The concept of complexity of respect for personal autonomy is quite complicated. Autonomy in medical ethics is defined as, “the ability of the person to make his or her own decisions” (Autonomy-Wikipedia). Several questions such as which request to abide by, and how to know if a patient wants full or partial disclosure are entirely debatable. In more instances than not patients change their minds regarding treatments, and this brings about the question of which request do we follow? Childress questions, “Which choices and actions should we respect? In particular is it justifiable to override a patient’s present autonomous choices and actions in the light of his/her past or (anticipated) future choices and actions?” (Childress, 310) This is the key question I am going to address in my argument.
When it comes to present versus past or future autonomy, Childress believes that the present autonomous statement is the one to listen to. I both agree and disagree with parts of this statement. Firstly, if one is in an autonomous state of mind and is able to make his or her own decisions, then their present statements should be considered. However, if one’s present autonomous requests completely contradict previous requests I think past autonomous opinions should be weighted more heavily. As well exampled in Childress’s argument , a woman who has been courageous about her treatment all her life who suddenly decides she wants to stop treatment is acting out of character. Although this is her present autonomous request, it should not be the end- all- be- all decision, because the authenticity is questionable.
Authenticity is another important concept regarding contradictory choices and is defined as, “an action is consistent with the attitudes, values, dispositions and life plans of the person” (Childress, 311). As the previous example portrayed, the woman’s authenticity was not intact, because her new rash opinion entirely contradicted what she had previously believed. Childress also argues that, “it would be a mistake to make authenticity a criterion of autonomy. At most, actions apparently out of character and inauthentic can be caution flags that warn others to request explanations and justifications to determine whether the actions are autonomous” (Childress, 311). This, I disagree with, because authenticity should be considered when a new judgment is inconsistent with previous ones. If a new opinion harshly contradicts years worth of beliefs then wouldn’t it make sense to more heavily consider prior opinions? Although this is very contradictory, an inauthentic statement should not change everything, it should mean little because long-standing opinions and beliefs more accurately represent one’s true stance. Another important point brought about by Levi in Respecting Patient Autonomy is that, “..in many cases present autonomous decisions conflict with the interest of preserving or promoting future autonomy, and one must choose between the two. This situation is perhaps most pressing when autonomous are greatly imprudent and likely to compromise future well-being in addition to autonomy” (Levi, 83). This statement entirely supports my argument because usually the inauthentic, imprudent judgments of patients that are inconsistent with their character greatly compromises their future well-being. Overall, I believe that past autonomous decisions that represent years worth of beliefs and opinions should be considered more heavily than rash, present autonomous decisions.
Interesting link regarding Doctors not respecting autonomy and pushing their own beliefs:
2.) Arguing About Bioethics- Holland
3.) Respecting Patient Autonomy- Levi
4.) Pressing Patients to Change Their Minds- Lerner