Autonomy

Autonomy essentially means "self-rule," and is a patient's most basic right. As such, it is the health care worker's responsibility to respect the autonomy of their patients. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals. The following case addresses patient autonomy--specifically the rights of an individual to decide her own fate, even when it conflicts with her physicians' opinions.

Case

A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead within a few minutes.

The woman is an erotic dancer and worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment and says that she will take her chances. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.

Questions

• Do you believe that the physicians' actions were justified? Why or why not?
• Do you think it is ever right to take away someone's autonomy? If so, under what conditions?
• Do you think a court order would have made the physicians' decision more ethical? What about more legal?
• Would you have said/done anything to intervene if you were one of the workers caring for this patient? Why or why not?

Reference:

Cirone, C. (2005). Cases in medical ethics: Student-led discussions. Retrieved from https://www.scu.edu/ethics/focus-areas/bioethics/resources/cases-in-medical-ethics-student-led-discussions/