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Autonomy Notes

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AUTONOMY OPENING QUOTE a) Charles Foster - 'any society whose sole principle is autonomy is unreflective, shallow and dangerous

WHAT IS IT a) Autonomy relates to the idea that a rational patient should be allowed to make informed, un-coerced decisions about their bodies and healthcare b) Cadizo J- American judge in 1914 said that, 'Every human being of adult years and sound mind has a right to determine what shall be done with his own body' HOWEVER c) Maclean - notes how there are many different conceptions of what autonomy is. Some see it as the ability to make un-coerced decisions, whereas Coggon and Miola say this is liberty

IT'S THE MOST IMPORTANT PART OF MEDICAL LAW a) Foster - in 2009 referred to the 'triumph of autonomy', previously had suggested that autonomy was an antidote to the 'doctor knows best' medical paternalism that permeated medicine b) Brazier - less trust in doctors due to scandals led to it c) Bailey-Harris - replacing medical paternalism with autonomy has led to less controversial decisions, especially where uncertainty on what is in the patient's best interests d) Ex p Brady - Kay J said that regrettably the rights of patients count for everything whilst other ethical values count for nothing e) Re B: Butler Sloss P confirmed woman on ventilator could refuse treatment f) Glover-Thomas - patients have access to more health care information now then ever g) NHS (2010) - patient services are now described as 'patient-led'

1 h) Chester v Afshar - the public policy ground adaptation to 'but for' so that people can make informed decisions IN PRACTICE IT'S NOT THAT IMPORTANT a) Wolpe (1998) - there is still a 'clinical nature of trust' whereby patients, lacking understanding, accede to doctor's proposals b) Cassileth et al - their research showed how many patients lack understanding c) Tallis - could be inefficient for doctors to get informed consent RESOURCES d) Stern - people don't want to make decisions (ie. research showed that most people don't want to think about death so don't make advance directives) e) Re (Burke) v GMC - patient can't demand doctors treat him where doctor thought medically inappropriate f) Female Genital Mutilation Act 2003 - prevents female genital mutilation, shows how autonomy does have its limits

IT SHOULDN'T BE SO IMPORTANT - BRIIIWT a) BAD DECISIONS i) Keown - bad decisions that undermine human flourishing shouldn't be ii)

respected Flamme & Foster - even pro-autonomy advocates scrutinize competency of decision maker ie. love-struck teenager (Keown) with death, Dworking only where death within 6 months and abortions at 36

iii) iv)

weeks Herring - BUT difficulty in drawing line between good/bad decisions St George's v A (CA) - woman at 35 weeks pregnant told she needed a caesarean but demanded the baby be born naturally, even though risk to baby and mother as a result. Declaration was given that the caesarean was permissible, however, after the birth judicial review held

v)

that this was unlawful CONTRAST Re MB (An Adult: Medical Treatment) (CA) - 40 weeks pregnant woman refused caesarian section because she had a phobia of needles

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