Autonomy In Patient-Centred Care
Civil law is divided into different categories such as Family law, Tort, contract law and administrative law (Nockleby, 2013). Family law is regarded as the law that regulates rights, duties and relationship within the family (Statsky, 2014) while tort is the general label given to a class of civil wrong whereby the courts provides a remedy as compensation for damages (Weller, 2013). Furthermore, Miller and Jentz, (2013) identified contract law is an enforceable agreement while Adamson (2011) defines administrative law as the part of law regulating public bodies like courts, local authorities and how other public institution operates. Also, Gaines and Miller (2012), emphasises that these laws should guide healthcare practitioners in decision
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making process so as to avoid errors. However, Thobaben (2009) argues that irrespective of law, ethical principle for decision making safeguards and ensures that a systematic approach is adhered to in making professional decision. Furthermore, healthcare professionals are obligated to provide care which should not be compromised (NMC. 2015). Hence, as required by legal and professional duty, nurses and midwives are required to provide patient care irrespective of their culture and diversity (NMC, 2015). Therefore, nurses are obliged to provide safe and sound care with respect to evidenced based findings (DiCenso et al., 2014).
In the above scenario, the healthcare team are faced with a dilemma of weather to adhere to the principle of non-maleficence (obligation not to cause harm to Miss KK by leaving a surgical scar), to adhere to the respect for the patient’s autonomy or to adhere to the principle of duty of care of beneficence (save Miss KK form dying) or the principle of justice (Beauchamp and Childress, 2001; Emanuel and Pearson, 2012; MacMillan, 2015). With the emergence of the principles of ethics which includes respect for autonomy, non-maleficence, beneficence and justice (Beauchamp and Childress, 2009), healthcare professionals are obligated to act on the principles in providing patient care as well as preserve professionalism (NMC,2015).
Autonomy means freedom from external pressure and the presence of critical mental capacity such as intention, understanding and voluntary decision making capacity (Beauchamp and Childress, 2009). An autonomous individual acts freely in conformity with a self-chosen plan. In contrast, a person of diminished or no autonomy, is in some respect incapable of deliberating or acting on the basis of his or her own desires or is being controlled by others (Ashcroft, 2007). Nevertheless, individuals with diminished autonomy either as a result of age or mental capacity are protected by the mental capacity act which ensures that decision made for individuals is in their best interest (MCA, 2005). According to Ashcroft (2007) and MacMillan (2015) the respect for autonomy involves an appreciation of an Individual’s value and decision-making rights, whereas disrespect for autonomy involves attitude and actions that ignore, demean, insult or are inattentive to the individual’s decision making right. Consequently, Daly (2009); Pavlovic and Spassov, (2011) asserts that patient’s right to acceptance or rejection of a treatment has led to a change in the balance of authority in the nurse-patient relationship and thus the patient is more fully engaged in decision making regarding patient care plan which has led to the promotion of patient centred care.
In contemporary health care practice, patient-centred care has been recognised as a relevant concept that serves as an underpinning of every care rendered (Sandman and Munthe, 2010).
Autonomy which is within the context of patient care has replaced paternalism which was the formal approach to patient care in healthcare practice (DH, 2010). The respect for autonomy which advocates for patients’ decision making rights (Gillet, 2008; Walker, 2009; Beauchamp and Childress, 2009) and discourages paternalism which has been the norm in the nurse-patient relationship for decades, permits Miss KK to decline surgery which she considered more of a concern and a burden than beneficial (Davies and Elwyn, 2008). Additionally, the healthcare professional owes the patient a duty of care to ensure the patient’s choice is respected and an acceptable standard of care is rendered at all-times (Pozgar, 2010; NMC, 2015). In contrast, the General Medical Council (2008) and Herring (2011) argues that no patient has the right to demand certain treatments and the healthcare professional is under no ethical or legal obligation to provide treatment requested by a patient that he or she views as not clinically specified. Consequently, Fagan (2009) and Harrison and Hart (2009) suggests that patient’s refusal to a particular treatment can pose a significant challenge to the healthcare professionals, as the patient’s decision may be in direct contrast to those of the healthcare team and thus result in a severe medical consequence. Notwithstanding, Varelius (2006), MacMillan (2015) and NMC (2015) asserts that as long as adequate information was given to Miss KK in respect to the surgery, regardless of any decision she makes, her rights to autonomy must be
respected
making process so as to avoid errors. However, Thobaben (2009) argues that irrespective of law, ethical principle for decision making safeguards and ensures that a systematic approach is adhered to in making professional decision. Furthermore, healthcare professionals are obligated to provide care which should not be compromised (NMC. 2015). Hence, as required by legal and professional duty, nurses and midwives are required to provide patient care irrespective of their culture and diversity (NMC, 2015). Therefore, nurses are obliged to provide safe and sound care with respect to evidenced based findings (DiCenso et al., 2014).
