Friday, January 3, 2020

Patient Autonomy; Legal and Ethical Issues?

Image result for patients autonomyMedicine has been recognized over the years as an ethical based practice. Ethical foundation serves as a backbone for setting out a legal policy. Initially, medicine was more of a paternalistic norm which was practiced in the doctor-patient relationship-“a profession where physicians decides what treatment a patient should receive based on their experience and knowledge”; however, recently, the advancement in medicine has changed its concept to a “patient centered care”. This simply means that the healthcare provider only advises and informs the patient on the possible treatment, but the patient makes the decision. This shift from paternalism to patient-oriented care is merely a reflection on the changes of ethical principle in medicine (Brooks & Sullivan, 2002). Therefore, Patient Autonomy is defined as the patient’s right to make their own healthcare decisions without the interference of the physician. Through the aid of patient autonomy, healthcare providers are permitted to educate patients; yet, are not authorized to undermine the decision of the patient (Entwistle, Carter, Cribb, & McCaffery, 2010).  

Patient autonomy is the foundation of professional ethics in medicine. It is significant that a healthcare professional develops the ability to recognize and practice patient autonomy in its different ways (Murgic, Hébert, Sovic, & Pavlekovic, 2015). The respect for patient autonomy in the healthcare sector is a focus on situations where decisions are made based on medical interventions. The goal of autonomy is to provide the patient the right to make their own choices on their respective healthcare services; this is associated with the principle of confidentiality, fidelity, privacy and honesty that are invoked in decisions based on the principle of autonomy (Entwistle et al., 2010). Furthermore, to respect a patient’s autonomy is to yield to their judgement and ensure that they have the absolute freedom to choose without any objection. Therefore, the core values of autonomy is the appreciation for a person, which integrates two moral commitment to “honor autonomy and support those with developing; impaired or recede autonomy”(Nurmsoo, 2014) .

For the past decades, it has been emphasized that patients have had the right to self-determination in healthcare even though the healthcare providers concentrated on the promotion of clinical benefits for their respective patients. Medical benefits as a mandatory service, and the respect for autonomy have increased the tension between patient-physician relationship. The concept of autonomy compels general physicians (GPs) to respect the right of a patient; nonetheless, this makes it challenging for physicians to mitigate and prevent their patients from suffering. While on the other hand, the beneficence principle supports the physician to act according to the medical practice; yet, they refrain from being accused of “Big Brotherism”(Tore Nilstun And, 2000). The concept of autonomous inpatient decision making is centralized by the concept of providing an informed consent (IC) to the patient-to outline the legislative laws and other healthcare policies. To issue an informed consent to the patient, the decision made by them has to be based on the fact that the patient had the ability to make the decision, the physician provided adequate and relevant information to the decision maker, and finally, the decision made by the patient or the patient’s representative was not acted as a result threat or coercion (Kevin W. Coughlin, 2018)

Recent studies have indicated that patient autonomy is important to medical ethics. The findings of the study done by “Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientist Johan Ng”, demonstrated that patient autonomy can lead positive changes in healthcare. The results states that supporting the psychological needs of a patient is fundamental for physicians to help patients sustain their health and wellbeing (Ng, 2012).
The thesis statement, “patient autonomy is considered as a standard in the modern medicine and ethics; and patients are entitled to their healthcare rights from their respective physicians; however, patient autonomy can be biased from a physician’s point of view because  at the moment of treatment, the patient maybe impaired to make the right decisions for themselves”.

BACKGROUND
The beliefs, desires, and decisions of an individual are autonomous when a certain criterion has been met. For instance, if the person’s behavior was a result of weak will or compulsion, then this is known as “Heteronomous” and not “Autonomous”. If the individual has had external factors such as unreflect of socialization, manipulation, coercion; the decision of the person was not autonomous. Furthermore, if the beliefs of a person regarding a subject were false, inconsistent with each other, or the person had little or no information of the subject without their realization, then this is not considered as autonomy (Varelius, J., 2006).

 It has been argued by many that autonomy in the western medical care is treated as a means of obligation than the act of beneficence. Patient autonomy stands for administering care in accordance to the values and believes of the patient; it can also permit them to utilize their freedom for self-realization. While patient autonomy still has its high grounds and morale in places like the United States and Canada (Murgic et al., 2015), some Latin American cultures and Asian Societies still practice paternalism within their healthcare system. In the Latin American society, there is still a great significance in the number of physicians and families who believe in paternalism. For the purpose of assuring the health of the patient, most physicians may have the tendency to withhold information on the diagnosis and prognosis of the patient’s health condition in the form of beneficence. This can or may interfere of overrule the will of the patient (Karime K. Machado, 2012).  Also, in some cases, most of the physician does not participate in the decision making of the patient; however, it is the family of the patient who plays the role of a decision maker because the family’s autonomy and well-being is observed as more significant(Cheng-Tek Tai, 2003). Therefore, it can be considered that patient autonomy does not meet the cultural values of certain countries.
In patient autonomy, there is a constant risk of disconnection between the concept of self-determination and the need for a social medical system (Graber & Tansey, 2005). Patient autonomy involves a person to have the right of authorizing an informed decision about their medical treatment plan which simply means that they can set a limit for any medical intervention rendered to them. Moreover, this brings attention to the fact that patient autonomy can act as a threat to the duties of the healthcare professionals. This implies that physicians would have to go against their knowledge and believes to “save the lives of their patients” to ensure that their patients were well informed of the consequences or inconsequence of their healthcare decision (Evanthia Sakellari, 2003). The more the patient is autonomous over their own decisions, the more the physicians will suffer its consequences. Physicians request for a mental evaluation of a patient if the refusal to treatment was not based on a religion belief. For instance, patients who are cognitive impaired are usually incapable of determining their medical treatment in the context of their best interest. “A hospitalized patient of a medical history of schizophrenia   with a life-threatening; yet, a curable condition, who rejects any medical treatment because the voices in their heads are instructing them to decline the medication given to them by their physicians are likely to receive the necessary treatment for their recovery”(DT, 2019). To summarize, patient autonomy acts a challenge for healthcare providers to have a more professional conduct towards their patients.

