Supporting Patient Autonomy: The Importance of Clinician-patient Relationships
Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients’ independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals’ autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients’ treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients’ autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy.
KEY WORDSpersonal autonomy professional-patient relations clinical ethics relationship-centred care
The authors receive salary support from their respective universities. Vikki Entwistle's post is part-funded via the Alliance for Self Care Research, which is funded by the Scottish Funding Council, Chief Scientist Office of the Scottish Government Health Directorates and NHS Education Scotland. Alan Cribb currently holds an AHRC Knowledge Transfer Fellowship relating to patient involvement. Kirsten McCaffery is supported by Australian National Health and Medical Research Council (NH&MRC Career Development Award 40286 and Program Grant no. 402764 to the Screening and Test Evaluation Program).
This work was presented in part at a conference on “Enhancing decision making in healthcare practice” organised by and held at the University of Stirling on 29 September 2009.
Conflict of interest statement
None of the authors are aware of any conflicts of interest, financial or otherwise, that could, either directly or indirectly, purposefully or inadvertently, affect the development or reporting of their scholarly activity.
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