Ethical Considerations in Regards to Patient Autonomy
Patients’ autonomy is one of the crucial foundations of medical ethics. While it is necessary for the nurses to respect the inmates’ decisions during treatment, their views on the patients’ autonomy often differ from the inmates’ opinions.
International Medical Association regards that the patients have the freedom to obtain the essential medical data and even the freedom to choose the appropriate treatment. Nurses are accountable for valuing the inmates’ autonomy in the process of improving their health condition. However, there are cases in which the nurses may violate this fundamental requirement. Thus, the nurses need to balance between the patients’ choices and the right decisions. Providing information about the illness and getting the patient involved in the process of making arrangements are the preeminent principles of proper respect for the patients’ autonomy (Rahmani, 2010).
Research by Rahmani (2010) shows that there are considerable differences in the ways nurses and patients see their attitude towards autonomy. While medical staff believes that they value the inmates’ freedom, the latter tend to consider their freedoms violated. The most common complaint on the part of the patients is that the nurses do not provide them with the whole amount of information about their health condition. Additionally, patients feel that they are not entirely involved in the procedure of making a resolution (Rahmani, 2010).
Based on a number of studies, Rahmani (2010) concludes that the notion of autonomy is culture-related. He also remarks that the health condition of the person is closely connected with his/her opinion about the nurse’s respect towards his/her rights. For instance, Rahmani (2010) mentions that the worsening of the patient’s state leads to a better opinion about the nurse’s conforming to the autonomy standards. The more time the nurse spends cooperating with the patient, the more trust on the patient’s behalf appears.
The autonomy model of treatment is manifested via the juridical principle of informed agreement (Will, 2011b). This policy became possible due to a proposal made by philosophy and legislation activists who proclaimed a fundamental value of the inmates’ resolution-making ability. Therefore, a medical worker has to get the person’s consent before starting the therapy. If the patient refuses to give his/her consent, it may lead to worsening of his/her health condition or even result in death. In such a situation, medical workers meet a difficulty regarding their primary duty of applying their abilities to pursue the best outcomes for the patient (Will, 2011b).
The Principle of Autonomy in Nursing
Ethical issues faced by nurses are numerous, but the most challenging one takes place when the patient’s autonomous decision conflicts with the doctor’s advice which aims at looking out for the patient’s best interests.
The so-called “beneficence model” dates back to the times of Hippocrates (Will, 2011a, p. 670). According to this model, the doctors have an ethical duty to do everything possible for the welfare of their patients. Thus, the doctors used to be accountable for the proper behavior: they had to decide what was best for the patients. Such norms created a situation of “benevolent deception”: the doctor has to conceal the facts which might impact the patient’s attitude towards his state and towards treatment (Will, 2011a).
The problem is that nowadays many doctors would like to conform to the beneficence model, while patients want to take part in their own fate. Under these circumstances, nurses meet with a difficulty of being between the two opposing sides. Medical ethics in such a situation plays a bad joke on the nurse who naturally has to take the best care of the patient but at the same time wishes to stay on good terms with a doctor.
A good way to solve the nurses’ problem is the new method of patients’ autonomy. According to this approach, the doctor has to provide the person with all the information regarding his/her illness and to ask for a person’s consent before choosing the treatment measures (Will, 2011b). Patients’ autonomy derived from the bioethics movement which was closely connected to the civil rights movement.
While patients’ autonomy sounds a good and fair idea, it still leaves many questions to consider both for doctors and nurses. For instance, there are medical states which do not allow a person to make a sensible decision. Also, sometimes patients’ resolution contradicts the law on nonmaleficence leaving the medical workers in a problematic situation where they have to choose between the inmate’s welfare and their consent (Will, 2011b).
The nurse has to meet a number of requirements in the situation of patient-doctor relationships under the circumstances of the autonomy principle. First of all, nurses need to observe the rule of benevolence and nonmaleficence. Also, nurses should be fair and loyal to their patients. The principles of paternalism and integrity are also decisive in the nurses’ profession. Therefore, when deciding on whose side to take in the conflict of interests under the autonomy principle, the nurse needs to consider the patient’s welfare first of all.
Rahmani, A. (2010). Respecting to patients’ autonomy in viewpoint of nurses and patients in medical-surgical wards. Journal of Nursing and Midwifery Research, 15(1), 14-19.
Will, J. (2011a). A brief historical and theoretical perspective on patient autonomy and medical decision making. Part I: The beneficence model. Chest, 139(3), 669-673.
Will, J. (2011b). A brief historical and theoretical perspective on patient autonomy and medical decision making. Part II: The autonomy model. Chest, 139(6), 1491-1497.