In the above scenario, the healthcare team are faced with a dilemma of weather to adhere to the principle of non-maleficence (obligation not to cause harm to Miss KK by leaving a surgical scar), to adhere to the respect for the patient’s autonomy or to adhere to the principle of duty of care of beneficence (save Miss KK form dying) or the principle of justice (Beauchamp and Childress, 2001; Emanuel and Pearson, 2012; MacMillan, 2015). With the emergence of the principles of ethics which includes respect for autonomy, non-maleficence, beneficence and justice (Beauchamp and Childress, 2009), healthcare professionals are obligated to act on the principles in providing patient care as well as preserve professionalism (NMC,2015).
Autonomy means freedom from external pressure and the presence of critical mental capacity such as intention, understanding and voluntary decision making capacity (Beauchamp and Childress, 2009). An autonomous individual acts freely in conformity with a self-chosen plan. In contrast, a person of diminished or no autonomy, is in some respect incapable of deliberating or acting on the basis of his or her own desires or is being controlled by others (Ashcroft, 2007). Nevertheless, individuals with diminished autonomy either as a result of age or mental capacity are protected by the mental capacity act which ensures that decision made for individuals is in their best interest (MCA, 2005). According to Ashcroft (2007) and MacMillan (2015) the respect for autonomy involves an appreciation of an Individual’s value and decision-making rights, whereas disrespect for autonomy involves attitude and actions that ignore, demean, insult or are inattentive to the individual’s decision making right. Consequently, Daly (2009); Pavlovic and Spassov, (2011) asserts that patient’s right to acceptance or rejection of a treatment has led to a change in the balance of authority in the nurse-patient relationship and thus the patient is more fully engaged in decision making regarding patient care plan which has led to the promotion of patient centred care.
In contemporary health care practice, patient-centred care has been recognised as a relevant concept that serves as an underpinning of every care rendered (Sandman and Munthe, 2010).
Autonomy which is within the context of patient care has replaced paternalism which was the formal approach to patient care in healthcare practice (DH, 2010). The respect for autonomy which advocates for patients’ decision making rights (Gillet, 2008; Walker, 2009; Beauchamp and Childress, 2009) and discourages paternalism which has been the norm in the nurse-patient relationship for decades, permits Miss KK to decline surgery which she considered more of a concern and a burden than beneficial (Davies and Elwyn, 2008). Additionally, the healthcare professional owes the patient a duty of care to ensure the patient’s choice is respected and an acceptable standard of care is rendered at all-times (Pozgar, 2010; NMC, 2015). In contrast, the General Medical Council (2008) and Herring (2011) argues that no patient has the right to demand certain treatments and the healthcare professional is under no ethical or legal obligation to provide treatment requested by a patient that he or she views as not clinically specified. Consequently, Fagan (2009) and Harrison and Hart (2009) suggests that patient’s refusal to a particular treatment can pose a significant challenge to the healthcare professionals, as the patient’s decision may be in direct contrast to those of the healthcare team and thus result in a severe medical consequence. Notwithstanding, Varelius (2006), MacMillan (2015) and NMC (2015) asserts that as long as adequate information was given to Miss KK in respect to the surgery, regardless of any decision she makes, her rights to autonomy must be
respected