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Patient Autonomy - why?

What do we mean by "autonomy"?

Discussions

Why do we need it?

  • Montgomery v Lankarkshire Health Board (General Medical Council Intervening) [2015] UKSC 11
  • "The right to self-govern, or the right to partial self-government, or the right to self-determination"
  • "Patient Autonomy: Perpetual myth or achievable reality?" Denis A Cusack.
  • "Every person has the right to have his or her bodily integrity protected against the invasion by others."
  • Law & Medical Ethics, J.K Mason & G.T Lawrie
  • YF v Turkey (2004) 39 EHRR 34
  • "The Law requires that an adult patient who is mentally and physically capable of exercising a choice must consent if medical treatment of him is to be lawful, although the consent need not be in writing and may sometimes be inferred from the patient's conduct in the context of the surrounding circumstances."
  • Lord Donaldson at 102-103 in Re T (Adult: Refusal of Treatment) [1993] Fam. 95
  • The Necessity Principle
  • Sidaway Appellant v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others Respondents [1985] 2 W.L.R. 480
  • St. George's Healthcare N.H.S. Trust v S. Regina v. Collins and Others, Ex Parte S. [1999] Fam. 26

Art 8, ECHR – The right to a private life suggests the freedom to live as one chooses.

In X and Y v Netherlands, the right to a private life was held to cover and protect the physical integrity of the person.

The right will be subject to limitations eg. The interest of society in preserving life, a balance must be sought in each case.

  • Regina (Burke) v General Medical Council (Official Solicitor and Others Intervening) [2005] EWCA Civ 1003
  • Relational autonomy (See J. Herring, Relational Autonomy and Family Law [Springer, 2014])

Quotes

  • W. Kymlicka, Contemporary Political Philosophy (Clarendon Press, 1990), p. 210
  • Paternalism & autonomy - causing difficulties

Conflicts

  • Hmong people
  • J.S. Mill, On Liberty (2005 [1859] Cosimo Classics), Chapter 3, III.3
  • Navajo Indians

"The human faculties of perception, judgment, discriminative feeling, mental activity, and even moral preference, are exercised only in making a choice... the mental and moral, like the muscular powers, are improved only by being used."

  • Refusal to perform a treatment? - FGM & Chinese cupping
  • Autonomy and liberty - a paradox?
  • Nuremberg code

Airedale NHS Trust v Bland [1993] A.C. 789

Lord Mustill - If the patient is capable of making a decision on whether to permit treatment... his choice must be obeyed even if on any objective view it is contrary to his best interests.

Re T (Adult:Refusal of Treatment [1992] 3 W.L.R. 782

Staughton LJ - An adult whose mental capacity is unimpaired has the right to decide for herself whether she will or will not receive medical or surgical treatment, even in circumstances where she is likely or even certain to die in the absence of treatment.

  • "One size fits all" not really a comfortable thought

"I should be left alone to do what I want with my life"

"I should be enabled to do what I want with my life"

Some commentators have criticized the priority given to autonomy on the grounds that it is an excessively individualistic value.

Refusing life-saving medical treatment ignores the impact this might have upon others such as dependent children

There may be a tension between a patient’s legal right to determine what is done to her body and her moral obligations to others.

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