The Principle of Patient's Autonomy: The Possible and the Real
The article aims to reveal basic difficulties related to the practical implementation of the principle of patient's autonomy. This tenet is one of the main principles of biomedical ethics, and it is fixed in international and local laws. Debates around the principle of autonomy are traditionally connected with its substantial concretisation and the question of how to unambiguously refer the principle of autonomy to other principles of biomedical ethics: "do good", "not to do harm", and the principle of justice. However, the issue of practical implementation of the principle of patient's autonomy given the competences the patient should have is rarely considered. The analysis of legal documents and special literature has shown that mandatory conditions of practical implementation of the principle of patient's autonomy are: voluntariness, awareness and the ability to make decisions. The substantial analysis of each of these conditions demonstrates inevitable difficulties related to their practical fulfillment. It has been revealed that basic difficulties in the fulfillment of the voluntariness condition are determined by the absence of clear criteria for differentiating between persuasion (rational argumentation) and use of force (use of threatening information), between the presence or absence of manipulation on the side of the doctor. The difficulty related to the fulfillment of the awareness condition is determined by the "information knowledge asymmetry" between the doctor and the patient, as well as by the fact that the "informed consent" in its essence does not warrant awareness. In the author's opinion, the condition of the "ability to make a decision" causes the greatest problem in terms of fulfillment. The ability to make a decision includes perception, analysis, systematisation of information, ability to make rational considerations based on processed information and in accordance with one's own vital plans and goals, ability to oppose manipulations, and readiness to make decisions and bear responsibility for them. If the patient lacks formed skills of independent decision-making, the implementation of the principle of patient's autonomy becomes highly unlikely. If such skills are actually developed in the patient, the disease getting a chronic nature and its acute course inevitably weaken their ability to make decisions independently, responsibly and in accord with their vital plans.
Keywords
принцип автономии пациента,
биоэтика и биомедицинская этика,
информированное согласие,
пациент,
врач,
principle of autonomy,
bioethics and biomedicine ethics,
informed consent,
patient,
doctorAuthors
| Barbashina Evelina V. | Novosibirsk State Medical University; Institute of Philosophy and Law of the Siberian Branch of the Russian Academy of Sciences | linaba@mail.ru |
Всего: 1
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