Patient Autonomy in Healthcare

After adding a new Catholic Medical Student to my blogroll, I was inspired to strive in coming weeks to attend more to some of the ethical problems in medicine and how I, as a Catholic, manage to come to terms with these. One of the comments I recently received asked how I could cope with the way abortion was taught at Medical School. Well, I have only been taught about this in the context of the Law (1967 Abortion Act), and have yet to meet it in medical practice (I have Obs & Gynae next month though!) but luckily the NHS doesn't provide this service in Birmingham (although it does pay for referrals to private clinics, of course).

For now, as I am quite busy with revision for next week, I just wanted to share with you some of the ethical observations I made whilst working in the field of Palliative Care, in the context of how Physician-assisted suicide has been argued using the buzzword of 'autonomy' or patient choice. It is interesting to see how the model of healthcare is evolving, and how that in turn affects the whole morality of medicine. The following is an extract from my elective project about reflective practice in Palliative Care:

The concept of ‘autonomy’ has been used in recent decades to refer to the idea of patient's rights. But there are various interpretations of this principle; the first of which enriches the traditional idea of ethical medicine, but the second is not compatible and implies a radical change in the doctor-patient relationship.[1]

Because autonomy is so important in palliative care, it is essential to be clear on which interpretation is used in the model of care. Kant (1785) introduced the concept of persons as self-determining, self-governing beings, whose decisions are essentially rational (when not blinded by our desires). This concept was modified by J. S. Mill (1859), who suggested an autonomous decision is less about rationality as it is about personal preference. When combined, this traditional Kantian-Millean idea of autonomy is that of preference and informed consent.

This allows openness in human relationship, something which isn’t as present with a paternalistic approach. It is certainly the helpful during a medical consultation, where the physician engages with the patient on an empathetic level.[2] This is where patient autonomy is the key to effective healthcare, requiring excellent communication skills and a robust doctor-patient relationship.

On the other hand, autonomy is also understood in terms of ‘consumer autonomy’, where the patient is seen more as the customer of a service industry, rather than part of the therapeutic relationship described above. The British Government is increasingly adopting this model of healthcare, with emphases being placed on consumer ethics; services being more accessible and subject to regulation, with the patients having more choice, information, and the ability to obtain redress. If this consumer concept of autonomy is adopted, then healthcare will seek less to retain the sorts of ethics which aim to protect vulnerable patients against exploitation.

References
1. Randell F, Dwonie RS. Palliative care ethics: A good companion. New York: Oxford University Press, 1996
2. Longmore M, Wilkinson I, Török E. Oxford Handbook of Clinical Medicine. 5th ed. (Facing Death, P. 7) Oxford: Oxford University Press, 2001.