Medicine 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.
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