This week we move to the ethical principle of autonomy. which is to respect the decisions made by other people concerning their own lives. This is also called the principle of human dignity. a very important principle in health care. It seems natural to us that each and everyl person would have the right to make theirown decisions about what Will happen to them, but this principle can, in real life. be very difficult to followI or to apply to situations. That is why we began with the ethical principles to do no arm (nonmaleficence) an to do good (beneficence). To add to the difficulties With this principle are other laws which must beconsidered. It has been said. sarcastically. that only young. healthy people from the dominant culture making popular decisions have the right to autonomy. There is certainly more than a speck of truth to this. We heavily legislate rights for the young. declaring them not competent to make their own deCISions. Underage children With cancer have been forced to undergo round after round of debilitating chemotherapy against their express Wishes, until an adult or court deCides enough is enough. Elderly patients have been declared incompetent when they can no longer live safely in their homes and forcibly been placed into nursing homes. deprived of all they have knoWn. in spite of their insistence that they understand the risks and are Willing to accept them. An 13 year old Jehovah's Witness is allowed to die from a refusal of blood transfusion under the principle of autonomy but a 45 yeaHJld would be prevented from committing suicide Via car exhaust under the same principle (except. perhaps in Oregon). You can see that there is a close relationship between the principle of autonomy and that of competence. The problem with this is that competence as a legal construct is assessed by medical professionals, and decided by courts Who are at risk of bemg influenced by aligning With what the medical professmnal deems "reasonable". Note that the legal definitions of competenceibeing deCisional may vary from state to state. Note also that While many conSIder this outside the scope of medical professionals: most facilities have forms in which two physicians may declare a patient not decisional which removes personal autonomy and activates the power of attorney for healthcare. Apart from the relationship with competence. the principle of autonomy is fairly straightforward and includes several aspects: to be able to make proper autonomous decisions a person must be given thorough explanations and potential consequences of their decisions people have the right to make what many would consider "bad'I decisions people have the right to make decisions that may lead to their deaths as long as they understand that this may be the end result lF THEY ARE CONSIDERED COMPETENT Example of Autonomy As I entered the room with the elderly couple and a younger woman who I assumed was their daughter. the tension was palpable. The elderly woman was there for treatment of a si nificant burn. When l asked what had happened to bring her here. she smiled vacantly at me and her husband responded for her. She had advanced dementia and had decided to light a fire in the fireplace in the middle of a summer eatwave. At that point the daughter burst out in a pent-up frustration-type tirade. It was all aimed at her father who she blamed for bringing her mother home from the "safety" of the nursmg home. Her father looked very sad and then spoke to me. \"I know how angry my daughter is at me. Elutl tried the nursing home. My Wife stayed six months: never adjusted: and for six months. cried. screamed: and demanded to go home. She lost weight: refused her pills; in spite of her dementia she knew she was not home. Sol brought her home." At that point the daughter interjected with a vehement comment about both of them burning to death in a fire set by her mother. Again. the man turned to me and said. " I would ratherwe both died in a fire she set. having been happy until that moment, than live for years in misery. l accept the consequences of this decision for myself and for her". Case Study You a55ist With running a small medical office With several health care providers. A patient is scheduled for a follow-up VlSll today and will receive the news that the repeated testing has confirmed that they have a posmve response to a resistant strain of TB. You have been told to put the public health department on standby for when they arrive. When you ask why. the response is that the patient will be required to undergo treatment. That surprises you because you are aware of the principle of autonomy and feel that the patient would have the ability to refuse treatment. Apply: your knowledge of autonomy to this case study. lnclude each of the following points in your assignment Summarize the important points in the case study List potential actions based on the ethical principle of autonomy Choose your action as you are the judge Defend your choice based upon your assessment of the ethical principle