Nikki Thao

Patient Autonomy
Understanding the importance of patient autonomy in medical- decision making is crucial
because of the limitations that surrounds a patients competency to make a decision regarding
their medical treatment. The right to patient autonomy centralizes around a persons ability to
accept or refuse treatment. Medically speaking, the autonomy of a competent person makes
him/her have the right to give a valid informed consent on treatments that they would deem
appropriate. Therefore, the respect for autonomy and right of consent from patients is essential
due to the weight that it has on the medical world.
What is a medical informed consent? A medical informed consent is a valid agreement
made between a physician and patient regarding some kind of medical treatment and the
potential advantages and disadvantages involving that treatment (Paterick, T., Carson, C.,
Marjorie, C., & Paterick, T., 2008). The consent process is an important part of the patients right
to accept or reject treatments that is presented based on a physicians diagnoses and ability to
treat the patient. Timothy J. Paterick et. Al (2008) addresses the importance of medical informed
consent and how it affects both patient and physician. In a legal stance, physicians have the legal
right to withdraw or refuse consent to patients. And in reverse, patients have the legal right to
make decisions that would affect his or her health. Overall, medical informed consent tends to
benefit patients and can be risky for physicians. By giving a valid informed consent, patients
acknowledge that they are competent and voluntarily agree to the treatment. Patients are given
the privilege of deciding what parts of their body can be touched or treated. In addition, patients
have the right to whether or not demand full knowledge of the treatment/ diagnoses and the
ability to strike out parts of the informed consent on which they do not agree. Physicians, on the
other hand, can be held accountable for negligence, if they fail to inform the patients of any
necessary information regarding patients health and treatment. Physicians can be accused of

Nikki Thao

battery, if treatment was performed without patients consent. Therefore, physicians must be alert
about what they inform the patient because failure to do so gives the patient the right to sue the
physicians.
Paterick et. Al (2008) introduces two approaches in which information can be presented
to patients. The professional standard informs the patient that all doctors have the same skills and
that the information they disclose are similar if in the same situation. The criticism of this
standard is that there is no set point to how much information should be disclosed to patients.
There are physicians who make the mistake of assuming that the patients have knowledge of the
treatment or that it takes too much time to inform patients. The materiality standard grants the
jury the ability to choose which information is important to the patient. The criticism of this
standard is that the court does not also specify how much information should be disclosed; only
that full disclosure is not required. This is a setback because as problems arise, physicians are
held liable. Paterick et. Als (2008) argument seems to imply that by focusing on the patients
interest would greatly emphasize better practice in a physician- patient relationship.
Although patients have the right to make their own decisions, to what extend is patient
autonomy fully practiced? In a case involving Susan, a woman who was diagnosed with
dementia, Brendan McCormack (2002) explores alternative ways to address proxy or surrogate
decision- making, when referring to informed consent. In the article, Mary, a registered nurse,
describes her treatment of Susan. Mary notes that Susans husband usually made choices that do
not comply with Susans decision, which is noticed through Susans body language. Therefore,
Mary feels a sense of paternalistic relationship to Susan. In the medical world, there is
stereotyping that people with dementia are considered incompetent, thus the most appropriate
way for informed consent is through the use of a proxy. However, McCormack (2002) argues

