Principle of Respect for Autonomy

AutonomyAutonomy

Autonomy: Key concepts

Competence Informed consent

Autonomy: Autonomy: DerivationDerivation Greek autos (“self”) nomos (“rule,” governance,” or “law”) originally referred to self-governance of

independent Hellenic city-states

Autonomy: Essential Autonomy: Essential ConditionsConditions Liberty - independence from controlling influences

Agency - capacity for intentional action

Autonomous ActionAutonomous ActionBy normal persons who act:IntentionallyWith understandingWithout controlling influences that determine their action

Principle of Respect for Principle of Respect for AutonomyAutonomy

Being autonomous is not the same as being respected as an autonomous agent.

Principle of Respect Principle of Respect for Autonomyfor Autonomy

To respect an autonomous agent requires recognition of other’s right to:

hold views, make choices & take actions based on beliefs and attitudes

Principle of Respect Principle of Respect for Autonomyfor Autonomy

Involves respectful action, not merely respectful

attitude

Kant’s ViewKant’s View

Respect for autonomy flows from recognition:that all people have unconditional worth &capacity to determine own destiny

Immanuel Kant’s ViewImmanuel Kant’s View

To violate a person’s autonomy is to treat that person as a means - in accordance with others’ goals without regard to his or her goals.

Immanuel Kant’s ViewImmanuel Kant’s View

Must assist persons in achieving their ends

Foster their capacities as agents

John Stewart Mill’s ViewJohn Stewart Mill’s ViewCitizens should be permitted to develop according to their personal convictions, as long as they do not interfere with a like expression of freedom by others.

Respect for Autonomy - Respect for Autonomy - Related ConceptsRelated ConceptsRights and obligations of:- privacy- confidentiality- truthfulness- consent

Respect for Autonomy: Respect for Autonomy: ScopeScopeDisagreement in literature over

scope of rights related to autonomy

Prima facie standingCan be over-ridden by

competing moral considerations

Autonomy & ConsentAutonomy & Consent

Basic paradigm of autonomy in health care:

express and informed consent

CompetenceCompetenceCore meaning - the ability to perform a task

Criteria for competence:- should be relative to decision- rarely incompetent in all

spheres

CompetencyCompetencyAsk - “Competency for what?”Sometimes the following are

inappropriate triggers for questioning competency:

- not doing what MD/nurse think should do

- preferences not mainstream

Categories of PeopleCategories of Peoplecompetent was competent but now is not - wishes known - wishes not knownnever competentnewborn

Categories of PeopleCategories of PeopleWas competent but now is not

permanent reversible

Incompetent Incompetent CategoriesCategoriesFetuses, newborns, childrenBrain deadPersistent vegetative stateRetardedClearly mentally illDementia

Competent Consent or Competent Consent or DecisionDecisionAdult person with ability to: - get information - comprehension - process information - capacity - make decision & communicate itAware of: medical situation &

prognosis; alternatives; & risks, benefits, & consequences of each

Competent Consent or Competent Consent or DecisionDecisionAbsence of coercionDecision is stable over timeDecision is consistent with person’s values & goals

Decision not a result of delusions or hallucinations