The Principles of Autonomy in Medical Practice

Autonomy defines as “self-rule” or “self-determination” which involves capacity to think, decide and act on the basic of such thought and decision freely and independently. In medical practice, autonomy applied when patient need to have capacity of thought, intention, and action when making decisions regarding any medical intervention and it must be free of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success of offered procedure and also alternative procedure. Here, professionalism of a doctor is required for better explanation regarding the benefits and complication of health care procedures as well as deliver a good advice of the best interest for their patient in order to help patient in making decision. With enough relevant necessary information provided to the patient, they able to make their own decision where the autonomy is applied. By this principle, patient also has right to refuse the medical procedure and a physician need to respect their decision and not doing anything that against the patient’s wishes.

According to Reyden in South African Journal of Occupational Therapist (2008) regarding the right to respect for autonomy, as for physicians, they need to fully understand the concept and implication of the ethical principle and the professional duty of respect for patients or client autonomy. In addition, they should not only accommodate respect for patient/client autonomy within daily practice, but also be able to facilitate the development of such capacity in order to enhance all interventions.

As for this case, patient was 10 years old girl which is considered as an under age based on Act 21 under Age of Maturity in Age of Majority Act 1971 which stated, in Malaysia, the age of maturity is at 18 years old. In another word, she was an incompetent patient who lack of decision-making capacity. Therefore, her parents (her mother) can provide consent on her behalf. From the history, her mother decided to take spinal anesthesia (SA) for her daughter’s surgery of ganglion cyst instead of general anesthesia (GA) based on her knowledge on that time after being informed about the complications of GA which has outweigh the risk of SA by anaesthetist in the anaesthetic clinic. However, in the ward, a day before her daughter’s surgery date, anaesthetist came to get consent of GA procedure without asking her point of view and opinion. Patient’s mother refused to sign the consent form which lead to cancellation of the procedure on the next day. Patient was then discharged and re-schedule the surgery.

Paternalism is happened in this case where the anaesthetist tried to limit the patient’s mother autonomy by decided to ignore her decision and leave her without further questioning or explaining the situation. According to Ilemona et. al. (2012), the problem of paternalism usually happen when there is conflict between principles of autonomy and beneficence. For example, a physician, who is paternalistic, intent to act in the patient’s best interest without fully considering and understanding of patient’s view. They also do not realize how their evaluation could be modified by a good communication with the patient.