Respect for Autonomy in Health Care, Essay Example

The term “autonomy” has its roots in the Greek words autos which means “self” and nomos, which refers to “rule” or “governance.” In essence, therefore, autonomy simply means “self-rule” or “self-governance.” Historically, the term was applied in international politics to refer to the independence of sovereign states in running their own affairs. In this context, autonomy meant the capacity to make and pass laws for self-governance without interference from other state players or foreign influences. During the enlightenment period, attention shifted from the society to the individual, emphasizing on what is good for the individual rather than for society as a whole. This is seen in the writings of early philosophers such as John Stuart Mill’s On Liberty (1863), in which he explored the quest for happiness as a basic right to which every person is entitled. Respect for autonomy demands that people are free to decide on and pursue what is good for them. In the context of health care and medical ethics, the concept of autonomy encompasses respect for the will of individuals regarding their own destiny, and seeking their consent before acting on their behalf. However, autonomy is limited to the individual’s ability to make sound judgment and reasonable choices. When such ability is lacking and the individual is unable to determine what is good for them, it becomes the obligation of family members, guardians or doctors to act in the best interest of the patient. In this regard, this essay argues that respect for autonomy does not necessarily mean giving individuals absolute powers to decide on what is good for them, but is limited to their mental capacity to make meaningful choices based on sound judgment of their condition.

Absolute respect for autonomy is only possible under two conditions: liberty and agency (Beauchamp and Childress 58). Liberty, which refers to “independence from controlling influences” (p. 58), encompasses the individual’s unrestricted freedom to exercise one’s rights and choices, as well as pursue one’s plans without hindrances. For this reason, prisoners and rehabilitation patients have no autonomy in terms of making and implementing their own plans because their institutional confinement robs them of their liberty. Their confinement presents a form of “coercive institutionalization,” which constrains their autonomy. They are subject to the regulations of the institutions that control them, and therefore are not free to make independent plans or decisions. At the same time, the functioning of society denies individuals absolute autonomy, because their actions are subject to the laws and values established by social institutions. For one to be truly autonomous, he should have the freedom, say, of drunk-driving without violating traffic laws. Agency, the capacity to make intentional actions encompasses the individual’s mental competence. Competence is necessary for decision making purposes, and to compel others respect the choices made. For instance, children’s autonomy in this regard is limited because they lack enough competence to make “mature” decisions, hence depend on their parents and guardians. Their agency, as it were, rests with their benefactors, who have the responsibility of determining what’s good for them. The same applies to mentally retarded persons, because their mental capacities have been compromised and could not make rational decisions.

Acting in the best interests of the individual is the license that others often use to overrule the person’s autonomous will. This is especially the case when dealing with terminally ill patients and mentally retarded persons, whose mental capacities have been incapacitated. The assumption is that in their state, terminally ill patients and mentally retarded people do not know what’s good for them, and it is the duty of their guardians to act in their best interests. They lack what the theories of autonomy regard as the traits of a truly autonomous person, which include deliberating, reasoning and understanding, and the ability to make choices based on personal beliefs (Beauchamp and Childress 63). This notwithstanding, however, autonomy does not necessarily mean ability to determine what’s right for one’s self, usually due to ignorance (as in the case of children) or constraints resulting from illness and mental incapacitation. For example, a drug addict undergoing rehabilitation may crave to have a smoke to suppress anxiety or depression. However, his caretakers may object because in their sound judgment, granting him his wish, in other words respecting his autonomy, may encourage the addiction. In this regard, it is common, and ethically justifiable so, for the individuals’ best interests as determined by his caretakers, to override his autonomy. Autonomy, therefore, is respected in so far as it does not compromise or jeopardize the individual’s best interests.

In the area of health care, the issue of autonomy is complicated not only because of the patient’s dependent condition, but also because of the legal authority of guardians acting on the powers of attorney and the professional authority of physicians. In particular, there is always a conflict between the patient’s autonomy and the physician’s professional authority, largely because “authority has not been properly delegated or accepted” (Beauchamp and Childress, 60). Coupled with the implications of rules and codes professional ethics, the physician may disregard respect for autonomy, and in some cases even the counsel of guardians acting on the powers of attorney, and assume “an unwarranted level of authority over the patient” (p. 60). For instance, the physician, based on his or her medical knowledge, may be certain that there are chances of improvement for a terminally ill patient, and therefore resist request for physician assisted suicide. Even if the patient’s mental capacities may be competent enough to make an independent decision, a request for termination of life conflicts with the physician’s professional ethics in light of his medical knowledge regarding the patient’s chances of recovery. In this case, the patient’s autonomy, regardless whether or not it meets the characteristics of an autonomous person, jeopardizes that patient’s best interests, in which case the physician may choose not to respect it.

Nevertheless, respect for autonomy on the one hand and the desire to safeguard the patient’s best interests on the other puts physicians in a dilemma when they have to make a decision regarding a terminally ill patient with no hope of recovery. Such is the case when family members are against terminating the life of a patient on life support, and the physician’s professional judgment suggests that turning the machines off is the best thing to do, both for the suffering patient and the anguishing family members not willing to see their loved one go. However, as Beauchamp and Childress observes, “Best interest judgments are meant to focus attention entirely on the value of life for the person who must live it not on the value the person’s life has for others” (p. 79). It is here that the physician’s professional authority affords him the privilege not to respect autonomy, if doing otherwise conflicts with the patient’s best interest.

In conclusion, autonomy constitutes an individual’s ability and freedom to make independent decisions without manipulation by others. Respect for autonomy includes allowing individuals to exercise their own will on issues that directly affect their lives. However, respect for autonomy is not absolute and automatic. It is dictated by other factors that are beyond the individual’s control, such as inability to make sound judgment due to illness, or to determine what is good for one’s self due to ignorance. In medical practice and health care, professional authority and codes of professional ethics allow the physician to assume authority and act in the patient’s best interests, regardless whether or not those interests agree with the patient’s wishes.

Works Cited

Beauchamp, Tom L., and Childress, James F. Principles of Biomedical Ethics. London: Oxford University Press, 2001.