Respect for Autonomy Any notion of moral decision-making assumes that rational agents are involved in making informed and voluntary decisions. In health care decisions, our respect for the autonomy of the patient would, in common parlance, imply that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act. See also Informed Consent.
The Four Principles are general guides that leave considerable room for judgement in specific cases.
All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment. To get some feel for how the Four Principles could be used by a clinical ethics committee consider the following hypothetical case study. Mrs Y is 56 years old and has a learning disability.
She is admitted to hospital with an ovarian cyst.
The cyst is blocking her ureter and if left untreated will result in renal failure. Mrs Y would need an operation to remove the cyst. Mrs Y has indicated quite clearly that she does not want a needle inserted for the anaesthetic for the operation to remove the cyst- she is uncomfortable in a hospital setting and is frightened of needles.
The clinician is concerned that if the cyst is not removed Mrs Y will develop renal failure and require dialysis which would involve the regular use of needles and be very difficult to carry out given her fear of needles and discomfort with hospitals.
The anaesthetist is concerned that if Mrs Y does not comply with the procedure then she would need to be physically restrained. The niece is adamant that her aunt should receive treatment. Consideration of the ethical issues using the Four Principles framework Respect for autonomy: Autonomy is not an all or nothing concept.
Mrs Y may not be fully autonomous and not legally competent to refuse treatment but this does not mean that ethically her views should not be considered and respected as far as possible.
She has expressed her wishes clearly; she does not want a needle inserted for the anaesthetic. However an autonomous decision is one that is informed — has Mrs Y been given enough information, in a manner that she can comprehend? This principle may clash with the principle of respect for autonomy when the patient makes a decision that the healthcare professional does not think will benefit the patient — is not in her best interests.
In the short - term Mrs Y will be frightened to have a needle inserted in her arm and to be in hospital — this may lead her to distrust healthcare professionals in the future and to be reluctant to seek medical help.
In the long term there will be a benefit to Mrs Y in having her autonomy overridden on this occasion. Without treatment she will suffer serious and long-term health problems that would require greater medical intervention ongoing dialysis than the treatment required now operation.
From a legal point of view the wishes of a competent patient cannot be overridden in his best interests. Do no harm to the patient. Here, Mrs Y would be harmed by forcibly restraining her in order to insert the needle for anaesthesia.
On the other hand if she is not treated now she will require ongoing dialysis a number of times per week. If she does not comply with dialysis it would be impractical to administer and may require restraint.
Which course of action would result in the greatest harm? This assessment relies on assumptions: It would be relevant to consider cost effectiveness of the treatment options for Mrs Y, and the impact the decision about her treatment has on the availability of treatment for others awaiting dialysis.Childress in Principles of Biomedical Ethics, resolves ethical issues in terms of • The principle of autonomy is based on the Principle of Respect for Persons, which holds that individual persons have right to make their (Beauchamp and Childress, and American College of Physicians Ethics Manual, 7).
Principles of Bioethics. Thomas R. McCormick, vetconnexx.com, Senior Lecturer Emeritus, Dept. Bioethics and Humanities, School of Medicine, University of Washington 1.
Respect for Autonomy Indeed, Beauchamp and Childress do not claim that principlism provides a general moral theory, but rather, they affirm the usefulness of these principles in.
“The principles [of biomedical ethics] emerged from the work of the National Commis- respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others.
To show lack of respect for. Measuring the Four Principles of Beauchamp and Childress. The Four Principles, originally devised by Beauchamp and Childress in their textbook Principles of Biomedical Ethics, are considered by many as the standard theoretical framework from which to analyse ethical situations in medicine.
Respect for autonomy: The right to participate in and decide on a course of action without undue influence. A norm of respecting the decision making capacities of autonomous persons. CHAPTER 2 Autonomy He alone is free who lives with free consent under the guidance respect for the autonomy of individuals and their right to choose what Beauchamp and Childress () present a model that clarifies this term and serves as a basis for.