The Intimate Connection Between Autonomy and Decision-Making in Applied Health Care Ethics

Abstract

The intimate connection between autonomy and decision-making in applied health care, especially in various kinds of consent and refusal has taken center stage in medical ethics since the Salgo decision in 1957. Prior to that time, the physician’s supposedly moral duty to provide appropriate medical care typically surpassed the legal obligation to respect patient’s autonomy. The Salgo decision concluded that physicians have a legal duty to provide facts necessary for the patient to make an informed decision. "The doctor knows best" long ago was replaced with "The doctor proposes; the patient disposes." There is no legal obligation for the patient’s choice to be palatable to anyone, other than that patient himself/herself. Although Beauchamp and Childress justified the obligation to solicit decisions from patients and potential research subjects by the principle of respect for autonomy, they however, acknowledged that the principle’s precise demands remain unsettled and open to interpretations and specification. This thesis addresses a current debate in the bioethical community on the four-principle approach. Using Tom Beauchamp and James Childress as case study, to discuss mainly the principle of respect for autonomy, I go on to explain their central arguments concerning this principle in relation to decision making in health care ethics. Rather than focus on their respective weaknesses, which many theorist and health care professionals do, I emphasis instead on the contribution the principle of respect for autonomy can make in the process of ethical decision making in health care situation.