define autonomy
self-determination ; the right to make independent decisions concerning one’s own life and wellbeing (and choices regarding healthcare)
what was paternalism in healthcare?
paternalism = old view towards HC; the physician is empowered to make decisions for the patient even if the patient is perfectly capable of doing it themselves
why was getting rid of paternalism important?
shifted away from physician centered medicine and provided a patient-centered approach where the patient could be autonomous
3 reasons autonomy is important
- limited paternalism
- legal reasons (e.g., failing to get permission to touch someone is assault)
- respect for persons
what is it meant by: Presumption of autonomy
patient is autonomous unless they “prove” they are not autonomous
3 standards/criteria to follow to determining a patient’s autonomy
The patient is autonomous when:
1. They are at liberty (not apprehended under the mental health act)
2. they are capable of effective deliberation (patients have knowledge [are being adequately informed] and reasoning abilities to make rational decisions)
3. They are capable of authenticity
what does it mean for a patient to be behaving authentically?
patients choice or action aligns with their total being or character
what is an example of medication messing with a person’s authenticity
Arch angel Gabriel sexually ravishing woman with schizophrenia [which she loved] was lost when she started her medication and she then had to accept that loss to heal her illness
what are 2 exceptions to limited paternalism and autonomy?
- a patient is unconscious – the physician HAS to intervene (therefore it is perfectly acceptable to decide for the patient because it is an emergency under 2 conditions:
* It must be in the patient’s best interest
* As soon as the patient regains consciousness, they can make their own decisions - Because there is no age of medical consent in BC – it is up to the physician to decide about the maturity and capability of the patient (limited paternalism) e.g., 15-year-old who wants to go on birth control
What happens when the patient can’t make autonomous decisions for themselves and need to decide about their care?
look for documentation e.g., DNR (do not resuscitate) only refers to CPR; Advanced Directives (AD: living will = great because it gives us a written reflection of a patient’s wishes); Psychiatric Advanced Directive (provides info in the event of psychiatric crisis)- these are not legally binding
what information is required from the RPN for a reasonable person to make a decision (consent to health care)
- the condition for which the health care is proposed
- the nature of the proposed health care
- the risks and benefits of the proposed health care that a reasonable person would expect to be told about
- alternative courses of health care
3 elements of informed consent
- the HCW gives the adult the information a reasonable person would require to make a decision
- the consent relates to the proposed health care
- the consent is given voluntarily
