Ethical Issues Concerning Patient Autonomy in Clinical Practice

Abstract

The paper takes up the perspective of clinical practice and discusses the importance of respect for patients’ autonomy from this angle. Until a few decades ago, physicians and nurses involved in ethical decision-making primarily considered the principles of beneficence and non-maleficence. Respect for the patient’s autonomy clearly played a subordinate role. In traditional ethical codes such as the Hippocratic Oath or the Declaration of Geneva of the World Medical Association of 1948, no reference is made to the patient’s wishes. This has changed radically: In line with the shift in values towards greater individuality and personal responsibility observed in the Western world in the second half of the twentieth century, patient self-determination became more and more important. Legal decisions and modern medical ethics emphasize that patient autonomy overrides what physicians and nurses consider best for the well-being of the patient. Informed consent is now a widely acknowledged normative standard in medical ethics, and patient autonomy finds its concrete expression in clinical practice in this concept of informed consent. The paper introduces the concept and discusses central issues concerning patient autonomy in clinical practice: What can health care professionals do to encourage patient autonomy? What are possible limits to patient autonomy? How can a patient’s capacity to consent be assessed? How should health care professionals deal with patients who have temporarily or completely lost their capacity to consent? What is the importance of advance directives? What are possible problems concerning advance directives in clinical practice, and how can they be solved?

This chapter is a development of Simon and Nauck (2013).