Autonomy means that a patient has the ultimate decision-making responsibility for their own treatment.
Autonomy also means that a medical practitioner cannot impose treatment on an individual for whatever reason – except in cases where that individual is deemed to be unable to make autonomous decisions (see Mental Capacity Act and Emergency Doctrine).
The principle that a patient has the right to choose what happens to their body seems pretty straight-forward – but it’s important to remember that historically this has not always been the case! Even today, some patients defer all decision-making to the “wise Doctor” – even if they do not feel comfortable with their treatment plan.
Autonomy is important because we need to make sure that the patient is actively involved in their diagnosis and treatment – and not just deferring to their Doctor.
During your interview, you may be given a scenario and asked what you would do or what you need to consider. For example:
A 26-year-old male has been involved in a high-speed collision, in which he sustained blunt force trauma to his head as his head hit the front windscreen of his car. He did not lose consciousness, he is fully responsive and has no indications of neurological damage. He does, however, have a significant head wound that is bleeding continuously. This patient has refused treatment on the grounds that he feels “fine” and is refusing to have sutures to close his head wound. He would like to leave the Department.
Even though the best interests of this patient would be served by undergoing a CT scan and having sutures, he is an adult with full mental capacity, and so we must respect his autonomy in choosing to leave the Department. We cannot prevent him from leaving, and if we did it would be unlawful detainment.
Autonomy is one of the things you need to consider when you’re answering ethics questions in your interview. You need to think about the following things:
These principles apply to all medical interventions, from a physical examination to major surgery. If a medical practitioner fails to obtain consent, it is known as a battery – a legal term that means “an infliction of unlawful personal violence.”
It is helpful, therefore, to think of autonomy as a limiter on how far a clinician can intervene in a patient’s care. If the patient does not consent to an action, we cannot intervene even if it will result in death.
Some questions you could be asked include:
Make sure you’re aware of hot topics where autonomy applies, for example:
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