Medical Law on Adult Patients Autonomy
It is highly agreed globally that physicians are expected to negotiate instead of dictating the best interests of a patient. In the UK, medical ethics has evolved in partial ways over the recent two decades as an essential reaction to the kind of paternalism. Somewhat, the slogan that on the assumption that the Doctor always understands what best for their patient closes the mood of the particular period. The current government highly favors partnership which is termed as a form of good care. Today, it is widely acknowledged that physicians are expected to negotiate with the patients what is generally good for them rather than make dictations. Autonomy stands as familiar theory within the political, legal and moral values. Within the healthcare and medical ethics law has graduated to something full of familiarity and a great concern. Autonomy can simply be described as self governance[1]. However, different medical situations present a differing degree of autonomy in regard to how much the physician reveals to the patient[2]. In this situation it can be stated that the patient consultation normally has a loss of a certain autonomy degree. In partial nature, autonomy is offered protection in UK’s Medical Law via the principle of informed consent.
Patient autonomy respect is probably amongst the most debated concepts in medical law and ethics. The general respect for decisions consent by patients as adults is the medical law’s cornerstone. In medical law autonomy is best articulated as the competent adults right in creating informed decisions that regards self medical care[3]. The concept lies on the necessity of seeking informed agreement of a medical patient prior to the conduction of any treatment of even investigation. The concept’s aggressiveness is normally viewed in most instances where the medical patients exercises their freedom by denying themselves treatment that is life sustaining[4]. Based on the UK adult consent law it is stated that any patient as an adult who suffers from no mental inability holds the comprehensive right in making decisions that regards their medical treatment based on the Mental Capacity Act 2005. The particular selection right is however, not restricted to those decisions that are termed to be sensible to others. The right for making the particular options exists despite the fact that the rationale for developing the choices are irrational, rational, nonexistent, insensible or even unknown and this is according to Lord Donaldson. Re T (Adult), (1992), 4 All ER 649.
Prior to the classification of any decision as one that is autonomous there should be the presence of two ordinary conditions. To begin with, the adult patient is necessitated to be a holder of relevant internal abilities for personal governance and is additionally required to be free from all the existing external limitations. In the context of medics when a decision is made it is commonly referred to as autonomous where a person holds the ability of making accurate and reliable choices, holds adequate information in regard to decisions making and conducts the choices in a voluntary way. As examined from the statement from Lord Donaldson 1992 given that the particular adults holds adequate and reliable capacity their choices are not required to be highly sensible or objective to the sensitive towards the interests of the individual. It is the comprehensive right of a person to choice on what they want and it is therefore, the obligation of the doctor to offer them adequate information that regards their medical situation as well as the available options[5].
Medical autonomy for adults in most cases exists in reduced degree or even less than necessary. Provided that there is a much greater obligation of respecting the patients autonomous choices that regards medical treatment the only existing and possible exclusion is the offering of compulsory treatment under the medical legislation health[6]. The proceeds by clinicians with the lack of autonomous decisions depend mainly on the rationale behind the lack. If an adult patient is particularly being intimidated into making choices by giving pressuring choices the decision cannot therefore be classified as their own and within the existing law it cannot therefore, be respected. In realism, it is actually very challenging to identify the occurrence of intimidation[7]. For instance a young lady may visit the physician alongside her partner in request for a pregnancy termination. The lady in the case may be acting under much pressure to ensure that the process proceeds but that cannot be easy to establish. In the 1985 case on Sidaway Vs Bethlem Royal Hospital Governors, a patient developed paralysis after undergoing an operation that was targeted at relieving a trapped nerve[8]. This is demonstrated similarly by Bolam Vs Frien Barnet Management Committee 1957 that demonstrated the responsibility of offering informed details in regard to treatment[9].
The current association within the healthcare system has not achieved patient centeredness which if achieved may result into the development of a partnership amid the patients and physicians. In addition most of the doctors retains the uneasiness in regard to the world where the privilege of the expertise autonomy is permanently altered by the growing demands for accountability as well as transparency. This leads to the growth of silence amid the parties. Communication is not present which would be crucial in assisting patients to make highly beneficial informed consent. Increasing talks amid doctors and physicians would end the silence millennia that took the paternalistic authority of the clinicians and created fewer options for patients and subjecting them to compliance and silence rebellion. The silence has created moral as well as psychic impacts and among the most destructive of the effects is the creation of distrust. In this case patients cannot trust their clinicians in acting in their best intentions while physicians operate in the assumption that physicians are not competent in the development of intelligent, informed and rationale choices regarding healthcare thus distrusting them to act in autonomy[10]. As a result the power of the patients is normally ignored by limiting the content they are given thus losing a certain degree of medical decisions control.
