Patient Autonomy

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CONSCIENTIOUS AUTONOMY Displacing Decisions in Health Care by REBECCA KUKLA The standard bioethics account is that respecting patient autonomy means ensuring that patients make their own decisions, and that requires that they give informed consent. In fact, respecting autonomy often has more to do with the overall shape and meaning of their health care regimes. Ideally, patients will sometimes take control of their health care but sometimes defer to medical authority. The physician’s task is, in part, to inculcate patients into the appropriate good health care regimes. At crucial moments of choice most of the business of choosing is already over. . . . The moral life is something that goes on continuously, not something that is switched…show more content…
This tentative definition intuitively captures a wide range of what we would normally call conscientious action, including acts as grand as civil disobedience and as small as taking conscientious care of a hamster. Whether or not conscientiousness—being responsible in our actions to standards to which we are committed—is a moral notion, it is certainly a normative one: we generally demand conscientiousness from our fellow citizens and deem them problematically irresponsible when they seriously lack it. And I think it is a virtue that we hope for in patients’ relationships to their health care practices. We should not think that conscientiousness is the special duty of pregnant patients in virtue of their responsibilities to their future children. Local ethics of responsibility with their own internal standards are established across the health care spectrum, and these standards open the possibility for conscientiousness or its failure. In our culture, the conscientious expectant mother will usually watch her diet, take childbirth classes, document fetal kicks, show up to doctor’s appointments, and so on. Usually, she does these things neither because they represent her own self-chosen…show more content…
Several empirical researchers have argued that in many contexts patients are not actually interested in making their own health care decisions and would rather cede this authority to their doctors. Some authors have concluded that many patients “don’t really want autonomy after all,” and thus that we may need to reconsider the value we assign it in bioethics.30 But on my account, what they perhaps do not want is instead a certain kind of free choice that may be inappropriate anyhow. Knowing that health professionals are better placed to make good judgments about various important health care choices, patients may wish to defer their authority and not be left to their own inadequately trustworthy devices. Kristina Orfali has shown that parents of newborns whose doctors exert more authoritative influence over treatment decisions often feel that they have more rather than less control over their infants’ care.31 I think it makes sense that we would feel out of control when forced to make a decision that we do not feel equipped to make and for which we do not feel capable of taking real responsibility. Is ensuring informed consent irrelevant to the protection of patient autonomy, at least in the context of primary and ongoing health care? Not at all. Rather, rituals of informed consent can enhance or undermine patients’ conscientious autonomy. Signing an informed consent form may or may not mark a real moment of selfdetermined choice. But

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