In Mappes and Zembaty’s essay, “Patient Choices, Family Interests, and Physician Obligations”, they discuss John Hardwig’s conceptions of autonomy.  Hardwig, proposes two forms of autonomy, A1 being “the patient’s freedom or right to choose the treatment he believes is best for himself” and A2 as “the responsible use of freedom” (Hardwig, 1990).  Hardwig believes that A1 is the “accepted meaning” of patient autonomy, despite rejecting this concept and proposing A2. What is to be thought of Hardwig’s suggestion?

I do not agree with Hardwig that A1 should be completely rejected, but I think A2 provides a new and important argument to the idea of patient autonomy. Individuals that are competent and capable of making decisions about their own medical treatments and such should have that power and freedom. With that being said, the expectation of those that qualify to make their own choices if that they will use this right responsibly and sensibly. However, in more complicated situations, such as when patients are deemed incompetent or are unable to make decisions about their own health due to unforeseen circumstances, the idea of “the responsible use of freedom” should then be applied to that of the surrogate decision maker.  For example, in case 1.1, Marie Francois has complications during surgery and is in need of another operation otherwise she will most likely die.  She communicates by way of written notes that seem rational, but her oldest son claims that she does not understand the consequences of her refusal.  I think that Hardwig’s proposed idea of patient autonomy seems appropriate.  If in fact she is competent, she is responsibly using her freedom and has the right to refuse treatment if she so chooses.

Rather than completely rejecting A1 and fully accepting A2, I would propose a slight alteration or rather combination of the two.  I believe patient autonomy should be defined as the patient’s responsible freedom or right to choose the treatment he believes is best for himself.  I still think that it is the competent patient’s right to make decisions, but with this freedom comes an immense responsibility as well.  By combining the definitions, it holds the patient accountable for their actions, but still presents them with the freedom to make their own choices about their health.

 
After reading Hardwig’s argument, I was curious to see how others felt about the concept of autonomy and found an article arguing that autonomy should only be an instrumental value rather than an intrinsic one in terms of medicine.  The author went on to explain that our society over values autonomy in terms of patient wellbeing and that this concept should be rejected.  I am one to greatly value my autonomy and was somewhat surprised after discovering this article.  If we act responsibly, why should our freedom be limited when it comes to our own decisions about health? Before my family travelled to Peru over the winter break, I had to go to the Emory Travel Well Clinic and get specific shots and learn about the risks of travelling to this area of the world. The healthcare professional informed me of a new available vaccine that she recommended, but that I was not required to receive.  However, the vaccine could possibly result in severe side effects.  In the end, I decided against having the vaccine.  Despite the doctor being more knowledgeable on the subject, my autonomy was still respected even if she disagreed with my decision.  I disagree that patient autonomy is overvalued and think it is incredibly important that patients are able to responsibly use their freedom.

Works Cited:

Hardwig, John. “What about the Family?” The Hastings Center Report 20.2 (1990): 5. Web.

Mappes, T. A. & Zembaty, J. S. “Patient Choices, Family Interests, and Physician Obligations.” Kennedy Institute of Ethics Journal, vol. 4 no. 1, 1994, pp. 27-46. Project MUSE, doi:10.1353/ken.0.0065

Thomas, John E, et al. “Case 1.1: When Physicians and Family Disagree.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

Varelius, Jukka. “The Value of Autonomy in Medical Ethics.” Medicine, Health Care, and Philosophy 9.3 (2006): 377–388. PMC. Web. 15 Mar. 2017.