In most cases autonomous should best be achieved by offering the involved patients some time to make their decisions without pressure. The only agreeable individual conduct to the decisions of others is the choice that concerns the wellness of the society[11]. However, in the situation where the choices concern themselves, their independence becomes an absolute right. This decision should be independent when it regards to individual mind and body thus becoming sovereign. Where adult patients lacks the capability of developing choices it therefore becomes the necessity of decisions being made on their behalf which results in the loss of greater autonomy. In the cases of adults the decisions are developed by health professions who are completely responsible for providing care but they additionally have the opportunity of choosing those that can make the particular decisions for them. In the medical practice, choices that are connected to adult patients who are incapacitated are supervised closely by the law[12].
Certain autonomous adult patients degree are lost based on the primary issue that the court makes more emphasis based on the presented cases to the passing of the necessary information by the physicians to the patient while the understanding of the given information’s or options is being ignored. In most instances that how greater, less of full patient autonomy is lost. In the sense that while the freedom to develop certain decisions is being guarded the autonomy is however, not protected. For instance, in the case such as that of Chester v Afshar the claimant’s scope was apparent[13]. The patient had the right on making the option of refusing the medical surgery that Afshar as the surgeon was offering , however based on her argument she should have been provided with more information regarding the surgery which involves details and the options that as the patient she had and the involved impacts. In the particular case the courts were not exposed to the obligation of establishing liberty’s limits rather their primary role was on evaluating the appropriate demands that were made on autonomy’s respect.
Prior to the provision of any kind of treatment or any medical procedures on the patients consent must be offered with competence exists. This is however based on the offered information by the doctor which should be sufficient in regard to making relevant decisions. The information should be regarding the condition, existing options benefits as well as the involved risks. In most consultations patients losses a part of autonomy in that the information disclosed to them is inadequate[14]. This results in the rise of unreasonable or unreliable choices that are not grounded on wellness. the lack of adequate information makes it apparent that it may lead to the loss of the patient’s autonomy since the patients are bound to make decisions which are not balanced based on the wrong judgment that is caused after the patient is deprived enough information[15]. Prioritizing autonomy in some cases leads to the determination of the type and the quality of information to be provided. the imbalance section amid the patient and the doctors is normally grounded on the lack of sufficient information by the patient. From a single perspective it is the role of the medical law and the governing law to address the issue of balance through ensuring that patients are fully given the right to the provision of sufficient data that regards their health and care. This may perhaps work best through the imposition of a doctor’s duty on the provision of sufficient information[16].
The existence of the patient without the right of information provision denies them their full autonomy. Individuality as well as the patient’s autonomy is best exercised with provision of privileges of acquiring information which best equips them with adequate knowledge. Autonomy that is based on the lack or the presence of little knowledge results in higher misunderstandings and the settling for insensitive choices since the patients are exposed to unbalanced judgments. The most important flaw lies on that the offering of information does not guarantee decisions with autonomy but only makes it certain that the doctor has given information that will assist in decision creation. The treatment decisions rely solemnly on the patient and thus information adequacy is a necessity. Despite the fact that the decisions being made medically are aimed to create a general wellness an individual has the right to denial. For instance in the case of ST. Georgia’s Healthcare NHS Trust Vs S the court made the ruling that the woman has the right of refusing treatment despite the fact that it is aimed at benefiting the unborn[17].
The current medical treatment can be categorized as one that is characterized by silence as well as the compliance of patients. From history the relationship of the physicians and the patients is grounded on a single root trust despite the most recent attempts by the judicially in offering patients with increased voice via the informed consent doctrine[18]. Physicians highly encourages their patients in giving up their individual autonomy and the silence that they demonstrate in denying patients information results in detrimental impacts on the general wellness of the patients. There is a growing necessity in the modern era for the healthcare sector to be fully covered by effective communication as well as honesty amid clinicians and the patients. In this context the rights of every individual should be respected by permitting patients to decide on their treatment options without being pressured. In addition the rights of the patients are violated since the physicians decides on giving inadequate data and also ignores the patients understanding of the given information.
Adults are always reluctant in acquiring more information that regards their health or to discuss the options given by the physicians in regard to treatment based on the assumption of compliance and confidentiality concerns[19]. Individuals have widely accepted to the thought that doctors have high authority over the patients based on their professional and the fact that they understand the best form of treatment for their patients. This issue has thus been rooted deeply in the modern society where acquiring and giving adequate information is the major concern. Patients comply with the silence offered by the physicians who are assumed to be holders of more authority that relates to their profession. The relevance of the issues of trust and less communication amid the physicians and the respective patients continues to be relevant in the world today. According to Katz the issue can best be resolved with the implementation of increased communication , development of trust and giving autonomy when it comes to the making of decisions[20]. Autonomy of the patient is highly affected by the issues while the authority and dominance of the physicians in regard to the matters is upheld.
Patients are highly denied the rights, liberty as well as autonomy as necessitated by the informed consent. The pressure and the manipulation that is exerted on the patents by the doctors results in psychological implications , the loss of independence as well as medical autonomy. Actual communication which holds the capability of creating mutual and meaningful trust and make the autonomy of the patients possible is denied by the physicians. Based on Al Hamwi v Johnstone and another, Al Hamwi desired to conduct an amniocentesis since she was pregnant and her family held the history of children being born with physical impairment. Miss Kerslake insisted on the involved screening risks without considering other factors that pressured the claimant to change her decision. Unfortunately the child was born with significant impairments which were physical. It is clear that the risks in the case were overstated thus intimidating the client.
