The Exchange

Commentary and Observations from
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Patient Autonomy: Keeping Our Patients’ Self-Determination Preserved

Patient Autonomy: Keeping Our Patients’ Self-Determination Preserved

If you’ve practiced in medicine for at least 20 years, you may remember the case of Terri Schiavo, a woman in her 20s who was in a coma for more than a decade and became a national controversy when her husband wanted to remove her feeding tube. Michael Schiavo contended that his wife had indicated to him that she would not want to have any measures to keep her alive if there was no evidence that her condition would improve, but there was no documentation or evidence that supported this claim. Michael fought for legal guardian status through the courts and faced fierce opposition from Terri’s parents, who wanted to keep her alive. The case was challenged through the court system and even in the governor’s office, where the governor at the time—Jeb Bush—attempted, through legislation, to make himself her legal guardian. After exhausting all efforts, Michael Schiavo’s guardian status was upheld. Terri’s feeding tube was removed, and within 10 days she died of starvation.

The issue of autonomy is a sacred right for all patients. Self-determination and rule are essential components in how a patient takes part in their own health. This ability to decide maintains the patient’s liberty and fundamental rights. It gives every patient the individual ability to express their rights and values and create a standard of their own for the very right of self-determination. Additionally, when a patient takes part in the decision-making process for their own health and treatment, they are more likely to own those decisions and stay adherent to the therapy that is given.

The issue becomes even more important when the patient’s status changes and a decision cannot be made as easily. Informed consent, advanced directives, and other legal preparations have been instrumental in preserving a patient’s wishes prior to not being able to make informed decisions. Consider the patient who is diagnosed with Alzheimer’s disease or another who develops dementia: without a full understanding of what a patient wishes to have done with their health prior to deterioration, decisions could be made on their behalf that may be contrary to what they may have wished. In consideration for this, the idea of the patient’s capacity to make their own choices plays an important role. Violating such autonomy could be deemed assault on the basic principles of a patient’s wishes.

When seeing patients within your practice, make sure you consider talking about advanced directives, informed consent for procedures, and what your patient’s wishes are through legal documentation. This will preserve the patient’s autonomy and improve the confidence of the patient’s self-determination.

  • Chubak B. Clinical responsibility in the age of patient autonomy. Virtual Mentor. 2009;11:567-570.
  • Beauchamp TL, C. J. Principles of Biomedical Ethics, 4th Edition. New York, NY: Oxford University Press.
  • Coggon J, Miola J. Autonomy, liberty, and medical decision-making. Camb Law J. 2011;70:523-547.
  • Haberstroh J. Autonomy and capacity to consent in dementia. Accessed March 11, 2019.
  • Keshner A. More Americans under the age of 40 are having heart attacks. Accessed March 11, 2019.
  • Thibodeau D. Associate Professor. Patient Autonomy. Norfolk, VA; 2019.

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Filed under: Health Policy and Trends, Public Health

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