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If there is a single ethical principle that students learn at medical school, the chances are it is the requirement to respect the autonomy of patients. This principle finds its clinical expression in the obligation to seek informed consent.
Respecting patient autonomy means that doctors have a duty to provide competent patients with the opportunity to make an informed decision about their medical treatment. This principle, and its practical expression in consent, is strongly defended in law. Failure by a doctor to properly provide the conditions for the patient to make an informed choice could lead to prosecution for battery, although such cases are rare. It is likely that the potential legal consequences of not respecting informed choices are drummed into future doctors just as much as the moral ones.
The rise in the importance of the need to seek informed consent is linked to the desire of both doctors and healthcare organisations to limit legal liability. 1 More positively perhaps, the principle of respecting autonomy has also been central to the move away from a culture of medical paternalism during recent decades. It is probably fair to say that the idea that "doctor knows best" has, to a great extent, been replaced by the idea that "an adult patient knows best."
The concept of autonomy is cited far more than it is understood. Although the principle of autonomy is well established in medical ethics, while competent patients clearly retain the right to make decisions on their own behalf, in a practical sense patient's interests are best respected by seeing medical decision making as a partnership based on mutual respect, communication, and information exchange. Poorly understood, there is a danger that a respect for autonomy can be misinterpreted as a requirement to thrust decision making responsibility on patients. Medical decision making should as far as possible be a shared process.
Autonomy
The word "autonomy" derives from the Greek for "self rule." Originally it was applied not to individuals but to cities. An autonomous state, in contrast to a colony, enjoyed the right to make its own rules. It was self governing. 2 Colonies, being ruled by external agencies, were deemed to be heteronomous. Transferred to individuals, autonomy has been broadly defined as "the capacity to...