Autonomy In Medical Ethics (Simply Explained)

Updated on: December 3, 2023
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Written By Dr Ollie

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Autonomy in medical ethics refers to the principle of respecting a patient’s right to make their own decisions about their healthcare.

It essentially means a patient gets to decide how they want their medical conditions treated.

This concept plays a crucial role in shaping the interactions between medical professionals and their patients.

In this article, I’m going to further explore what this principle means to both doctors and patients, as well as look at some real-life examples of it in play.

What Is Autonomy?

Autonomy in medical ethics refers to the principle that patients have the right to make their own decisions regarding their healthcare, treatment and overall well-being.

This concept is central to the practice of medicine and is deeply rooted in respect for individual rights, fostering trust between patients and healthcare professionals.

Autonomy In Medical Ethics Pixel Infographic

One of the key applications of autonomy is the informed consent process, in which healthcare professionals share comprehensive information about a proposed treatment or procedure, including the potential benefits, risks, and available alternatives.

Patients’ decisions should be respected, even if they choose a different course than the one recommended by their healthcare provider.

Respecting patient autonomy fosters a sense of dignity and personal identity, as well as promoting a collaborative approach to healthcare decision-making.

LEARN MORE: My comprehensive guide to the four pillars of medical ethics

Why Is Autonomy Important?

The importance of autonomy in medical ethics lies in its role as a cornerstone for open, honest and supportive relationships between patients and healthcare professionals.

By promoting this decision-making power, autonomy empowers patients, enables personalised and patient-centred care, and upholds the ethical standards of the medical profession.

By reflecting the importance of individual choice and decision-making, autonomy helps ensure that patients are active participants in their own care.

This fosters a healthcare environment that respects the unique needs, values, and perspectives of each patient.

Autonomy also means that patients have the ultimate responsibility for their own treatment decisions.

Healthcare professionals are ethically obliged to respect these choices, providing information and support without imposing their own beliefs or preferences.

This principle underpins key medical practices such as informed consent, where patients must be given sufficient information to understand the implications of a proposed intervention and can freely decide whether to accept or decline it.

Patients should be given accurate information about their diagnosis, prognosis, and treatment options, allowing them to make informed decisions based on the facts.

While autonomy is vital, it is essential to balance it with other ethical principles such as beneficence, non-maleficence, and justice.

These principles work in tandem, ensuring that healthcare providers not only respect patient autonomy but also strive to do good, prevent harm and promote fairness in healthcare.

Autonomy Interview Question Examples

Being one of the four main pillars of medical ethics, autonomy is frequently discussed at medical school interviews.

Refusing Your Advice

As a GP, you’ve just diagnosed a patient with high blood pressure (hypertension). To treat their high blood pressure, you recommend they take a blood pressure lowering medication. However, the patient refuses your advice, saying they don’t want any “harsh chemicals” in their body. What are your options as the doctor?

At the end of the day, a competent adult can make their own decisions about what they do, or do not, want to do.

You, as the doctor, can only provide your expert advice regarding a patient’s healthcare.

In this example, there’s not a huge amount you can do. If a patient refuses your advice and doesn’t want treatment then you have to respect their autonomy and not prescribe them any treatment.

All you can do is explain in the clearest way possible why you think treatment would be beneficial and what the consequences of refusing your treatment might be for their health in the future.

A Stabbing Victim

A 30-year-old man has just been stabbed and is immediately brought into the emergency department. He’s profusely bleeding from an abdominal wound and a cut on his upper left thigh. He needs an urgent blood transfusion in order to replace the blood he’s losing from his wounds. However, the patient refuses stating that he’s a Jehovah’s Witness. What would you do?

This is an absolute classic of an interview question as Jehovah’s Witnesses are model examples to use to test a candidate’s understanding of autonomy.

Jehovah’s Witnesses are known to refuse blood transfusions due to their religious beliefs even when they may be life-saving.

If the patient is fully compos mentis, the short answer is that you respect their autonomy by not giving them the blood transfusion and potentially letting them die.

However, these scenarios can quickly become a lot more complex- you can find more detail in this article about the ethical dilemmas Jehovah’s Witnesses can pose clinicians.

Refusing A Vaccine

The parents of a 3-year-old boy are refusing to give their consent for their son to receive a vaccination. They’ve read some questionable studies online that have led them to believe the vaccine could have long-lasting negative effects on their son’s health. How would you approach this situation as the child’s doctor?

This scenario challenges a candidate’s ability to respect parental autonomy while considering the well-being of the child.

If doctors and parents disagree about what’s best for a child it can lead to some really sticky situations.

In this case, a doctor wouldn’t force the parents to have their son vaccinated- their autonomy would be respected.

However, in more serious cases, where a child’s life could be at risk, things can escalate as both the doctors and parents fight for what they think is best- as we’ll see in the next section.

