The document discusses the importance of patient autonomy in medical decision-making, emphasizing that physicians should provide all relevant information to allow patients to make informed choices about their treatment. It outlines the legal aspects of consent, including the need for clear, informed, and voluntary agreement from patients before examinations or procedures, with special considerations for gender dynamics. The document also mentions the principle of informed refusal, where patients can decline treatment, and stresses that these decisions must be respected by healthcare providers while ensuring proper documentation to avoid legal repercussions.

1. Bioethics - Case Studies on
Autonomy and Decision Making

2. Patient’s Autonomy
Physician provides all relevant information to
patient about his medical condition taking into
consideration the risks and benefits of a
proposed treatment, the availability of alternative
treatments including ‘no treatment option’ to
make him able to take a learned decision about it

3. Patient’s Autonomy
To respect patient’s decision about medical
care of their without putting any undue
influence/pressure by their health care
provider

4. Patient’s Autonomy
Paternalism is an outdated concept- where the physicians
used to take decision on the behalf of patients without due
regard to their autonomy.
The best way is to provide all the relevant information to
patients and encourage them to participate actively in
deciding the course of action needed. It not only increases
compliance of treatment by patients, produces better
treatment outcomes and reduces chances of litigations.

5. Consent
 Definition-
As per S. 13 of Indian Contract Act, Consent
is ‘when two or more persons agree upon the
same thing in the same sense’
 Must not examine a patient without consent

6.  When a patient visits a doctor for treatment or advise,
consent is implied. ‘Implied’ means that it is not
stated but it is legally effective. It is limited to general
physical examination including inspection, palpation,
percussion and auscultation
 For anything beyond, consent for that specific
examination/procedure/treatment must be taken,
preferably in writing
 If consent is being taken orally, it must be witnessed

7.  Special care must be taken by male doctors
when examining a female patient (eg: A surgeon
doing breast examination for a possible
surgery). A female nurse/chaperone should be
present.
 Examination of patient without consent is
considered as an assault

8. Components of consent
 1. Clear, i.e., in unambiguous words
 2. Direct- directly conveyed to doctor without any intermediate
 3. Free- without any fear or undue influence
 4. Informed-Patient is made aware of all the relevant information
about treatment including not taking any treatment
 5. Intelligent- The patient has clear understanding of implications
of treatment
 6. Personal- Doctor should not convey to others what the patient
has consented
 7. Voluntary- of his own accord

9. Exceptions
 An arrested person may be examined at the
request of police without consent using
reasonable force if such an examination is
likely to provide information as the
commission of an offence
 A person may be examined/treated without
consent when there is threat to his life and
he is not in a position to express consent

10. Informed Refusal
 A person, who is in sound state of mind, has the
right to refuse any treatment of a medical
condition even if such a decision puts his
health/life in danger.
 The patients may opt for DO NOT RESUSITATE
(D.N.R.) or Withdrawal of Life
Support(WoLS) ,i.e., patient denies treatment
all together or they do not wish for any
aggressive measures to be taken when they are
critically ill or injured to save their lives.

11.  If doctor is aware of such a decision, it
must be respected. However, it is always
advisable to ask patients as their minds
may have been changed.
 Patient’s DNR/WoLS wish may be due to
any undue fear of treatment, any
misconception about a treatment.

12.  The doctor should allay such fears and
encourage patient to get himself treated and
also by briefing him about the consequences of
not taking any treatment, etc. Undue pressure
should be avoided. But the final decision is of
the patient, NOT of the physician.
 ALL informed refusal cases must be properly
documented in details to prevent legal problems
at a later stage

13. THANK YOU