What is Autonomy ?
Individual freedom is the basis for the modern concept of bioethics. This freedom, usually spoken of as autonomy, is the principle that a person should be free to make his or her own decisions. It is the counterweight to the medical profession’s long-practiced paternalism (or parentalism), wherein the practitioner acted on what he or she thought was “good” for the patient, whether or not the patient agreed. This principle does not stand alone but is derived from an ancient foundation for all interpersonal relationships a respect for persons as individuals.
Physicians have only grudgingly begun to accept patient autonomy in recent years. From three perspectives, which is understandable.
First, accepting patient autonomy means that physicians’ roles must change. They must be partners in their patients’ care rather than the absolute arbiters of the timing, intensity, and types of treatment.
Second, they must become educators, teaching their laymen patients enough about their diseases and treatments to make rational decisions.
Finally, and most distressing to clinicians, is that accepting patients’ autonomy means that some of them will make foolish choices.
For physicians dedicated to preserving their patients’ well-being, having to allow people to select what the physician considers terrible treatment options (often refusing treatment or opting for ineffective regimens) may be both frustrating and disheartening. Allowing these “foolish choices” is part of accepting the principle of patient autonomy, however. If patient autonomy is fully understood, much of the rest of clinical bioethics naturally follows.