Challenges To Autonomy

While doctors will always do their best to uphold the pillar of autonomy, there are cases where things can get a little more tricky.

Paediatric Cases

In paediatric cases, challenges tend to arise since children usually lack the capacity to make complex decisions.

In these cases, the responsibility falls on the parents or guardians.

It is therefore essential for healthcare providers to collaborate with the families, while still considering the child’s preferences and level of understanding.

When a child’s parents and doctors disagree as to what is best for the child, each side may end up having to argue their viewpoints out in court.

The court can then decide which course of action is best for the child (patient) in question.

A recent example of this happening would be the tragic case of Charlie Gard.

Mental Incapacity

Another challenge to autonomy in medical ethics concerns patients without mental capacity.

These individuals may be unable to fully comprehend the risks, benefits, and potential outcomes of their medical decisions so are generally deemed to lack capacity.

This problem poses ethical dilemmas for healthcare providers who must balance the need to respect autonomy with the need to provide appropriate care.

In such scenarios, surrogate decision-makers can be appointed to act on the patient’s behalf, or healthcare professionals can be guided by the patient’s previously expressed wishes and best interests.

Cultural Differences

In a culturally diverse society, varying values and norms have the potential to affect decision-making processes.

Some cultures emphasise collective decision-making, where autonomy might not be the dominant ethical principle.

Healthcare providers should respect cultural differences, but at the same time, strive to uphold the importance of patient autonomy.

This challenge involves navigating around cultural sensitivities, understanding patients’ perspectives, and emphasising the value of patient-centred care within the context of diverse cultural backgrounds.

Notable Cases

Here are a couple of notable cases that put the principle of autonomy under the spotlight in real-life situations.

Montgomery v Lanarkshire Health Board (2015)

In the landmark case of Montgomery v Lanarkshire Health Board in the UK Supreme Court, a significant shift in the law around informed consent and autonomy was marked.

Before Montgomery, the standard for disclosure of risk relied heavily on the “Bolam test.” The Bolam test is essentially whether or not you acted in the same manner as another doctor would have in your position.

In Montgomery, the Court set a new patient-centred standard.

Doctors were required to inform patients of any material risks involved in the treatment and any reasonable alternative treatments, considering the patient’s perspective and what they would likely attach importance to.

Aintree University Hospitals NHS Foundation Trust v James (2013)

In Aintree University Hospitals NHS Foundation Trust v James, the UK Supreme Court clarified the approach to be taken when making a decision for an incapacitated patient under the Mental Capacity Act 2005.

As the patient could not make the decision himself, the Court emphasised that any decision made on his behalf should be based on the principle of the patient’s best interests.

This would involve considering the patient’s past and present wishes, feelings, beliefs, and values, thereby respecting their autonomy despite their incapacity.

Balancing Autonomy With Other Ethical Principles

Doctors don’t just consider autonomy on its own when deciding on the most ethical course of action in a scenario. They consider it alongside the other 3 pillars of medical ethics.

Beneficence

Autonomy is often balanced with the principle of beneficence– the ethical obligation to do good and promote the well-being of the patient.

A house officer taking the blood pressure from a patient
A doctor taking a patient’s blood pressure

While respecting a patient’s autonomy means allowing them to make their own informed decisions, medical professionals must also weigh the potential benefits of treatments or interventions.

This can lead to a complex interplay between autonomy and beneficence, with medical professionals striving to find the most appropriate course of action that respects the patient’s wishes while promoting their overall well-being.

Non-Maleficence

Non-maleficence, the obligation to not cause harm or impose unnecessary risks, is another key principle in medical ethics.

Autonomy and non-maleficence can sometimes appear to be in conflict, as patients may choose a course of action that could potentially be harmful or risky.

In such cases, medical professionals must carefully consider the patient’s autonomous decision, while also evaluating the potential harms and benefits associated with the chosen course of action.

Striking a balance between autonomy and non-maleficence requires clear communication and a deep understanding of the patient’s values and preferences.

Justice

Finally, the principle of justice– ensuring fairness and equal treatment for all patients – must be balanced with autonomy.

Respecting a patient’s autonomous choices becomes more complex when those choices could potentially lead to unfair distribution of resources or unequal access to care.

In such situations, medical professionals must consider not only their ethical obligation to respect individual autonomy but also the broader implications of those choices on justice within the healthcare system.

Medical professionals must navigate these complex interactions in order to make the most appropriate ethical decisions that respect patients’ wishes while promoting health, minimising harm, and ensuring fairness in the distribution of resources.

Final Thoughts

The notion of autonomy has been a core component of medical ethics since the early days of the field.

The idea signifies that every patient has the right to self-govern, allowing them to maintain their dignity and independence even when facing difficult medical decisions.

By better understanding and enhancing respect for patient autonomy, healthcare providers can aspire to deliver more compassionate, patient-centred care.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.