Advertisement

A Critique of Autonomy and Patient Responsibility

  • Barbara MaierEmail author
  • Warren A. Shibles†
Chapter
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 47)

Abstract

Autonomy for patients is respect for the rational decision-making, without coercion, of a patient regarding his or her medical care. Autonomy involves the view that the patient has the capacity: 1. to create ideas and goals for life, 2. for moral insight, self-legislation, privacy, 3. for political involvement and personal responsibility. Self-determination, care and responsibility go together, their separation weakens each of them. Unquestioned autonomy is challenged by criticisms of the principle of autonomy: Autonomy can be a way to avoid decision-making, it can be a way for physicians to transfer responsibility such as leaving patients to their autonomy as a form of defensive medicine. From autonomy follows responsibility. Challenging a severely limited autonomy concept we need rational, informed, critical decision making and a consequentialistic, naturalistic theory of ethics.

Keywords

Autonomy criticisms of the principle of autonomy paternalism consent rational choice self-determination responsibility transfer of responsibility patient code of ethics patient duties 

References

  1. 1.
    Parts of this chapter were published in Maier, B. 2006. Autonomy: On decision-making in prenatal diagnosis, In Parental Testing Individual Decision or Distributed Action. 179–189. München, Wien: Profil Verlag.Google Scholar
  2. 2.
    Hope, T., Savulescu, J., and Hendrick, J. 2003. Medical ethics and the law: The core curriculum, 34. London: Churchill Livingstone/Elsevier.Google Scholar
  3. 3.
    Maier, B. 2000. Ethik in Gynäkologie und Geburtshilfe. Entscheidungen anhand klinischer Fallbeispiele, 14–16. New York, Tokio: Springer, Berlin.CrossRefGoogle Scholar
  4. 4.
    Arras, J. 2002. Pragmatism and bioethics: Been there, done that. Social Philosophy and Public Policy 19:29–58; esp.29.CrossRefGoogle Scholar
  5. 5.
    O’Neill, O. 2002. Autonomy and trust in bioethics, 36. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  6. 6.
    Loewy, R. 2000. Integrity and personhood: Looking at patients from a bio/psych/social perspective, 48. Dordrecht: Kluwer.Google Scholar
  7. 7.
    Nussbaum, M., and Sen, A. 1993. Quality of life, 127. Oxford: Clarendon Press.CrossRefGoogle Scholar
  8. 8.
    Quante, M. 2002. Personales Leben und menschlicher Tod: Personale Identität als Prinzip biomedizinischer Ethik, 174. Frankfurt am Main: Suhrkamp.Google Scholar
  9. 9.
    Jonsen, A., Siegler, M., and Winsdale, W. 1982/1998. Clinical ethics, 4th edn, 56. New York: McGraw-Hill.Google Scholar
  10. 10.
    Maier, B. 1999. Ärztliche Aufklärung in ethischer Perspektive. In Ärztliche Verantwortung und Aufklärung. eds. Harrer, F., and Graf, A., 165–178; esp.176. Wien: Orac Verlag.Google Scholar
  11. 11.
    For a discussion of responsibility see Maier, B. 2000. Ethik in Gynäkologie und Geburtshilfe. Entscheidungen anhand klinischer Fallbeispiele, 14–19. Berlin, New York, Tokio: Springer.Google Scholar
  12. 12.
    O’Neill, O. 2002. Autonomy and trust in bioethics, 24. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  13. 13.
    Kilner, J. 1994. Allocation of health-care resources: Microallocation. In Encyclopedia of bioethics. ed. Post, S., vol 2, 1107–1116; esp. 1081. New York: Macmillan.Google Scholar
  14. 14.
    Hope, T., Savulescu, J., and Hendrick, J. 2003. Medical ethics and the law: The core curriculum, 123. London: Churchill Livingstone/Elsevier.Google Scholar
  15. 15.
    Berghmans, R., and Widdershoven, G. 2003. Ethical perspectives on decision-making capacity and consent for treatment and research. Medicine and Law 22:391–400.PubMedGoogle Scholar
  16. 16.
