Principle of Respect for

Autonomy

Autonomy
Autonomy: Key
concepts
Competence
Informed consent

Autonomy:
Derivation

Greek
autos (self)
nomos (rule, governance,
or law)
originally referred to self-governance of
independent Hellenic city-states

Autonomy: Essential
Conditions

Liberty - independence
from controlling
influences

Agency - capacity for

intentional action

Autonomous Action
By normal persons who act:
Intentionally
With understanding
Without controlling
influences that determine
their action

Principle of Respect for

Autonomy
Being autonomous is
not the same as being
respected as an
autonomous agent.

Principle of Respect
for Autonomy
To respect an autonomous
agent requires recognition of
others right to:
hold views, make choices &
take actions based on
beliefs and attitudes

Principle of Respect
for Autonomy
Involves respectful action,
not merely respectful
attitude

Kants View
Respect for autonomy
flows from recognition:
that all people have
unconditional worth &
capacity to determine own
destiny

Immanuel Kants View

To violate a persons
autonomy is to treat that
person as a means - in
accordance with others
goals without regard to
his or her goals.

Immanuel Kants View

Must

assist persons in
achieving their ends
Foster their capacities as
agents

John Stewart Mills View

Citizens should be
permitted to develop
according to their personal
convictions, as long as
they do not interfere with a
like expression of freedom
by others.

Respect for Autonomy Related Concepts

Rights and obligations of:
- privacy
- confidentiality
- truthfulness
- consent

Respect for Autonomy:

Scope
Disagreement

in literature over
scope of rights related to
autonomy
Prima facie standing
Can be over-ridden by
competing moral considerations

Autonomy & Consent

Basic paradigm of
autonomy in health care:
express and informed
consent

Competence
Core

meaning - the ability to

perform a task
Criteria for competence:
- should be relative to decision
- rarely incompetent in all
spheres

Competency
Ask

- Competency for what?

Sometimes the following are
inappropriate triggers for
questioning competency:
- not doing what MD/nurse
think should do
- preferences not mainstream

Categories of People
competent
was

competent but now is not

- wishes known
- wishes not known
never competent
newborn

Categories of People
Was competent but now is
not
permanent
reversible

Incompetent

Categories
Fetuses, newborns, children
Brain

dead
Persistent vegetative state
Retarded
Clearly mentally ill
Dementia

Competent Consent or

Adult person with ability to:

Decision
- get information - comprehension
- process information - capacity
- make decision & communicate it
Aware of: medical situation &
prognosis; alternatives; & risks,
benefits, & consequences of each

Competent Consent or
Decision
Absence of coercion
Decision is stable over time
Decision is consistent with
persons values & goals
Decision not a result of
delusions or hallucinations