Pharmacology Seminar on Autonomy

1. R AH U L K AR S O L I YA 2 0 0 5 9
R AM P R AS A D 2 0 0 6 0

2. PRINCIPLES OF MEDICAL ETHICS
• Autonomy
• Beneficence
• Non-maleficence
• Social justice

3. WHAT IS AUTONOMY?
• The principle of autonomy applies in terms of rights and
obligations.
• It emphasizes on the rights of patients to take decisions about
their medical treatment.
• Autonomy relates to being “free from controlling influences or
personal limitations such as inadequate understanding”
• Autonomy is a general indicator of health.
• This makes autonomy an indicator for both personal well-
being, and for the well-being of the profession.

4. • The healthcare providers are obliged to be truthful
(veracity) to their patients and to respect the choices that
their patients make.
• The patients have the right to decide for themselves in
regard to the treatment plan, provided that they receive
complete, accurate and comprehensive information.

5. AUTONOMY NOTION
• Personal autonomy is, at minimum, self-rule that is free from
both controlling interference by others and from limitations,
such as inadequate understanding, that prevent meaningful
choice.
• The autonomous individual acts freely in accordance with a
self-chosen plan, analogous to the way an independent
government manages its territories and sets its policies.
• A person of diminished autonomy, by contrast, is in some
respect controlled by others or incapable of deliberating or
acting on the basis of his or her desires and plans.

6. AUTONOMY - CLINICAL APPLICATION
• Respect for patient autonomy is now fully integrated into the
practice of medicine.
• In the clinic, the patient's right to accept or refuse medical
care changes the balance of power in the physician-patient
relationship and engages the patient more fully in ownership
of care plans.
• Shared decision-making has become the norm, and it is
viewed by the patient and the physician as essential for
honoring the individual and his or her dignity.

7. RESPECT FOR AUTONOMY (PERSON)
• Includes respect for their privacy and confidentiality
• Need to provide sufficient information for them to make informed choices
• Truth telling protection of persons with diminished or impaired autonomy.
• Recognize the capacity of mentally and legally competent patients.
RESPECT:
• To think and make decisions independently
• To act on the basis of their decisions
• To communicate their wishes to health workers
• Uphold patient confidentiality.

8. PROMOTING AUTONOMOUS
BEHAVIOUR
• Presenting all treatment options to a patient.
• Explaining risks in terms that a patient understands.
• Ensuring that a patient understands the risks and
agrees to alI procedures before going into surgery.

9. WHAT IS BENEFICENCE?
• Beneficence Literally-"Being charitable or doing good".
• Where a doctor should act in the "best interests" of the patient,
the procedure be provided with the intent of doing good to the
patient.
• The ethical principle of beneficence requires healthcare
professionals to treat their patients in a way that provides
maximum benefit to that patient.
• These duties are viewed as self-evident and viewed as the
proper goals of medicine
• These goals are applied to both the patient, and to the good of
society as a whole.
- Vaccinations for disease prevention example

10. BENEFICENCE
• Promotes patient "Best interest" by:
-Understanding patient perspective
- Address misunderstandings and concern
-Try to persuade patient
-Negotiate a mutually acceptable plan of care
- Ultimately let the patient decide

11. BENEFICENCE
• The physician cannot be required to violate fundamental
personal values, standards of scientific or ethical
practice, other law.
• If the physician is unable to carry out the patient's
wishes, the physician must withdraw and transfer care of
the patient.

12. • Illustrative case: One clear example exists in
health care where principle of beneficence is
given priority over the principle of respect of
autonomy which is in the Emergency Room:
Patient is incapacitated by the grave nature of
accident or illness
• We presume that the reasonable person would
want to be treated aggressively and we rush to
provide beneficent intervention.

13. CONFLICTS BETWEEN AUTONOMY AND
BENEFICENCE/NON-MALEFICENCE
• Autonomy can come into conflict with beneficence when
patients disagree with recommendations that healthcare
professionals believe are in the patient's best interest.
• When the patient's interests conflict with the patient's welfare,
different societies settle the conflict in a wide range of
manners.
• Beneficence without respect of an individual's autonomy may
lead to actions that are not really beneficial as they try to
promote the other person's well-being against his/her will.

14. • There is a delicate balance between autonomy and beneficence.
• Autonomy and beneficence can get in conflict with the principle of
autonomy.
• For example, physicians have a moral responsibility to listen to the
patient's wishes (if autonomous) or to the patient's surrogates (if
non-autonomous), but they also have the responsibility to do what is
“good” for the patient.
• It is the role of a physician to find balance between autonomy and
beneficence in case and take the right decision.

15. • In general, Western medicine defers to the wishes of a
mentally competent patient to make their own decisions,
even in cases where the medical team believes that they
are not acting in their own best interests.
• However, many other societies prioritize beneficence
over autonomy.

16. EXAMPLE 1
• Examples include when a patient does not want a
treatment because of, for example, religious or cultural
views. In the case of euthanasia, the patient, or relatives
of a patient, may want to end the life of the patient.

17. EXAMPLE 2
• Also, the patient may want an unnecessary treatment, as
can be the case in hypochondria or with cosmetic
surgery; here, the practitioner may be required to
balance the desires of the patient for medically
unnecessary potential risks against the patient's
informed autonomy in the issue.

18. • A doctor may want to prefer autonomy because refusal
to please the patient's self-determination would harm the
doctor-patient relationship.
• Individuals' capacity for informed decision-making might
come into question during resolution of conflicts between
autonomy and beneficence.

19. • The role of surrogate medical decision makers is an
extension of the principle of autonomy.
• On the other hand, autonomy and beneficence/non-
maleficence may also overlap.

20. • For example, a breach of patients' autonomy may cause
decreased confidence for medical services in the
population and subsequently less willingness to seek
help, which in turn may cause inability to perform
beneficence.

21. • The principles of autonomy and beneficence/non-
maleficence may also be expanded to include effects on
the relatives of patients or even the medical
practitioners, the overall population and economic issues
when making medical decisions.

22. CONCLUSION
• To sum up, there seems no perfect answer to an ethical
dilemma.
• It is hard to justify the use of one principle over another.
Yet the ethical decision making process provides a guide
to take a step ahead and apply the best possible
principle.

23. • However, it may not be the perfect choice but it may result in
maximum beneficence and minimum harm which could be
avoided.
• Nevertheless, in any such situation, pros and cons and risks
and benefits should be weighed against to get to the best
possible solution which would be in favor of the patient.
• The potential benefits of any intervention must outweigh the
risks in order for the action to be ethical.

24. CONCLUSION