Patient autonomy has influenced the doctor-patient relationship over the years. Doctor-patient relationship is crucial in the healthcare system; once it as been established, there must be a consistent commitment to provide an ongoing care to patients  which means that decision making has to be shared between the patient and physician throughout the incubation period of the disease. Furthermore, physicians are mandated by law and ethics to ensure that their patients receive the necessary care throughout the course of their medical condition, no matter the outcome or the challenge. On the other hand, patient autonomy brings about conflict of interest between the physician and the patient as it becomes medical and moral problem. To illustrate more, a cancer patient may decide not to follow-up with their medical intervention if they believe it may not be beneficial to their current health status; however, the physician may be obligated to provide that specific care to their respective patient because they have taken the oath of “do no harm”(Wancata & Hinshaw, 2016). The concept of patient autonomy becomes unsatisfactory in the terms of chronic diseases and primary medical due to the fact that there is a difference in the communication level between the physician and the patient, and that certain decisions may be insignificant compared to the maintenance of the relationship. Although patient autonomy should be respected in a strict manner, the healthcare system should pay a great amount of attention to the particularities of the patients or those who need medical services (Arrieta Valero, 2019).   

CONCLUSION:
In conclusion, patient autonomy is seen as the ethical principle in medical practices. It plays an important role in the improvement and advancement of the quality of healthcare services that a patient receives. While ethics remains the backbone of legal policy, medicine which was initially a paternalistic norm is now transformed to a more patient-centered care. Even though physicians are required to understand and apply patient autonomy in its own various aspect, patient autonomy has proven to have a more negative impact towards the healthcare system. 






REFERENCES:
Arrieta Valero, I. (2019). Autonomies in Interaction: Dimensions of Patient Autonomy and Non-adherence to Treatment. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01857
Brooks, H., & Sullivan, W. J. (2002). The importance of patient autonomy at birth. International Journal of Obstetric Anesthesia, Vol. 11, pp. 196–203. https://doi.org/10.1054/ijoa.2002.0958
Cheng-Tek Tai, M. (2003). The ethics of biobanking View project The St. Jude valve prosthesis. Evaluation and Followup View project. Retrieved from www.cmj.hr
DT, T. (2019). Jehovah’s Witnesses’ refusal of blood: obedience to scripture and religious conscience. J Med Ethics, 25(6), 469–472.
Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010, July). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine, Vol. 25, pp. 741–745. https://doi.org/10.1007/s11606-010-1292-2
Evanthia Sakellari. (2003). (PDF) Patient’s autonomy and informed consent. (13). Retrieved from https://www.researchgate.net/publication/241752332_Patient’s_autonomy_and_informed_consent
Graber, M. A., & Tansey, J. F. (2005). Autonomy, consent, and limiting healthcare costs. Journal of Medical Ethics, 31(7), 424–426. https://doi.org/10.1136/jme.2003.003574
Karime K. Machado, M. P. M. H. M. F. (2012). Autonomy Versus Paternalism in Latin America.
Kevin W. Coughlin. (2018). Medical decision-making in paediatrics: Infancy to adolescenceMedical decision-making in paediatrics: Infancy to adolescence | Canadian Paediatric Society. Canadian Paediatric Society, 23(2), 138–146. Retrieved from https://www.cps.ca/en/documents/position/medical-decision-making-in-paediatrics-infancy-to-adolescence
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: Views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics, 16(1). https://doi.org/10.1186/s12910-015-0059-z
Ng, J. (2012). Supporting Patient Autonomy Is Critical to Improving Health – Association for Psychological Science – APS. Journal of the Association for Psychological Science. Retrieved from https://www.psychologicalscience.org/news/releases/supporting-patient-autonomy-is-critical-to-improving-health.html
Nurmsoo, S. M. (2014, September 16). Incidental findings and patient autonomy. CMAJ, Vol. 186, p. 1017. https://doi.org/10.1503/cmaj.114-0063
Tore Nilstun And, S. B. (2000). Patients’ autonomy and medical benefit: ethical reasoning among GPs | Family Practice | Oxford Academic. Family Practice, 17(2), 124–128. https://doi.org/https://doi.org/10.1093/fampra/17.2.124
Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, Health Care and Philosophy, 9(3), 377–388. https://doi.org/10.1007/s11019-006-9000-z

Wancata, L. M., & Hinshaw, D. B. (2016). Rethinking autonomy: decision making between patient and surgeon in advanced illnesses. Annals of Translational Medicine, 4(4). https://doi.org/10.21037/9213

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