Question

Explain the difference between patient and physician autonomy, according to Pellegrino. Then provide one concrete example that makes clear why we cannot always maximize both patient and physician autonomy.

Answer 1

Autonomy is principle of human dignity. The right of the patient to make decisions about their medical Care with out their health Care provider trying to influence the decision .Patient autonomy does allow for health care provider to educate the patient but does not allow the health care provider to make decision for the patient.if the physician not seen to be autonomy professional and their decisions are influenced by the intrest of the organization that employ them or by insurance pharamesutical companies.

Both patient and Physician should maintain autonomy ,if it maximize or minimize health care may effects.

For example, if a patient wants antibiotics for a viral infection or renal dialysis for urinary incontinence, the physician will refuse because antibiotics don’t fight viruses and dialysis doesn’t treat incontinence. At the same time, there are potentially negative consequences for these treatments. Sometimes, if a patient makes a decision that causes moral distress within the team, it might be necessary to determine whether the patient appreciates the extent or full implications of their decision.

While it is quite correct to say that in some circumstances, other considerations take precedence over the wishes of individuals (for instance, if a person has ‘irrational’ desires or if they will cause avoidable harm to others), autonomy should be thought of more broadly. Patient wellbeing and autonomy go hand-in-hand. Autonomy should not necessarily be seen as ‘patient control of decision-making,’ but as a clinical reality which consists of education, conversation and concern for patient wellbeing.

It is helpful for healthcare professionals to think of autonomy, not as a disembodied principle or as something that is entirely lost if a right to choose is denied, but rather as a matter of the degree to which it is honoured, aimed at providing respectful patient care. The implication is that once information relevant to treatment is made available and the patient is deemed capable of making treatment decisions, then the healthcare professionals proposing treatment should not prevent the patient’s choice unless respecting the wishes would cause harm to others, or seriously undermine the patient’s wellbeing.

Fundamentally, autonomy is the pivotal healthcare notion. Consideration for patient autonomy (in the broadest sense) must always be the starting point for interventions that seek to enhance patients’ dignity.

Beyond this, the issues must be resolved using appropriate moral reasoning, clear communication, comprehensive assessment of the situation, respect empathy and personal judgement.