Two Different Levels of Patient Autonomy

Abstract

Autonomy, literally the use of one’s own law, is the quality or state of being independent, free, and self-directing, and employing “the sovereignty of reason, self-determination and self-legislation in the realm of morals” (Webster’s). Implied here is a social-interpersonal milieu wherein other-directed behavior is the counterpoise of autonomy. However, these general definitions are inadequate for the question of autonomy in doctor-patient interactions. Take, for example, a case of “simple” influenza. The doctor may prescribe prophylactic antibiotics and forbid next month’s scheduled business trip, out of concern for its possible effects upon his patient’s cardiac condition and for the danger of a secondary infection. The patient refuses to comply, having always succeeded through unflagging work, while ignoring what he calls his “minor heart problem.” At what point would the doctor’s respect for his patient’s autonomy become a medical blunder?