From the Guidelines
Autonomy in medical ethics refers to the principle that individuals have the right to make their own informed decisions about their healthcare, as emphasized in the most recent and highest quality study by the American Thoracic Society and American Geriatrics Society in 2020 1. This principle recognizes that patients should have control over what happens to their bodies and should be able to accept or refuse treatments based on their personal values and preferences. Respecting autonomy requires healthcare providers to obtain informed consent before procedures, which means patients must receive adequate information about their condition, treatment options, risks, benefits, and alternatives. Some key points about autonomy include:
- Patients have the right to make informed decisions about their healthcare
- Healthcare providers should obtain informed consent before procedures
- Patients have the right to privacy and confidentiality regarding their medical information
- Autonomy is balanced against other ethical principles like beneficence, non-maleficence, and justice In practice, respecting autonomy means healthcare providers should act as advisors rather than decision-makers, supporting patients to make choices aligned with their own goals and values, even when these choices might differ from what providers would recommend, as highlighted in the American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care in 2015 1. Additionally, the principle of autonomy is also supported by other studies, such as the Association of Anaesthetists of Great Britain and Ireland's guidelines on consent for anaesthesia in 2017 1, and the American College of Physicians' position paper on ethics and the legalization of physician-assisted suicide in 2017 1. However, the most recent and highest quality study by the American Thoracic Society and American Geriatrics Society in 2020 1 provides the most up-to-date guidance on this topic.
From the Research
Definition of Autonomy in Medical Ethics
The principle of autonomy in medical ethics refers to the patient's right to make their own decisions about their healthcare, free from coercion or undue influence [(2,3,4,5,6)]. This principle is based on the idea that patients have the right to self-determination and should be able to make informed decisions about their own care.
Key Elements of Autonomy
Some of the key elements of autonomy in medical ethics include:
- The right to informed consent [(2,5)]
- The right to refuse or accept treatment [(2,4,5)]
- The right to make decisions about one's own healthcare [(3,4,6)]
- The importance of clinician-patient relationships in supporting autonomy 2
- The need to consider the patient's values, preferences, and goals in decision-making [(4,6)]
Challenges to Autonomy
There are several challenges to autonomy in medical ethics, including:
- Limited ability for self-determination due to illness or disability [(5,6)]
- Coercion or undue influence from healthcare professionals, family members, or society [(5,6)]
- Lack of access to information or resources necessary for informed decision-making [(3,6)]
- Conflicts between patient autonomy and other ethical principles, such as beneficence or non-maleficence [(4,5)]
Relational Understandings of Autonomy
Relational understandings of autonomy emphasize the importance of social relationships and interactions in supporting or undermining patient autonomy [(2,3,6)]. This perspective recognizes that autonomy is not solely an individual concept, but is influenced by the patient's relationships with healthcare professionals, family members, and others.