Patient autonomy: Beyond informed consent

Lisa Dive1

1 Centre for Values, Ethics and the Law in Medicine, Level 1, Medical Foundation Building K25, The University of Sydney, NSW 2006, lisa.dive@sydney.edu.au

While it has been subjected to significant scrutiny and debate over the years, the value of respecting patient autonomy as conceived by Beauchamp and Childress remains one of the central concepts in medical ethics. Increasingly, consumerist approaches to healthcare reinforce the emphasis on informed consent procedures as a mechanism for respecting patient autonomy. I will argue, following O’Neill and others, that this conception of autonomy conflates it too closely with informed consent. Although informed consent is ethically important, it leads to a problematic emphasis on only providing information to patients. Medical ethics requires a richer conception of autonomy.

I will make use of case studies from genomics to illustrate the shortcomings of a conception of autonomy that identifies informed consent as the primary way of ensuring it is respected. This discussion will show that providing greater amounts of information is often not in the best interests of patients, and that an increased array of choices do not always enhance patients’ autonomy. Rather, the quality of the available choices, and the ability to vary the amount of information and tailor it appropriately is a more effective way of ensuring or safeguarding patient autonomy.

I will also argue that autonomy as a concept has greater ethical value if it incorporates the social and relational context of the person, their ability to reflect critically on their values and preferences, and their capacity to take meaningful action in order to achieve their goals.


Biography

With a background in analytic philosophy and several years’ experience working in health policy, Lisa has a strong interest in applied ethics in the healthcare context. Currently her research is exploring the challenges that emerging medical technologies – especially genomics – pose for fundamental concepts in medical ethics. She is also interested in the impact on patient autonomy and clinical decision making when patients approach healthcare as consumers.