Autonomy, Term Paper Example

Introduction

The concept of autonomy in psychotherapy implies the respect for the patient’s right to be self-governing. The concept lays emphasis on the commitment of the patient to participate in the process, especially on a voluntary basis (Barbara, 2007). This principle of autonomy opposes the manipulation of the patient against their will. This in essence implies that the patient has the liberty to refuse the therapy altogether. A therapist in accordance to the concept of autonomy cannot compel an individual to undergo therapy. The principle of not causing harm to others justifies the case for autonomy. It justifies that an individual can exercise autonomy provided this does not result in injury to others. This, therefore, projects to a patient refusing therapy and the therapist not intervening against the patient’s wishes.

Nevertheless, the principle of beneficence dictates that the therapist must act in the best concern of the individual based on the expert assessment of the therapist. Beneficence is a decisive factor especially in dealing with patients whose capacity or autonomy is not clear. Beneficence assists the therapist in deciding the competence and autonomy. Lack of understanding, extreme distress, or serious disturbance may result in the lack of capacity of a patient to make competent decisions and requires beneficence. There is a duty on the part of the psychologist to employ beneficence in providing therapy or assessing the competence of a patient’s decision.

Reasons for refusing therapy

It is an inherent right of every patient to make decisions regarding treatment. This right to decisions to treatment dictates whether to accord the patient with the treatment. In this regard, the therapist should respect the right of a patient to skip, a therapy session. Laura & Catherine (2005) provides that these patients have decision-making capacities thus their decisions are correct and; therefore, the therapist should respect the same regardless of the implications of skipping the therapy. The right to self-determination is an autonomous right and should be respected. The patient’s decision to undergo or refuse treatment or intervention is a mere exercise of self-determination, and as such must be respected.

The legal position on the issue of refusal of therapy is also clear. It indicates that the practitioner should respect where the patient has the capacity to decide on the treatment the patient’s decision. In striving to put the legal position in context, McDougall J in Hunter & New England Area Health Service v. A [2009] NSW SC 761 provided that, in order to understand the interests of the society relating to life clearly, it becomes essential to put into consideration the attributes of life. Accordingly, the right of autonomy and self-determination play an essential part in a free and democratic society. McDougall J goes ahead to point out that in consideration to the patients’ capacity to make decisions the wishes of the patient must be respected. Similarly, Martin CJ in Brightwater Care Group (Inc) v. Rossiter [2009] WASC229 agrees and notes that the common law assumption is that, the individual posesses the right to decide what ought to be done to her or his body. In this regard, therefore, it is eminent that the autonomy of the patient prevails over other factors provided the patient posses the ability to make a free and well-versed decision.

Furthermore, putting into consideration the fact that a successful therapy session is dependent on both the therapist and the patient the wishes of the individual play a central role in the success of the therapy. Where a patient shows disinterest in therapy it would be fruitless to undertake the therapy as the patient’s attitude is negative towards the intervention (Barbara 2007). Patient participation is vital to a successful therapy and, therefore, where a patient does not acknowledge the therapy process as a means of intervention the patient’s participation will negatively affect the outcome of the therapy. The therapist, patient relationship is majorly a partnership in the healing process, and as such, the choice to participate determines the outcome. In this case, therefore, the therapists have a fiduciary relationship with the patient and, therefore, must observe ethical obligations and above all put into consideration the patient’s best interest.

Additionally the therapy may not be necessary in the current circumstances. The essence of therapy and in this case, post trauma psychotherapy, is to help the individual overcome the fears caused by the traumatic event and develop an optimistic approach towards life. If the trauma event did not compromise the individual’s perception or state of mind then, the therapy is not necessary. In some circumstances, the individual has developed a means of overcoming the trauma either through previous therapy or self-control and therapy does not facilitate anything but a mere waste of time. The individuals also perceive therapy offered to them a process and does not serve the intended purpose but only a necessary process. These individuals undergo therapy because of coercion by the by the rules, and the choice of therapy is not their free will because of restricted choices.

Furthermore, the therapy sessions are a requirement in such circumstances to assess the effect of the traumatic event and accordingly provide therapy where necessary. The essence of therapy in such circumstances is to establish the posttraumatic state of mental health of the individual, and whether therapy is necessary or not. This, therefore, implies that not all the individuals who come to the therapist require actual therapy. In essence, the therapist is able to do the paperwork without the actual therapy where the therapist acknowledges that therapy is not necessary.

Reasons against refusing therapy

The right to refuse therapy is not unconditional and in occasions where the conditions are such that the interest in therapy preserves life, maintains ethical integrity or aimed at protecting innocent third parties, the right is limited. Where individuals do not have the competent capacity to make decisions regarding treatment or use of interventions, it would not be correct or ethical for therapists do the paper work without actual therapy. The capacity of the individual that is his or her mental capacity to make rational decisions might be lacking. In such a case, the therapist is ethically bound to refuse to do the paperwork without the therapy. Where the therapist is certain that the individual lacks the capacity the therapist should ensure that the individual gets actual therapy. John & Catherine (2006) articulate that the legal position in the capacity of the individual to make informed choices provides that the decision must be contemporaneous and informed. An important factor to put into consideration in this case is the aspect of mandated therapy for these individuals, the right of choice of therapy by these individuals faces restrictions by rules, and; therefore, they cannot refuse therapy. This implies that these individuals have no choice to make concerning the therapy and must do it because the law mandates it. Although mandated therapy shows little success, it is noteworthy that the same helps other individuals initially against the previous beliefs. The perception of many individuals on the concept of therapy is a negative one and result in a waste of time. Despite of this perspective therapy eventually turns out to be helpful of many of individual’s overcome posttraumatic stress disorders.