    Hope, T., Savulescu, J., and Hendrick, J. 2003. Medical ethics and the law: The core curriculum, 34. London: Churchill Livingstone/Elsevier.Google Scholar
  17. 17.
    Medical Ethics Manual. 2005. World medical association, 44. France: Ferney-Voltaire Cedex.Google Scholar
  18. 18.
    Medical Ethics Manual. 2005. World medical association, 64. France: Ferney-Voltaire Cedex.Google Scholar
  19. 19.
    Maier, B. 1999. Ärztliche Aufklärung in ethischer Perspektive. In Ärztliche Verantwortung und Aufklärung. eds. Harrer, F., and Graf, A., 165–178; esp.172. Wien: Orac Verlag.Google Scholar
  20. 20.
    Glover, J. 1977. Causing death and saving lives, 77. Harmondsworth: Penguin.Google Scholar
  21. 21.
    Loewy, R. 2000. Integrity and personhood: Looking at patients from a bio/psycho/social perspective, 53. Dordrecht: Kluwer.Google Scholar
  22. 22.
    Hasenöhrl, G., Maier, B., Steiner, H., Stempfl, A., Georgoulopoulos, A., Zuchna, C., and Staudach, A. 2004. Sectio oder nicht Sectio – oder sollen wir uns das noch antun? Speculum 22:1–3.Google Scholar
  23. 23.
    Hippocrates. 1957. Jones, W. tr. Precepts IX, vols 2. Cambridge, MA: Harvard University Press.Google Scholar
  24. 24.
    Jonsen, A., Siegler, M., and Winsdale, W. orig. 1982/1998. Clinical ethics, 4th edn, 51. New York: McGraw-Hill.Google Scholar
  25. 25.
    Loewy, E. 1996. Textbook of healthcare ethics, 61. New York: Plenum.Google Scholar
  26. 26.
    Beauchamp, T., and Childress, J. 1999. Contemporary issues in bioethics, 5th edn, 19; 20. Belmont, CA: Wadsworth.Google Scholar
  27. 27.
    Reiter-Theil, S. 2001. The Freiburg approach to ethics consultation: Process, outcome and competencies. Journal of Medical Ethics 27, suppl I: i21–23; esp. i22.PubMedCrossRefGoogle Scholar
  28. 28.
    Nussbaum, M., and Sen, A. 1993. Quality of life, 186 f. Oxford: Clarendon Press.CrossRefGoogle Scholar
  29. 29.
    Maier, B. 2000. Ethik in Gynäkologie und Geburtshilfe. Entscheidungen anhand klinischer Fallbeispiele, 63. Berlin, New York, Tokio: Springer.CrossRefGoogle Scholar
  30. 30.
    Griffin, J. 1986. Well-being: Its meaning, measurement and moral importance, 33. Oxford: Oxford University Press.Google Scholar
  31. 31.
    Jopling, D. 1996. Philosophical counselling, truth and self-interpretation. Journal of Applied Philosophy 13:297–309; esp. 304.CrossRefGoogle Scholar
  32. 32.
    Harris, J. 1999. The concept of the person and the value of life. Kennedy Institute of Ethics 9:293–308.CrossRefGoogle Scholar
  33. 33.
    Jonsen, A. 1998. The birth of bioethics, 104. New York: Oxford University Press.Google Scholar
  34. 34.
    Loewy, R. 2000. Integrity and personhood: Looking at patients from a bio/psycho/social perspective, 33. Dordrecht: Kluwer.Google Scholar
  35. 35.
    Loewy, R. 2000. Integrity and personhood: Looking at patients from a bio/psycho/social perspective, 36. Dordrecht: Kluwer.Google Scholar
  36. 36.
    Post, S. 2004. Encyclopedia of bioethics, 3rd edn, 5 vols, 1260. New York: Macmillan.Google Scholar
  37. 37.
    Hope, T., Savulescu, J., and Hendrick, J. 2003. Medical ethics and the law: The core curriculum, 67. London: Churchill Livingstone/Elsevier.Google Scholar
  38. 38.
    Lenk, H., and Maring, M. 1995. Wer soll Verantwortung tragen? Probleme der Verantwortung in komplexen Systemen. In Verantwortung: Prinzip oder Problem? ed. Bayertz, K., 286–366; esp. 347. Darmstadt: Wissenschaftliche Buchgesellschaft.Google Scholar
  39. 39.
    Lenk, H. 1998. Konkrete Humanität. Vorlesungen über Verantwortung und Menschlichkeit. Frankfurt am Main: Suhrkamp Taschenbuch Wissenschaft.Google Scholar
  40. 40.
    Maier, B. 2000. Ethik in Gynäkologie und Geburtshilfe. Entscheidungen anhand klinischer Fallbeispiele, 14–15. Berlin, New York, Tokio: Springer.CrossRefGoogle Scholar
