Autonomy in medical practice is the right of competent adults to make decisions on their own healthcare based on information from medical professionals. The principle of autonomy requires healthcare professionals to acquire consent from the patient before engaging in any investigations or treatments. Typically, a decision is considered autonomous when two conditions are met; the individual must have all relevant mental capacity to make rational decisions and must be unaffected by external constraints (Chapman, Toretsky, & Phoenix, 2019). In the healthcare field, a decision is viewed as autonomous when the patient has sufficient information, the capacity to make a decision and arrives at a decision voluntarily.
According to Chapman, Toretsky and Phoenix (2019), medical practitioners are expected to respect the principle of autonomy by disclosing medical information including the available treatment options to allow patients to make their own decisions. The principle of autonomy is not applicable to people who do not have the capacity or competence to make autonomous decisions such as infants and young children and patients who lack competence due to mental, developmental, or physical disorders (Chapman, Toretsky, & Phoenix, 2019). To make informed consent, there are several requirements; the patient must have the capacity to understand and decide based on the information provided to them, understand the disclosure, and acts voluntarily to give consent.
According to the article by Gómez-Vírseda, De Maeseneer and Gastmans (2020), patients have the legal right to make decisions as long as they are in their right mental status. Patients can decide whether or not to get treatment even if their decisions do not align with the physicians’ recommendations. Legal precedents have advanced the necessary requirements for patient autonomy such that patient autonomy is now the dominant principle instead of the physician’s beneficence.
McGee, Dingle, & Edelsohn, (2016), note that the welfare and health of children are maintained by their guardians. However, children and adolescents should also be involved in the decision-making process on the types of treatment they receive. Medical professionals should explain the medical issues and possible treatment options in a way that both the children/ adolescent patient and the guardian can understand. The child/adolescent should then be allowed to participate in decisions about the care they will receive to the best of their abilities to act rationally and comprehend their options. Children or adolescents have the right to agree or disagree with the treatment options presented to them. The guardians of the children or adolescents have the right of proxy consent where they can make decisions for the minors under their care. In some jurisdictions, the consent of adolescents of a certain age is required.
The psychiatrist of the child/ adolescent is required to obtain the minor’s assent whenever it is reasonable and the legal guardian’s consent before any medical actions occur. However, as noted by McGee, Dingle, and Edelsohn (2018). There are some provisions for emergencies, such as the case of emancipated minors. During emergency medical care, medical professionals can consider assent and consent as secondary considerations to provide urgent medical care to the minor patient. Emancipated minors are legally responsible for their care and their consent must be obtained before any actions take place. In some jurisdictions, minors involved with sexually related situations, minors are allowed to make autonomous decisions regarding their care.
Song et al. (2020) argue that there are cases when the decisions of the child or adolescent and the guardians are in conflict. In situations where the guardian consents to treatment while the minor dissents, medical practitioners may opt to treat the minor patient in spite of their dissent. It is up to the minor patient’s psychiatrist to determine the consequences of treating the patient without their consent and encourage the minor and guardians to collaborate to enhance the health of the minor.
Psychiatrists and all medical professionals have the ethical responsibility to maintain their patient’s autonomy through providing the all necessary information and allowing them to make their own decision. In my practice, I will strive to maintain my patient’s autonomy and in cases where my ethical responsibilities conflict with the law or other governing legal authority, I will take the necessary steps to resolve the conflicts using the Ethical Standards of Ethics Code and General Principles. I will also ensure that I never use any conflicts or standards to violate my patients’ right to autonomy.
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