Lisa (2012) on the other hand provides that it is beneficial to put into consideration the interests of third parties and in essence the individuals who encounter the affected individual. Where the failure to conduct therapy will ultimately result in the harm or risk to third parties the therapist is under moral and ethical obligation to accord the individual therapy. The interests of third parties play a vital role in that, with the individual’s decision to take treatment or intervention notwithstanding, the same cannot be exercised to the detriment of third parties. In this case, the obligation to protect an innocent third party from harm overrides the duty to accept the patient’s refusal of therapy. In essence, where there is a third party at risk due to lack of therapy, then skipping the therapy and only doing the paperwork cannot be justified. The interests of the public override personal decisions despite the competence of the decisions. If the lack of therapy will potentially affect the emotions or finances of individuals associated with the patient or the public, then therapy must be conducted.

According to Jennifer &, Anne (2007) another factor to put into consideration in opting for therapy is maintaining the ethical integrity of the institution. As much as the patient has the autonomy of deciding whether to participate in the therapy in essence, the needs of the patients must not tarnish therapy or not the ethical integrity. The professional ethics of the profession should guide the therapist in making decisions on whether to treat the patient recommended for therapy or do the paperwork only. In light of this where the code of ethics compels the therapist to conduct a therapy the decision of the patient becomes irrelevant further more since the therapy is mandated. Also, important is the safety of the individual, which simply implies that the refusal of therapy does not put the patient at suicidal state. The essence of therapy is to prevent harm to the patient and the prevention of events like suicide (Jennifer 2010). The importance of this is the prevention of irrational, self-destruction on the part of the patient due to therapy refusal.

What to do when patients refuse therapy

Where the patients refuse therapy, it is necessary to ensure that the patient gives an informed consent. The patient must be aware of both the benefits of therapy as well as the repercussions of refusing therapy. When a psychologist deals with a patient who refuses therapy the psychologist should ensure that, the patient understands the facts surrounding the situation. The decision of the patient should be made in light of knowledge on the matter as provided by the psychologists. In this regard, the psychologists should provide all the essential information that facilitates the informed decision to the patient Jennifer &, Anne (2007). In respect of patients who do not believe in therapy, it becomes necessary to convince these individuals to try out therapy. The perception of the ineffectiveness of therapy is a serious hindrance and, therefore, these individuals need to appreciate the importance of therapy first.

In contrast, it becomes indispensable to balance the interest of the public that of the patient and put into context the ethical issues pertinent in determining the patient refusal for therapy. If, by therapy refusal, the patient jeopardizes the well-being of third parties the public or even the individual, then the practice of mandatory therapy prevails. In respect to the ethics of the profession, the psychologists based on the relevant ethics governing the practice makes decisions on whether to include or exclude an individual from therapy and should not be founded on the influence of the patient but on ethical principles. The necessity of therapy is also essential to the psychologists in determining the patient’s refusal of therapy. Where there is the eminent need for therapy based on the situation the psychologists must give it priority and decline the refusal for therapy. The psychologist should clearly articulate the importance of therapy to the patient, in instances where the practitioner feels the need for the patient to have therapy, in order to assist the patient in decision-making.

Conclusion

It is clear that the patient has an autonomous right to make a personal decision as to whether to undergo therapy based on an informed consent. The presumption is that the patient has discretion to make an independent decision and that the consent of the patient is critical in the process. Given that the patient-psychologist relationship determines the success of therapy, it is essential for the patient to have a positive attitude. In light of this decision, to undergo therapy must be borne out of free consent to result in effective therapy. Where a patient refuses therapy, the patient’s decision should be respected as mandatory therapy yield little results. Furthermore, the psychologists must determine the necessity of therapy to patients referred for therapy because the laws that refer individuals to therapy do not necessarily imply that the individuals require therapy but rather the individuals may require therapy and it is the responsibility of the psychologists to determine this (Laura & Catherine, 2005). The determination of the necessity of therapy should rely on the circumstances relating to the referral to therapy and the individual’s willingness to engage in therapy, as well as his/her interests together with that of the public. It is conclusively pertinent to note that in cases involving individuals who have been mandated to therapy, it is upon the psychologist to assess the necessity of therapy for the patient and the kind of therapy the patient requires. The establishment of competence to make rational decisions by the patient also lies within the psychologist and, therefore, the validity of refusing therapy. A  case in point is the post 9-11 attack. According to Yuval et al. (2006), the police officers and firefighters were recommended for therapy but not all the individuals underwent therapy. In circumstances where the officers or fire fighters articulated they were fine then the therapist did not force the individuals to therapy. It is, therefore, clear that it is ethically correct for therapist to sign the paperwork and let these individuals back to work provided the individual is well versed.

Reference list

Barbara, A. & John, W. (2007). Clinical and Professional Reasoning in Occupational Therapy. Lippincott Williams & Wilkins.

Jennifer, C. (2010). The Core Concepts of Occupational Therapy: A Dynamic Framework for Practice. Jessica Kingsley Publishers.

Jennifer, C., & Anne, L. P. (2007). Contemporary Issues in Occupational Therapy: Reasoning and Reflection. John Wiley & Sons.

John, B., & Catherine, S. (2006). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. SAGE.

Laura, L. S., & Catherine, G. (2005). Professionalism In Physical Therapy: History, Practice, & Development. Elsevier Health Sciences.

Lisa, L. (2012). Trauma Counseling: Theories and Interventions. Springer Publishing Company.

Yuval N., Raz G., Randall D., & Ezra S. (2007). 9/11: Mental Health in the Wake of Terrorist Attacks. Cambridge University Press