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PubMed · 6520849

Paternalism and partial autonomy.

O O'Neill
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Abstract

A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy.

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BeneficenceDisclosureEthical AnalysisEthical TheoryEthics, MedicalHumansInformed ConsentPaternal BehaviorPaternalismPersonal AutonomyPhysician-Patient RelationsVolitionAnalytical ApproachPhilosophical ApproachProfessional Patient RelationshipJournal Article

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O O'Neill. 1984. Paternalism and partial autonomy.. https://doi.org/10.1136/jme.10.4.173

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Emergency determination of decision-making capacity: balancing autonomy and beneficence in the emergency department.

The determination of decision-making capacity (DMC) is an essential component of securing voluntary informed consent, for either treatment or refusal of care. Decision-making capacity should be determined on some level during each patient encounter. Decision-making capacity includes the ability to receive, process, and understand information, the ability to deliberate, the ability to make choices, and the ability to communicate those preferences. For patients in whom DMC may be uncertain, a more explicit approach to determination of DMC is recommended. However, DMC determination must neither compromise patient safety nor delay needed care. When DMC determination is challenging, or when the ramifications of a decision are serious, the assistance of a third party (such as a surrogate, a consultant, or another clinician) may be valuable in discerning the most appropriate action. In addition to the obvious clinical utility of DMC assessment, the steps taken in the very establishment of DMC may promote patient trust, professionalism, and humanistic clinical practice. While DMC may be conditional, the compassion and respect we have for our patients must be unconditional.

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