  41. 41.
    Maier, B. 2000. Ethik in Gynäkologie und Geburtshilfe. Entscheidungen anhand klinischer Fallbeispiele, 14. Berlin, New York, Tokio: Springer.CrossRefGoogle Scholar
  42. 42.
    Mitterauer, B., Maier, B., and Griebnitz, E. 1999. Probleme der Aufklärbarkeit und Einwilligungsfähigkeit psychisch kranker Patienten bei klinischen Studien zur Prüfung von Psychopharmaka. In Ärztliche Aufklärung und Verantwortung. eds. Harrer, F., and Graf, A., 155–184; esp. 155, 159. Wien: Orac Verlag.Google Scholar
  43. 43.
    Mitterauer, B., Maier, B., and Griebnitz, E. 1999. Probleme der Aufklärbarkeit und Einwilligungsfähigkeit psychisch kranker Patienten bei klinischen Studien zur Prüfung von Psychopharmaka. In Ärztliche Aufklärung und Verantwortung. eds. Harrer, F., and Graf, A., 155–184; esp. 160. Wien: Orac Verlag.Google Scholar
  44. 44.
    Mitterauer, B., Maier, B., and Griebnitz, E. 1999. Probleme der Aufklärbarkeit und Einwilligungsfähigkeit psychisch kranker Patienten bei klinischen Studien zur Prüfung von Psychopharmaka. In Ärztliche Aufklärung und Verantwortung. eds. Harrer, F., and Graf, A., 155–184; esp.161. Wien: Orac Verlag.Google Scholar
  45. 45.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352.CrossRefGoogle Scholar
  46. 46.
    American Medical Association. Principles of Medical Ethics. Adopted by the AMA´s House of Delegates June 17, 2001 in its Preamble to the Principles of Medical Ethics.Google Scholar
  47. 47.
    Resnik, D. 2005. The patient’s duty to adhere to prescribed treatment: An ethical analysis. Journal of Medicine and Philosophy 30:167–188; esp.179 ff.PubMedCrossRefGoogle Scholar
  48. 48.
    Resnik, D. 2005. The patient’s duty to adhere to prescribed treatment: An ethical analysis. Journal of Medicine and Philosophy 30:167–188; esp.172.PubMedCrossRefGoogle Scholar
  49. 49.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.335.CrossRefGoogle Scholar
  50. 50.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.338.CrossRefGoogle Scholar
  51. 51.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.340.CrossRefGoogle Scholar
  52. 52.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.341.CrossRefGoogle Scholar
  53. 53.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.343.CrossRefGoogle Scholar
  54. 54.
    Draper, H., and Sorell, T. 2003. Patient’s responsibilities in medical ethics. Bioethics 16:335–352; esp.344.CrossRefGoogle Scholar
  55. 55.
    National Health Service. 2002. Engendering patient responsibility. NHS 2002:26.Google Scholar
  56. 56.
  57. 57.
    Buetow, S., and Elwyn, G. 2006. Are patients morally responsible for their errors? Journal of Medical Ethics 32:260–262; esp.260.PubMedCrossRefGoogle Scholar
  58. 58.
    American Medical Association’s Code of Medical Ethics 2009 Chicago: American Medical Association Opinion 10.02. Patient Responsibilities http://www.ama.assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion1002.html
  59. 59.
    Medical Ethics Today 2004. 63.Google Scholar
  60. 60.
    For an account of how patients can be more responsible about their healthcare, see http://www.familydoctor.org/736.xml.
  61. 61.
    e.g., German Code of Ethics. http://www.bundesaerztekammer.de.
  62. 62.
    Schneider, S. 2005. The patient from hell: How I worked with my doctors to get the best of modern medicine and how You can get too. New York: Da Capo Press.Google Scholar
  63. 63.
    Hope, T., Savulescu, J., and Hendrick, J. 2003. Medical ethics and the law: The core curriculum, 123. London: Churchill Livingstone/Elsevier.Google Scholar
  64. 64.
    Salzburger Nachrichten. July 13th, 2006:6.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsParacelsus Medical University SALKSalzburgAustria
  2. 2.University of Wisconsin–WhitewaterWhitewaterUSA

Personalised recommendations