Patient Autonomy

Conventional wisdom use to hold that the “doctor knows what is best for the patient”, leading to a paternalistic and unbalanced relationship between most physicians and patients. This idea of medical paternalism stems from the Hippocratic oath which states that “ [a physician] will apply dietetic measures for the benefit of the sick according to [his or her] ability and judgment”. The Hippocratic oath as historically said by all physicians and medical students is based on a foundation of beneficence yet the oath does not emphasize the personal autonomy of the patient. The oath focuses on the characteristics of a doctor and his or her duties, yet does not mention the role of doctors in respecting the patients wishes. This principle of paternalism

There are two essential components that compose the legal right of patient autonomy. The first component involves the patient having the capacity and ability to make a willful decision. The second component involves the autonomous decision itself which relies on independent informed decision making process. The first components is well illustrated by Justice Benjamin Cardozo in the 1914 court case of Scloendorff v. Society of New York Hospital where he stated that “every human being of adult years and sound mind has a right to determine what shall be done with his own body...”. The second component is better illustrated through the process of informed consent as the person who is autonomous may find him or herself constrained from acting freely due to the fact that the physician or hospital didn’t ensure that the patient had adequate comprehension of the information provided. The autonomous decision involves the process, context and content involved in the decision between the health professional and the patient. Informed consent is a shared decision made in an

courts repeatedly affirmed the right of autonomous individuals to refuse medical intervention even if refusal would lead to his or her own death. Many doctors, moral philosophers and patient family members disagreed with the notion of autonomy ultimately leading to death. This controversy is best exemplified by the 1986 court case of Elizabeth Bouvia v. Superior Court. Elizabeth Bouvia was a mentally competent quadriplegic who suffered from cerebral palsy causing her to be bedridden and dependent on others. Elizabeth was unable to support herself so she had to rely on public assistance for medical care. In 1983, Elizabeth Bouvia expressed a desire to end her life through self-starvation at a Los Angeles County hospital. The physicians monitoring Elizabeth at the hospital had determined that she was not eating enough and her weight loss was a life-threatening condition. The staff and physicians at High Desert Hospital in Los Angeles County, California, inserted a nasogastric feeding tube into Elizabeth against her wishes in order to ensure proper nutrition. The staff at the hospital justified their actions through the state’s interest in persevering life as her prognosis indicated that she could survive an additional 15 years with adequate nutrition. Elizabeth sued the hospital and it’s staff while seeking an injunction for the removal of the tube. The trail court denied her request and justified the action’s of the hospital staff in preserving