Intended for healthcare professionals

Student Ethics

Patient autonomy

BMJ 2011; 342 doi: (Published 01 March 2011) Cite this as: BMJ 2011;342:d680
  1. Julian Sheather, ethics manager, BMA
  1. 1London

Why should people have the right to make their own choices?

If there is a single ethical principle that students learn at medical school, the chances are it is the requirement to respect the autonomy of patients. This principle finds its clinical expression in the obligation to seek informed consent.

Respecting patient autonomy means that doctors have a duty to provide competent patients with the opportunity to make an informed decision about their medical treatment. This principle, and its practical expression in consent, is strongly defended in law. Failure by a doctor to properly provide the conditions for the patient to make an informed choice could lead to prosecution for battery, although such cases are rare. It is likely that the potential legal consequences of not respecting informed choices are drummed into future doctors just as much as the moral ones.

The rise in the importance of the need to seek informed consent is linked to the desire of both doctors and healthcare organisations to limit legal liability.1 More positively perhaps, the principle of respecting autonomy has also been central to the move away from a culture of medical paternalism during recent decades. It is probably fair to say that the idea that “doctor knows best” has, to a great extent, been replaced by the idea that “an adult patient knows best.”

The concept of autonomy is cited far more than it is understood. Although the principle of autonomy is well established in medical ethics, while competent patients clearly retain the right to make decisions on their own behalf, in a practical sense patient’s interests are best respected by seeing medical decision making as a partnership based on mutual respect, communication, and information exchange. Poorly understood, there is a danger that a respect for autonomy can be misinterpreted as …

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