Nikki Thao

that having a proxy is not always the best choice because some proxies are prone to make
decisions based on their own emotions and relationship to the patient.
Rather than relying on the proxys decision, McCormack (2002) explains that everyone
has their own narrative identity. Your narrative identity is not something that only you write;
other people contribute to parts of your story. They add to who you are. In informed consent,
having a narrative identity is important to the person who has dementia and the person taking
care of him/ her. A narrative identity is who you say you are in the stories that you tell yourself,
your experiences. In the article, Susan and Mary each have their own identity, but the identity
that McCormack (2002) emphasizes is intersubjetive identity or interconnectedness. The
narrative identity revolves around the stories of Susans illness and how Marys invention as a
nurse is part of making that interconnection. McCormack (2002) argues that when there is an
interconnected relationship, the idea of paternalism is diminished because the patients autonomy
for informed consent is respected. In Susans case, Marys nursing intervention reflects that of
Susans consent, thus although Mary may seem like a proxy, Mary takes actions that act
accordingly to Susans narrative identity. Therefore, the main idea that McCormack (2002)
argues is that the proxy should not be emphasize over the patient, but the proxy should serve as
another narrative identity that would contribute to the patients autonomy to achieve a better
decision. He argues that not all people should be assumed to be incompetent. By embracing the
narrative- based approach, the use of proxies would not be stressed as the patient can somehow
participate in decisions about their lives.
In the article that addresses the intervention on prenatal substance users, Lenora
Marcellus (2004) notes that beside the autonomy, women are oppressed educationally, socially,
and economically. The lack of opportunity that a woman receives contributes to her being
neglected by society and thus it can affect the pregnant mother and fetus. In society, the fetus-

Nikki Thao

centered model is favored because society sees the mother as the evil villain for her use of drugs
and threat to the babys life. Although, a pregnant woman may abuse drugs, she must have her
reasons. Marcellus (2004) criticizes that by favoring the fetus- centered model, the rights of the
woman is obstructed because the mother is seen only as an environment for the fetus. There can
be several compelling reasons to why a woman abuses drugs during her pregnancy, whether its
because she is poor, lacks education about prenatal care, or is economically oppressed. Thus
should we protect the civil rights of these women? The women- centered model focuses on the
protection of womens rights and respecting what she does to her body or her baby. But by doing
so, we dismiss the risk that may threaten the fetus. Instead of choosing either model, Marcellus
(2004) presents the idea of pregnancy embodiment. Instead of individual rights, the mother and
child is perceived as a unit, thus both mother and fetus benefit. This way, prenatal substance
users would more likely reach out for public assistance instead of running way, for the fear of
being prosecuted.
Marcellus (2004) argues that instead of blaming individual women for their substance
abuse, society should try to find a way to help these women with their addiction. Most prenatal
substance users choose not to seek prenatal care because of the laws that men write. Criminal
prosecution of prenatal substance users is more likely to cause harm to the fetus than helping it
because of the womens fear to access prenatal services. Therefore, it is not right to judge the
autonomy of a woman since there are several factors that affect her decisions. Marcellus (2004)
suggests relationships should be established with individuals and families, so that pregnant
mothers can inform others of their life situations. Thus, allowing professionals to ratify practices
in a way that respects the autonomy of the woman, recognizing the constraints within which she
is trying to make decisions, and value the relationship between maternal and fetal rights.

Nikki Thao

In conclusion, a patients right to autonomy reflects his or her ability to make a valid
informed consent. Patients have the right to demand treatment, but physicians also have the right
to deny that treatment. I believe that before a person is considered an incompetent being, he or
she has the right to voice his/her opinion. And when they are not able to, the person who
advocates for them should do so. McCormacks argument of narrative- based approach is
appealing because it respects patient autonomy. However, one concern is rather the one who
advocates for the patient is actually reliable. Although Paterick argues that patients can strike out
procedures that they deem unrealistic, conflicts arise because not all patients have the right
knowledge to know what the treatment or procedure is. Without criticizing women for their
decisions regarding pregnancy, we should consider factors that affect women autonomy. In a
way, men have no right to label women as incompetent because they do not have the experience
that women have. Instead of blaming women for their careless actions, we should help women
establish relationships that would enhance their well- being and rights.

Nikki Thao

References
Marcellus, L. (2004). Feminist ethics must inform practice: interventions with perinatal
substance users. Health Care For Women International, 25(8), 730-742.
doi:10.1080/07399330490475584
McCormack, B. (2002). The person of the voice: narrative identities in informed consent.
Nursing Philosophy, 3(2), 114-119. doi:10.1046/j.1466-769X.2002.00091.x
Paterick, T. J., Carson, G. V., Allen, M. C., & Paterick, T. E. (2008). Medical Informed Consent:
General Considerations for Physicians. Mayo Clinic Proceedings, 83(3), 313-319.