Respect for patients’ autonomy is now firmly entrenched in medical ethics but some doctors are reluctant to relinquish paternalism. This article discusses some of the perceptions of doctors who do not think autonomy is in their patients’ best interests.
What is autonomy?
Autonomy is a Greek word meaning self-rule. Historically the term related to political self-rule, but in medical ethics it is widely used to cover personal autonomy: an individual’s moral right to make and act on personal choices without interference. The writings of Immanuel Kant and John Stuart Mill have strongly influenced contemporary thinking about autonomy as an ethical principle. In medicine, respect for autonomy ‘obliges doctors to disclose information, to probe for and ensure understanding and voluntariness, and to foster adequate decision making’.
Respecting patients’ autonomy is more than a platitude; it is an ethic for doctors to effect. This means not only providing patients with information, but also helping them to understand it, without undue influence or coercion; hence, allowing them to make informed decisions. This includes assisting patients to comprehend the pros and cons of treatment options (including anticipated side effects) and of treatment refusal.