Principle of Respect for Patient Autonomy PDF

Principle of Respect for Patient Autonomy Onur TURAN, PT, PhD (c), Lecturer Principle of Respect for Patient Autonomy Learning Outcomes; 1. Defines the principles of respect for autonomy. 2. Defines the concept of autonomy. Concept of Autonomy "Autonomy", is a word coming from ancient...

Principle of Respect for Patient Autonomy Onur TURAN, PT, PhD (c), Lecturer Principle of Respect for Patient Autonomy Learning Outcomes; 1. Defines the principles of respect for autonomy. 2. Defines the concept of autonomy. Concept of Autonomy "Autonomy", is a word coming from ancient Greek. This word is derived from the combination of the Greek words; "autos", meaning "self", and "nomos", meaning "rule", "management" or "law". Self management Concept of Autonomy "Autonomy" in the sense it still has today; Citizens can make their own rules and laws without being under any external pressure, or It is the ability of citizens to govern themselves. It was first used in this sense in ancient Greek civilization. Apart from this, autonomy is a term with philosophical features that is used in many areas other than just describing the relationship of citizens with the state. Concept of Autonomy Personal autonomy is widely valued: most people think it is preferable to somehow be their own person and shape their own lives than to live under the control of others. Recognition of the particular vulnerability of patients’ autonomy has underpinned the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. Concept of Autonomy Considerations of respect for autonomy in health care contexts tend to focus on situations in which decisions need to be made about health care interventions. A principle of respect for autonomy is also invoked in discussions about confidentiality, fidelity, privacy and truth-telling, but is most strongly associated with the idea that patients should be allowed or enabled to make autonomous decisions about their health care. Beauchamp and Childress’ influential definition identifies autonomous decisions as those made intentionally and with substantial understanding and freedom from controlling influences. Autonomous Individual Every individual has their own values, beliefs and life goals Has a right to make rational-free actions and choices in accordance with the needs and conditions The autonomous individual distinguishes whether his action is "autonomous action". Autonomous Individual In order for such an autonomous individual to take autonomous action, at least; 1. Self-management; 2. Ability to take some principles into consideration when taking any action; 3. They must have the ability to express their own unique views in their attitudes and behaviors.  Autonomous Selection Autonomous selection; They are the choices made by the individual while determining his original-rational decisions and actions within his own competence and free conditions. Autonomous Action Autonomous action can be briefly defined as the "action" performed by the "autonomous individual" by making an "autonomous choice". In this context, the features that determine the nature of "autonomous action" are as follows: 1. Action's Purpose 2. Conscious Action 3. Willingness of Action 1. Action is Purposeful The action must be chosen and planned rationally by the individual. However, it should be emphasized that the action does not always have to be an absolutely desired action. For example; Sometimes, the action chosen may run counter to the individual's own beliefs and values. This does not eliminate the autonomy of action. Because the action is in accordance with the goals and the individual in question has taken a rational action based on his ability to reason. 2. Consciousness of Action Before taking an autonomous action, the individual determines his/her intended action; must be understood. The action does not otherwise qualify as "Autonomous". For example, it cannot be claimed that the patient's action is "autonomous" if he has not understood and comprehended information about the treatment planned to be administered to the patient.  In the actions of the individual; It is the absence of any external factor that directs him to this action, and the individual can act within his own freedom. 3. Willingness to The individual should not be influenced while taking an autonomous action. Action If such a situation is the case, it cannot be claimed that the action is autonomous because the state of willingness disappears. Can an Autonomous Individual always take Autonomous Action? Sometimes autonomous individuals with the stipulated conditions and competencies may have to take non-autonomous actions, sometimes even temporarily. These temporary situations are; In medicine, it may include, for example, different diseases, mental disorders such as depression, and special conditions such as being under pressure. Respect For The Individual What is meant by the expression "respect to the individual" is that the aspects related to him such as his values, beliefs, abilities, choices, and thoughts (including of course his physical aspect) are valued and respected by another individual (group, society, state, etc.). ; It is the acceptance of these individual aspects of him. Undoubtedly, this relationship between individual and individual must be reciprocal. Mutual respect is the ethically