Abstract
The previous chapters have elaborated on various issues related to the concept of autonomy and the principle of respect for autonomy. In this chapter I will pick up these various threads and try to connect them, in order to answer the research questions posed at the beginning of this book. I will start with the question as to the meaning of autonomy, both in a descriptive and a normative sense (Section 1). After that, Section 2 will address the question of what respect for autonomy means and requires in medical practice in general. The third section will concentrate on the more concrete implications of respect for autonomy in hospital practice. I will summarize the most significant findings and conclusions from Chapters 5 to 9 and make some recommendations for policy. The line of discussion in this chapter will thus run from a more general and abstract conceptual analysis to more concrete and specific recommendations. In the final section I will evaluate the research method I have used.
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The notion of development does not necessarily indicate an improvement — it indicates change, but not necessarily for the better. When people change or adjust themselves to new circumstances this does not mean that either their former or their later self is more authentic. Both can be authentic, depending on the authenticity of the process of adaptation and change.
I have used the term ‘choices’ because the term ‘decisions’ has a connotation of conscious deliberation, which is not suitable to describe the kind of mainly unreflected everyday choices I am referring to.
Strictly speaking, these conclusions only apply to the specific hospital wards I have observed. The fact that I performed my empirical research in an academic hospital may be relevant here, since it can be assumed that in an academic setting medical ethical norms are adopted faster than in a peripheral hospital. Some remarks by patients and physicians I interviewed indicated that this might indeed be the case, although I cannot exclude the possibility that these were ‘socially desirable’ remarks.
That such an attitude can be difficult to acquire is illustrated by a comment of one of the nurses in my study, who said that she used to find it problematic if patients wanted something that she would not want for herself. “It is more difficult to do what a patient wants, to find out what he wants, than to just think of what you would want, or what you find best for that patient.” Over time and through experience, however, she had learned to put herself in the patient’s place and to see that what mattered was the patient’s own wish, though at times this remained a difficult task.
Recently, a study on guidelines supported by the Dutch Medical Association (KNMG) has made similar recommendations (de Bruijn, Cense & Klazinga 2000, van der Burg et al. 1999).
These requirements were mentioned in Chapter 1. They entail that the paternalistic intervention should be in keeping with the values held by the patient herself; that the intervention should maximally restore or retain the decision-making capacities of the patient; and that the intervention should be as effective and as little restrictive and unpleasant as possible.
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© 2002 Springer Science+Business Media Dordrecht
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Schermer, M. (2002). Conclusions. In: The Different Faces of Autonomy. Library of Ethics and Applied Philosophy, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-9972-6_10
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DOI: https://doi.org/10.1007/978-94-015-9972-6_10
Publisher Name: Springer, Dordrecht
Print ISBN: 978-90-481-6161-4
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