Within the developed legal and ethical medical law’s framework it becomes very challenging to restructure the relationship amid the doctors and patients based on the doctor’s behaviors of limiting information and the assumptions that the doctor’s profession offers them better opportunities in making decisions[21]. Patients with the required mental competence can be trusted in making medical decisions that regards their wellness[22]. on the other hand physicians holds the right and trust on making accurate decisions for patients who lacks the competence. For the rights of both parties to be respected without the domination of a single party in the matter trust creation is a greater necessity[23]. In some instances information can be withheld from the patient based on The Data Protection Act 1998 which allows information to be denied given that it may lead to mental or physical damages on the patient which highly requires adequate and documented justifications.
The interests of the patients, their values are normally neglected at the period when they are of much significance in the subjects of wellness, existence and death. The modern society emphasis more on quality healthcare which in turn creates the training on physicians that they are best equipped to make choices for the patients. The non disclosure of sufficient information to patients is historically perceived as a necessity that is fully medical doubt and doctors incapability with not much to give to the patients above the psychological and wording comforts[24]. The modern medical science has achieved so much in regard to treatment options and diagnosis but non disclosure has continuously been promoted. The medical sector is characterized by high uncertainty the ability to empower patients as decisions makers in regard to healthcare should be emphasized[25]. The silence that is demonstrated by doctors and particularly in times when their medical uncertainty confronts them is equal to the neglect of patients rights.
In summary, It is apparent that when patients makes a doctor’s consultation there is always a loss of a certain autonomy degree which may be less or greater depending on the condition. It is clear that the autonomy of the patients in the healthcare sector is normally lost due to the provision of inadequate information in reference to their condition, treatment options, the risks as well as the involved benefits. The information that is normally offered to the patients is characterized by much complexity that makes it hard for them to understand and make the right judgments. In most cases clinicians will always offer the benefits that are related to a treatment and ignore the involved risks. Physicians normally withhold much of the details by only exposing the information that places the patients at settling for the decisions that are considered to be sensible. Competence capability is always not considered since information limit is always targeted at intimidating the patients to make decisions that the clinicians believes to be the most appropriate in form of offering benefits that are related to treatment. The ability and the privilege held by physicians in withholding information limits the general ability of the patients in making decisions based on the limited knowledge. In addition the clinicians fail to clarify the information to make it easier to understand.
References
Dalphinis, J. (2016). Safeguarding adults: an update on legal principles. Practice Nurse, 46(9), 12-16.
Gray, A., & Harrison, S. (2004). Governing medicine: Theory and practice. Maidenhead, Berkshire, England: Open University Press.
Katz, J. (2002). The silent world of doctor and patient. Baltimore: Johns Hopkins University Press.
Leino-Kilpi, H. (2000). Patient's autonomy, privacy and informed consent. Amsterdam [u.a: IOS Press [u.a..
NHS. (2016). Consent to Treatment Capacity. Retrieved from http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Capacity.aspx
- (2014). Consent and Confidentiality, Main Principles of Consent. Ministry of ethics. Retrieved from http://ministryofethics.co.uk/?p=6
Uk. (n.d). Mental Capacity Act 2005. Retrieved from http://www.legislation.gov.uk/ukpga/2005/9
[1] Safeguarding Adults: An Update on Legal Principles. (Practice Nurse 2016)
[2] Consent and Confidentiality, Main Principles of Consent (Ministry of ethics UK 2014)
[3] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[4] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[5] Safeguarding Adults: An Update on Legal Principles. (Practice Nurse 2016)
[6] Consent and Confidentiality, Main Principles of Consent (Ministry of ethics UK 2014)
[7] Mental Capacity Act 2005 (UK n.d)
[8] Governing medicine: Theory and practice (Maidenhead 2004)
[9] Governing medicine: Theory and practice (Maidenhead 2004)
[10] Patient's autonomy, privacy and informed consent (Amsterdam 2000)
[11] Patient's autonomy, privacy and informed consent (Amsterdam 2000)
[12] Consent and Confidentiality, Main Principles of Consent (Ministry of ethics UK 2014)
[13] Consent and Confidentiality, Main Principles of Consent (Ministry of ethics UK 2014)
[14] Safeguarding Adults: An Update on Legal Principles. (Practice Nurse 2016)
[15] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[16] Patient's autonomy, privacy and informed consent (Amsterdam 2000)
[17] Patient's autonomy, privacy and informed consent (Amsterdam 2000)
[18] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[19] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[20] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[21] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[22] Consent to Treatment Capacity (NHS 2016)
[23] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[24] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
[25] The Silent World of Doctor and Patient (John Hopkins Paperbacks 2002)
