This is an extract of our Autonomy document, which we sell as part of our Medical Law and Ethics Notes collection written by the top tier of University Of Oxford students.
The following is a more accessble plain text extract of the PDF sample above, taken from our Medical Law and Ethics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
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
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
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
Buy the full version of these notes or essay plans and more in our Medical Law and Ethics Notes.