Recently, there has been an increasing need for expanding patient autonomy within the care process in order to make it more efficient and less time-consuming. Patient autonomy refers to the right of patients to make sound decisions regarding their medical care without involving care providers in influencing the decision. The debate about patient autonomy has reached a consensus that two conditions were essential to guarantee autonomy: liberty and agency. Liberty refers to the independence for controlling influences, while agency implies a capacity for intentional action. The issue with patient independence lies in the regulatory dimension, which is concerned with the principle of respect for patients’ choices and opinions rather than theoretical underpinnings (Arrieta Valero, 2019). Therefore, when considering how nurses can give more autonomy to their patients, it is imperative to include the notions of agency and liberty as crucial bioethical principles that guide interactions between patients and their care providers.
Patient autonomy implies that healthcare providers educate individuals on how to best manage their care despite not allowing the decisions to be made for patients. In order for healthcare providers to increase patient autonomy, they should act as consultants and educators. It is necessary to equip patients with an abundance of informational resources that would help make care decisions based on sound judgment. In the absence of time to care for patients who can already manage their care with minimal supervision, the introduction of educational materials, as well as care guidelines can significantly redistribute the workload of nurses to allow them to focus on more important and urgent cases. When patients have questions or concerns about their care, they can contact nurses to get some advice on the most appropriate treatment or condition management. However, within the model, it is important to consider the issue of patient autonomy from the perspective of healthcare.
Historically, the sphere of healthcare has subscribed to the ethical norm that the main duty of healthcare professionals is to promote patient welfare even at the expense of their autonomy. In the case when a patient is given a high degree of autonomy, the ethical issue associated with the need to provide compulsory treatment can arise. This issue can be managed by establishing a clear understanding of why compulsory treatment is necessary and how it will ultimately improve patient care. It is also imperative to make distinctions between what is good and bad for patients, ultimately without viewing autonomy as the most important and defining factor of care. According to Arrieta Valero (2019), it is plausible that, in the end, the cases about the competing conceptions about effective and ineffective interventions will come to the forefront instead of the issue of autonomy. Therefore, as long as medical ethics considers the procedural conception of autonomy and there is no available arguments to support the view that autonomy has intrinsic value, patients’ autonomy should only have instrumental value in medicine.
The circumstances in which autonomy should be prioritized over other nursing values are usually concerned with complex health issues in which patients have to make crucial decisions regarding their care regardless of what medical professionals may be offering. For example, in terminal patients who do not have a chance of recovering despite complex treatments, patient autonomy should be prioritized over the duty of professionals to provide care (Kilbride & Joffe, 2018). A patient may choose to stop a treatment that has numerous side effects when there is ultimately no chance of survival either with or without a medical intervention. Such cases will be complicated to manage from multiple standpoints. However, in instances when an illness is severe and terminal, giving a patient the autonomy to remain without treatment not to experience additional pain and discomfort during treatment can be a valuable point in the ethics of autonomy.
In a specified environment, it is morally reasonable to allow terminally ill patients to make informed decisions on treatment or the absence of such, and it is necessary that nursing guidelines consider this issue. Moreover, as mentioned by LiPuma and DeMarco (2016), under certain conditions, namely, in those individuals who have been diagnosed with a terminal condition and who have been expected to live less than six months, it should be allowed to conduct treatments that would hasten death deliberately, in cases when patients choose to undergo them. The broadening of policies that guide the choice of treatment or no treatment for terminal patients should be consistent with the high standard of the principles of bioethics, namely the respect for the autonomy of adults who are competent. For health care providers, there is the opportunity to provide relief from symptoms of a terminal illness to reach the highest quality of life that is achievable in a particular situation. The issue is the most relevant for patients who no longer want to undergo the challenges associated with living with a terminal illness and would like to receive a relief that is essential for eliminating the burden of disease. Moreover, instead of engaging in treatments that would hasten death, the lack of patient autonomy causes them to endure severe symptoms, suffering, and an undesirable state of consciousness.
Autonomy is significantly important in the situation described above because it shows that a patient has control over his or her life. There is comfort in knowing that they can make a choice to stop an intervention that would not bring any long-term benefit. While the debate on whether terminal patients should be allowed to make decisions on refusing treatment is still ongoing, the ethics of patient autonomy play an essential role in highlighting the importance of informed and sound decision-making. However, autonomy should be prioritized in such a situation only in instances when patients are capable of giving informed consent, which means that their psychological condition allows them to be active participants in their process of care. In terminal individuals who do not have the ability to established informed consent, decisions on whether to continue treatment or not will be made by a relative or caretaker. In such an instance, autonomy is a much more complicated subject that requires further consideration from the bioethics perspective.
The issue of patient autonomy is imperative to consider within the area of bioethics due to the need to allow patients to have greater control over their treatment and the potential for enhancing their quality of life. Information exchange between patients and their care providers will improve the capability of individuals to make informed decisions about their personal care management. Patient autonomy has come to play an essential role in the care choices of terminally ill patients, especially in terms of choosing further actions for treatment or refusal from treatment. Overall, the ethics of patient autonomy should be studied further and involve the perspectives of patients.
Arrieta Valero I. (2019). Autonomies in interaction: Dimensions of patient autonomy and non-adherence to treatment. Frontiers in Psychology, 10, 1857.
Kilbride, M. K., & Joffe, S. (2018). The new age of patient autonomy: Implications for the patient-physician relationship. JAMA, 320(19), 1973-1974.
LiPuma, S. H., & DeMarco, J. P. (2016). Palliative care and patient autonomy: Moving beyond prohibitions against hastening death. Health Services Insights, 9, 37-42.