PATIENT AUTONOMY AND
RIGHT
I Nyoman Mangku Karmaya
The Doctor-Patient Relationship
1. this relationship is not only professional but also
human
2. it is decisive for the dignity of each
3. it develops in the hope to be able to cure and be
cured
4. it needs empathy, trust, compassion and
sensitivity
5. it is unequal in professional terms but not in
human ones
The Nazis Doctor Experiments
(research scandal/unethical)
Twenty doctors revealed evidence of
sadistic human experiments
Conducted at the Dachau, Buchenwald
and Sachenschausen concetration camps
by murdering and torturing the patient in
the name of research
The brutal medical experiments
Characterized by several shocking features:
(1) persons were forced to become subjects
in very dangerous studies against their will;
(2) nearly all subjects endured incredible
suffering, mutilation, and indescribable pain;
and
(3) the experiments often were deliberately
designed to terminate in a fatal outcome for
their victims
(4) the experiments resulted in death,
disfigurement, or permanent disability
Basic value in medical practice
Respect for
person/autonomy
Beneficence
Non-maleficence
Justice
What is
Autonomy
Definition
The right of patients to make decisions
about their medical care without their
health care provider trying to influence the
decision.
Patient autonomy does allow for health
care providers to educate the patient but
does not allow the health care provider to
make the decision for the patient.
Definition
Autonomy is the personal rule of the self
that is free from both controlling
interferences by others and from personal
limitations that prevent meaningful
choice.
Autonomous individuals act intentionally,
with understanding, and without controlling
influences.
Clinical Applications:
Respect for autonomy is one of the fundamental
guidelines of clinical ethics.
Autonomy in medicine is not simply allowing patients to
make their own decisions.
Physicians have an obligation to create the conditions
necessary for autonomous choice in others.
For a physician, respect for autonomy includes
respecting an individuals right to self-determination as
well as creating the conditions necessary for
autonomous choice.
Clinical Applications:
Individuals come to doctors for guidance in making
choices because they do not have the necessary
background or information for making informed choices.
Physicians educate patients so that they understand the
situation adequately.
They calm emotions and address fears that interfere with
a patients ability to make decisions.
They counsel patients when their choices seem to be
disruptive to health and well-being.
Clinical Applications:
Respect for autonomy also includes:
confidentiality,
seeking consent for medical treatment and
procedures,
disclosing information about their medical
condition to patients,
and maintaining privacy.
Autonomy
Autonomy = the capacity to think, decide and act
on the basis of such thought and decision freely
and independently
Freedom from the interference of others
This freedom is protected by the law
Legal right to refuse any treatment (even life-
saving)/doing the best for the patient
Conflict between principle of respect for patient
autonomy and principle of beneficence
Autonomy
Criticize medical paternalism
Development of patient centred medicine
Inreasing standards in providing patients
with information
Development of informed consent
The analysis of autonomy
Evaluations
What kind of life we think we should live/we think
might be best for us
Evaluations should be rational
Based on correct understanding of the relevant facts
Without making a relevant error of logic
Able to imagine what the relevant state of affairs will
be like
Respecting a persons autonomy is not always be the
same as respecting her choice
Desires higher in the hierarchy should be
respected
Delegate the choice
The choice is burdensome
Not very good in choosing for herself
Usually enjoys going alongwith the choices of
her friends
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Ask for the doctor to choose = autonomously:
He trust the doctors judgement
Making choice is difficult
Believes with the doctors experiences
Right
Patient rights encompass legal and ethical
issues in the provider-patient relationship:
right to privacy
right to quality medical care without prejudice
right to make informed decisions about care
and treatment options
right to refuse treatment
The purpose
to ensure the ethical treatment of persons
receiving medical or other professional health
care services
a person's ability to sue a health plan provider;
access to emergency and specialty care,
diagnostic testing,
prescription medication without prejudice;
confidentiality and protection of patient medical
information;
continuity of care.
The basic rights include the right to:
participate in the development and implementation in the
plan of care
be treated with respect and dignity
be informed about condition, treatment options, and the
possible results and side effects of treatment
refuse treatment in accordance with the law, and receive
information about the consequences of refusal
quality health care without discrimination because of
race, creed, gender, religion, national origin, or source of
payment
privacy and confidentiality, which includes access to
medical records upon request
The basic rights include the right to:
personal safety
know the identity of the person treating the patient, as
well as any relationship between professionals and
agencies involved in the treatment
informed consent for all procedures
information, including the medical records by the patient
or by the patient's legally authorized representative and
hospital charges, except for Medicaid and general
assistance
consultation and communication
complain or compliment without the fear of retaliation or
compromise of access or quality of care
Hak pasien (Deklarasi Lisabon
1991)
Hak memilih dokter
Hak dirawat dokter yang bebas
Hak menerima/menolak pengobatan
setelah menerima informasi
Hak atas kerahasiaan
Hak mati secara bermartabat
Hak mendapatkan dukungan
moral/spiritual
Hak pasien (UU Kesehatan)
Hak atas informasi
Hak atas second opinion
Hak memberi persetujuan
pengobatan/tindakan medis
Hak atas kerahasiaan
Hak pelayanan kesehatan
Recommendations for Enhancing Patient
Autonomy
Share your medical expertise fully while listening
carefully to the patient's perspective.
Recommendations must consider both clinical
facts and personal experience
Focus first on general goals, not technical
options
Disagreements should initiate a process of
mutual exchange
Final choices belong to fully informed patients
TERIMAKASIH
