose between courses of treatment, therefore directly influencing their health outcome) is the “new normal” for medical practitioners. However, Gawande also contends that there are times when patients are better served by a voluntary relinquishment of that autonomy.
Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed
Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s
The new rules allow patients to participate with all aspect of their healthcare decisions. It focuses on patient’s involvement, decisions, continuous healing and patient control. The new rules are design to meet the patient’s needs. Throughout the years, physicians had more of a paternalistic view with competent patient’s healthcare choices. Even though, the physicians optimal goals is to practice non-maleficence and beneficence care, their knowledge regarding patient’s illness and care paternalistically diminish patient’s autonomy and involvement. The new rules reinforce those principles; it changes patient’s involvement, choices and preferences. It increases transparency, predict patient’s needs, continuity of care among physicians, institute evidence-based decisions and health records access.
You probably don’t know this about me, but I used to be an eagle scout. And in order to be an eagle scout, you have to do things like go camping. And over the summer, my troop would like to travel about six hours north of Milwaukee to a place called Camp Lefeber, where we would camp in the wilderness for several days. About ten to twenty other scout troops from around Wisconsin would meet us there, and there were no cabins at the camp grounds. Instead, we slept in tents. My first year at camp, my friend, Matthew, and I had just the minimum age requirement to go: twelve years old. And, being the good friends that we are, we decided to share a tent for the time we were at camp. It’s not weird. We were in the wilderness. We shared for survival.
Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.
The Doctor and Patient relationship aspect of Medicine has changed drastically in the last twenty years. It has evolved from paternalism (the doctor makes the decision for the patient) to shared decision making where the patient is considered an equal partner in his/her own health related decisions. Informed consent is the cornerstone for this view. When a patient or a research subject makes an autonomous decision after understanding, the risks and benefits involved with the decision is Informed consent. Complete Informed consent covers the following components: competency, disclosure, comprehension and voluntary. Competency refers to the requirement for the individual to be of legal age and be mentally competent to understand the process.
To begin with the person is the centre of the plan, to be consulted with and their views must always come first: It should include all aspects of their care, and every professional should work together to provide it. (Leathard 2000) Autonomy refers to an individuals’ ability to come to his or her own decisions and requires nurses to respect the choices patients make concerning their own lives (Hendrick 2000).However Gillon Argues that the principle respect for autonomy may need some restriction, otherwise we may be morally obliged to respect an autonomous course of action with unthinkable consequences.( Gillon 1986) Every human being has an intrinsic value, they all have a right to well being, to self-fulfilment and to as much control over their own lives as is consistent with others (British Association of Social Workers 2002).Professional Judgement and patient preference cannot be suspended if practice is to be safe and effective rather than routine(DOH 2005) Alex had to attend this session as it was within his Timetable, how could it have been effective?, he was unhappy and
There are times that self-determination has opposition with the values and beliefs of health care providers. The five step ethical decision making model is in place for patients that are unable to make their own health care decisions due to incompetency; paternalism is not the method used anymore. “In relation to health care, paternalism manifests itself in the making of decisions on behalf of patients without their full consent or knowledge. (Burkhardt & Nathaniel, 2008). Value systems, which includes a patients and family morals, play a factor in ethical decision making.
Before we can fully examine how informed consent, patient autonomy and beneficence promote the most good for the patient, we must first define what each of
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I believe that patients have the right to decide what they intend to do for their future health care. Patients are not just people we give a bed to so they can die. They have plans that they intend to have laid out for themselves. As healthcare professionals, we must respect the patient’s
The Posters that were used during World War II targeted women, Mechanics, and Hard working men. They targeted different types of people in order to get these people join and fight for America. By targeting these people it helped because these people to join in the fight. It targeting men who worked in factories, women who were nurses and doctors, and young mechanics who knew the inside and outside of cars. Because they targeted a specific audience it caused many more people to join the air force, army, and the air force. This was a way for the government to get more troops and more doctors.
Nursing is an all encompassing profession in which practitioners are not only proficient in technical medical functionality, they also have the obligation to remain compassionate and respectful of patients and as such are expected to adhere to pre established codes of ethics. Of these ethics, autonomy is of extreme importance as it offers patients a sense of personal authority during a time where they may feel as if their lives, or at the very least their health, is no longer under their control. Autonomy in the context of nursing allocates the patient and often their family with the final word on the course of treatment. The concept of patient autonomy is a highly variable subject in all fields of health care. It is a universal concept that varies widely in its meaning and interpretation. Autonomy in its simplest form can be defined as a state of independence or self governing (Atkins, 2006). Patient autonomy can also be defined as the ability to make once own decisions, based on one’s sound judgment. It is defined by the American Nurses Association (ANA, 2011) as the "agreement to respect another 's right to self determine a course of action; support of independent decision making." This seemingly straight forward ethical concept is rife with difficulties when one considers potential disagreements that may arise even when informed consent is provided, particularly among children or vulnerable people. Relevant research and
Autonomy applies to the profession of nursing because the patient should always be allowed to make decisions regarding their care while being treated with respect and dignity; however, autonomy can serve as a limiting agent when the patient decides to refuse care that would be of benefit to them. Autonomy is a sensitive issue because it allows the patient to choose to die and all health care can do from that point is allow the patient to do so comfortably. With healthcare always being one step ahead, it allows a surrogate to serve as a voice piece for that patient when they are unable to make decisions. However, that surrogate can end up making decisions they think is best for the patient ignoring the patients’ will. The responsibility of the nurse and interdisciplinary team is to inform and educate the patient and patient’s surrogate on all aspects of care to include medical diagnosis, treatment, and care plan so that the patient and