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Supporting Patient Autonomy: Fututres Review

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Medical history is highlighted with achievements that have improved quality and increased longevity of life. It has also been scorched by unthinkable acts such as crimes against humanity like the ones exposed by the Nuremberg Doctor’s Trials. Crimes committed by physicians who swore an oath to do no harm presented several deeply engrained ethical issues which the Nuremberg Code attempted to address. Its impact is far reaching as it strongly advocates for human rights and influences patient autonomy by providing a framework for informed consent. 

It is a physician’s duty to support patient autonomy in the healthcare setting by obtaining informed consent before performing any medical procedure. This is accomplished by providing sufficient information in a comprehensive manner, ensuring the patient is not acting under duress, and evaluating the patient’s capacity to make decisions.

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In order to obtain informed consent, the patient must first be informed. This can be accomplished by having a discussion involving the patient that remains truthful and honest (Health Information and Quality Authority, 2016). The content of the information and how the information should be provided depends on individual circumstances. Information such as diagnosis, benefits, and risks of a procedure should be given in terms that the patient understands. 

It is also an opportunity to learn the patient’s values and preferences which can guide decisions and present alternative options. The discussion should take place in private, and enough time needs to be given to consider, understand, and retain the information. It may be necessary to repeat certain information, draw diagrams, or provide an interpreter if the patient communicates in another language (Health Information and Quality Authority, 2016). Efforts should be made to maximize accessibility of information to patients. 

Conversely, a patient can decline receiving any information with regards to their treatment or condition. In such cases, the patient’s decision should also be respected, however attempts should be made to provide basic information involving major interventions in order to obtain consent, and refusals should be documented (Health Service Executive Quality and Patient Safety Directorate, 2013).

While autonomy is the freedom to make decisions about a person’s own body, it is also making these decisions free from constraints and coercions. Consent can only be considered valid if the patient is not acting under duress and his agreement or refusal is voluntary (Health Service Executive Quality and Patient Safety Directorate, 2013). 

Although the patient is free to seek the opinions and advice of others, he must make a decision for himself. This becomes challenging when the patient’s strength of will is undermined by pain, depression, or drugs, or if the patient has a strong relationship with a third party who can persuade the patient to the extent that it overrides the decision-making process (Stewart & Lynch, 2003). 

The doctor should consider these factors to determine whether the patient makes a decision freely or to satisfy someone else. Power imbalance is also key when contemplating influences on the patient. A weakened patient may be persuaded he can no longer decide for himself and will blindly trust the opinions and recommendations given by the stronger party (Stewart & Lynch, 2003). Doctors should be conscientious of their own powerful position with regards to the patient and the role it plays on the patient’s decision-making.

A patient is presumed to have capacity to make decisions about his care unless proven otherwise (Health Service Executive Quality and Patient Safety Directorate, 2013) (Fade, 2007). If, after appropriate efforts and provided help, the patient is still unable to communicate a clear and consistent choice, or he is unable to understand and use the information and choices provided, doctors should assess capacity to make decisions. Incapacity should never be assumed. 

A patient is considered to have capacity if he understands the information relevant to the decision; can retain the information long enough to make a voluntary choice; can weigh the information into the decision-making process; and can communicate his decision (Government of Ireland, 2015). If the patient is assessed and found incapable to make a particular decision, it falls onto healthcare professionals to proceed with the intervention in such a way as to respect the patient’s body, preferences, and beliefs. 

This can be done with the help of the patient’s appointed decision-making assistant (Government of Ireland, 2015). Doctors should continue encouraging patient participation and keep in mind that although the patient may be incapable to make this particular decision, it does not mean he lacks the capacity to make all decisions.

An essential means by which doctors can support patient autonomy is by obtaining informed consent before performing any medical procedure. Such a simple idea can sometimes prove to be challenging in practice; however, it plays a critical role in redistributing power in favour of the patient and reinforces trust: an essential component to the doctor-patient relationship. 

Our family case study allowed us to practice fundamental skills which will help us support the autonomy of patients in the future. It gave us an opportunity to exercise active listening and learn the values of the family, as well as communicate effectively to convey information and involve the parents in the study. Durant (1926, p.87) is of the view that “we are what we repeatedly do”. Therefore, perfecting these fundamental skills now as students can only translate later in practice as professionals.  

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