Medical Ethics: Autonomy

What Is Patient Autonomy?

In Medicine, autonomy means that a patient has the ultimate decision-making responsibility for their own treatment. A medical practitioner cannot impose treatment on a patient.

The only exception is in cases where the patient is deemed 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 straightforward – 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.

Why Is Patient Autonomy Important?

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.

Autonomy Example

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 patient autonomy in choosing to leave the Department. We cannot prevent him from leaving, and if we did it would be unlawful detainment.

Discussing Autonomy at Interview

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:

• Have you explained fully the patient’s medical condition, their options for treatment and the advantages and disadvantages of those treatments?
• Is the patient able to retain this information, evaluate their options and arrive at a decision?
• Has the patient provided informed consent for our actions?

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 battery – a legal term that means “an infliction of unlawful personal violence.”

It is helpful, therefore, to think of patient autonomy as a limiter on how far a clinician can intervene in their care. If the patient does not consent to an action, we cannot intervene even if it will result in death.

Autonomy Questions

Some questions you could be asked include:

• What are the ethical issues involved with a depressed patient who has refused treatment, and admitted they’re having suicidal thoughts?
• Should the NHS fund treatment for smokers?

See the answers to these and more ethical questions here.

Hot Topics

Make sure you’re aware of NHS hot topics where autonomy applies, for example:

• The Charlie Gard case – his parents acted on his behalf because Charlie was too young
• COVID-19 – how does autonomy apply if someone refuses to wear a mask in public?
• Vaccination – how does autonomy apply to those opposed to vaccines?