Autonomy (which literally means self-rule) is the capacity to independently think, make decisions, and act on thoughts freely without being hindered or need for permission. As far as action is concerned, it is crucial that distinction be made between on one side, liberty, freedom, license or just doing what a person pleases and on the other side, acting in autonomy, that can be doing whatever one pleases but based on reasoning or thought. Animals, for instance, are not autonomous but can be considered free (or at liberty), what may be referred to as a thin sense of liberty or freedom, when not under constraints of drugs, cages or clipped wings. Autonomy is an aspect of liberty or freedom, but not all liberty or freedom can be considered as autonomy. Gillon1 states that this autonomy concept involves rationality, a particular attribute noted by Aristotle.
The Principle of Respect for Autonomy
Beneficence as a concept is widely referenced in Medicine but it is hard to precisely define what it is. Several interpretations have therefore been floated. According to Beauchamp2, while its use in English is expansive, people take its meaning to be 'doing good acts, actively promoting charity, kindness and good." Steven3 reports that the word can also be taken to mean good acts targeted at benefiting other people. While traditionally people are obligated to do good acts, the beneficence concept suggests humanity, altruism, optional morality and unconditional love. Ethics in medicine understands beneficence as the requirement that physicians give, as much as is possible, such benefits as prevention and curing of harmful disorders or conditions and excellent health. This means that beneficence as understood in medicine is an obligation. According to Munyaradzi4, Physicians are obligated to assist patients meet interests they desire and desist from causing harm in any form (psychologically, physically or morally) to patients.
A Utilitarian might get the temptation to give rationality a definition which relates it to utilitarianism; that which is rational leads to maximization of utility. Such a definition raises questions, though (utilitarianism could be rational since it causes utility maximization since maximization of utility is rational). So, there is need to defend the concept of utilitarianism without using rationality. Furthermore, Gandjour5 reports that utilitarians should be aware that it is not any less rational for a person to hold a view that enforces the concept of utility maximization. If not, they should give an explanation detailing how individuals who are rational can have the motivation to do this.
Andre and Velasquez6 states that paternalism can be taken to mean the interference with the freedom of another person for her or is own good. This gives a picture of a father ( "pater" is father in Latin) that arrives at decisions for the children instead of allowing them to make their own decisions, given that a father knows what is good for the children The paternalism principle is the basis of several practices, actions and laws. Examples would be physicians making the decision on what is good for a patient, signage prohibiting taking a swim when there is no lifeguard on duty, laws prohibiting euthanasia that is voluntary, laws making it illegal to use cocaine, heroin, marijuana and other substances, mandatory saving plans for retirement as well as laws making it compulsory to wear seat belts. Such laws are designed with the public's best interests at heart.
Paternalistic practices may be common, but are they acceptable morally? It conflicts 2 critical values: (1) the value placed on an individual's freedom to arrive at their own choosing on the way they will direct their lives and (2) the value placed on the promotion and protection of other people's well being. According to Andre and Velasquez6, when individuals choose freely to do things that do not serve their well being, the concept of paternalism is brought to light and may save the day.
Application to Modern Medicine
It could be possible that persons who are autonomous are capable of making the determination of what best suits them, consequently, arguments can be made that autonomy is critical and should be considered in medicine. But besides placing value on the autonomy of patients, a number of biosthetics argue that autonomy is so critical that some cases exist in which patients ought to be given the chance to choose their own treatment even when all parties are not certain that another person making the decision would be more befitting for the patient.
Beneficence involves an obligation founded on morality of a provider acting primarily in the patient's best interests. "Patient first" best exemplifies the concept. This aspect of ethics is grounded on such concepts like No Conflict of Interest and Continuity of Care. Continuity of Care makes sure that a patient gets treatment as a person, no neglect being made on the health history, beliefs, socioeconomic condition and health goals he/she has. The Commission for Reproductive Health Services Standards7 report that the primary care physician of the patient is at a better place to comprehend these aspects of circumstances of the patient and every specialist has the responsibility as someone consulting with the PCP to ensure continuity of care. Further, the doctor has the responsibility to shield the patient from any conflicts of interest by communicating transparently the financial and transcendent options the provider has. The doctor then must be the servant and leader and always uphold the preeminence of the patient.
Mills8 state the basic feature of utilitarianism is that moral behavior promotes that which is good and minimizes what is harmful. According to Roberts9, in public health writings, utilitarianism is appreciated as an aspect of the general picture of ethics in public health, but it is not given any stronger a role because of 2 reasons: first, given its extreme stance, it is problematic morally, since it might literally allow anything that serves the greatest good, and secondly, it is impossible to live a life of morals in the extreme sense of utilitarianism since it is difficult to understand the obligations (the reason for promotion of good) and it is not possible to execute (the 'how'). Utilitarianism, in moderation, as is used in ethics in public health points to the fact that our policies and actions should have a focus on raising the total 'net' goodness instead of the average 'net' good of individuals. Kirkwood10 reports that the school of individual rights and the appreciation of autonomy of patients aren't against this principle since they serve the good of all, and as the good of individuals increases so does total good, and this serves as a cure for unwarranted actions of the majority against the wishes of the minority.
The IEP11 reports that this concept as applied in modern medicine is the belief that morality is all about achieving the right overall outcomes. Overall outcomes refer to the consequences of actions and the specific action too. For instance, if you hold the belief that the goal of morality is (a) spreading happiness and relieving suffering, or (b) creating the most possible freedom, or (c) promoting the survival of the human species, then you agree with consequentialism. While the three might differ on which aspects of the consequences matter, there is agreement that all that matters is consequences.
According to McCormick12, The patient's autonomy should always be respected, prima facie. Giving such respect is not a case of attitude but a behavior recognizing and promoting patient autonomy. An autonomous individual can choose freely his/her values, religious beliefs or loyalties as long as those choices do not limit the freedoms of others. For instance, Jehovah's Witnesses hold the belief that blood transfusion is not right. Therefore, in a situation where life hangs in a balance and blood transfusion is necessary to save life, the patient must be made aware. The consequences of rejecting a blood transfusion must be clarified to the patient who is risking succumbing to loss of blood. In a desire to help the patient, the medical professional may want to carry out a blood transfusion, believing that it is a benefit to the patient. When a patient is compassionately and properly informed, that specific patient is free to make a decision on whether to accept or refuse blood transfusion -- to give more weight to his/her religious beliefs or to the prospect of dying in case the transfusion is foregone.
McCormick12 states that a clear example can be found in healthcare where people give priority to the beneficence principle even over the principle of autonomy of patients. The example is from Emergency Medicine. In case of incapacitation for various reasons like illness or accident, a presumption is made that any reasonable person would be accepting of aggressive treatment, and physicians rush to intervene beneficently by arresting any bleeding,…
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