desired form The Concept of Respect for the Individual Respect for the individual unconditionally stems from the human being. Therefore, the concept of respect for the individual should be preserved even in situations such as mental illness or physical disability encountered in medical practice. Another example of the same situation is the attitude and behavior to be shown towards a patient who has lost consciousness and is in a coma. The Concept of Respect for the Individual The main point aimed at the concept of respect for the individual is respect for human dignity. On the other hand, it is also suggested that respect for the individual can be achieved through methods such as "acting empathetically" and "not seeing others as tools". Principle of Respect for Autonomy The process of the "principle of respect for autonomy" is undoubtedly parallel to the development of "patient rights". The "principle of respect for autonomy" is that other individuals respect the actions of the individual that demonstrate his or her "autonomy" and the individual has the right to expect this respect. Principle of Respect for Autonomy According to Kant, individual autonomy is related to whether any individual's attitude and behavior complies with ethical principles and rules. Rational attitudes and behaviors that the individual develops by adhering to ethical values and principles fulfill the necessary conditions for autonomous action. Principle of Respect for Autonomy Kant → «Principle of respect for autonomy» → «respect for the individual» J.S. Mill → «Principle of respect for autonomy» → «respect for autonomous action» Principle of Respect for Autonomy Implementing the principle of respect for autonomy in health care is undoubtedly one of the primary obligations of healthcare professionals. This principle includes listening to the patient carefully, answering his questions; It produces guide-rules that aim to convey information about the disease and ultimately enable the patient's own "autonomous" choice and action in the light of this information. Can the Principle of Respect for Autonomy be Violated? The point of emergence of ethical problems regarding this issue is the situations that endanger, eliminate, or take away the patient's quality of being an "Autonomous individual". Mental illnesses, coma, physical and mental disabilities The dominance of the paternalistic view of health in medicine Can the Principle of Respect for Autonomy be Violated? As stated, medical facts that eliminate the patient's ability to be an "autonomous individual"; Mental illness, coma, physical disabilities may occur. Such medical cases are situations that can eliminate the competence and conditions that ensure the autonomy of the individual (autonomous individual, autonomous choice, autonomous action). Can the Principle of Respect for Autonomy be Violated? Limit on making decisions on behalf of the patient? No matter how much the medical decision is in the patient's best interest, it must be made by respecting the patient's autonomy. A medical decision made without respecting the patient's autonomy becomes an example of the healthcare worker's paternalistic attitude. Can the Principle of Respect for Autonomy be Violated? Autonomy in psychiatric illness? If there is a psychiatric illness, the assumption that autonomy is removed makes it easier to prevent this principle from being considered…? How can this problem be overcome? Can the Principle of Respect for Autonomy be Violated? Treatment-Patient-Health Worker The use of pressure elements such as persuading, influencing or even coercing the patient in order to ensure that the patient voluntarily participates in the medical decision they propose. Can the Principle of Respect for Autonomy be Violated? Some consequences that may harm autonomy occur in relationships with patients who use drugs that cause temporary unconsciousness. The attitude of the health worker in the face of such a patient is extremely important. What if the prejudice that patient awareness is insufficient leads the healthcare professional to make decisions on behalf of the patient unduly? Can the Principle of Respect for Autonomy be Violated? Another problem that is useful to identify in terms of ethics is the situations arising from differences in education and culture that manifest themselves in the doctor- patient relationship. Health worker with scientific-technical knowledge X Helpless and needy patients?  Principle of respect for autonomy → Emergencies? Unconscious states Can the Principle of respect for autonomy → Public Principle of health? Kant X Mill According to Kant, for practice to be moral, Respect for it must include a sense of duty and obligation. Autonomy According to Mill, for the practice to be moral, the maximum happiness of the be maximum person affected by the action must be achieved. Violated? Principle of respect for autonomy → Religious beliefs? Blood transfusion Can Autonomy be Abandoned? On the other hand, there may be cases where the individual voluntarily transfers his autonomy to the physician. In these cases, the physician, who assumes the patient's autonomy, must be careful not to make medical decisions that contradict the patient's beliefs and values and must not violate the principle of respect for autonomy, in order to fulfill his obligation.  Thanks Questions?