Autonomy principle

The principle of autonomy entails that persons should be treated as inherently valuable individuals with the moral right to make decisions about their own lives. To the extent that one s actions and choices do not negatively affect others, individuals with the capacity to make their own decisions should be free to do as they wish, even if their choices are risky or harmful to themselves. The principle also entails that persons with diminished autonomy, such as those who are illiterate or retarded, deserve to have their interests protected. Many moral obligations for professionals engaged in scientific research or health care are derived from the principle of autonomy, such as the physician-researcher s obligation to fully inform potential research subjects and respect the individual s informed consent or informed refusal. This obligation is founded on the principle that individuals are the appropriate decision makers for choices that do not harm others. 

The principles of autonomy, beneficence, nonmaleficence, and justice form a foundation for analysis of ethical quandaries. In addition, a comprehensive ethical analysis will include considerations of cultural and reh-gious diversity of patient-subjects, health care providers and interpersonal relationships an assessment of the profession-based duties and obligations of the health care professionals, including an examination of relevant professional oaths and codes and an analysis of relevantly similar previous bioethical dilemmas. 

At minimum, the principles of autonomy and beneficence require that patients be told the source of funding for sponsored studies in which they are invited to enroll and advised of any potential conflicts between the physician s research interests and treatment recommendations. 

L D. The principle of justice is a relevant consideration when subjects are selected for clinical research. It requires that members of a vulnerable population, such as institutionalized patients with mental retardation, not be exploited. The principle of autonomy would be most relevant to the parents ability to consent or refuse on the child s behalf, something Dr. Martin thinks is handled satisfactorily. Dr. Martin believes risks have been minimized and the overall study drug is likely to help the participants, so the study has satisfied the principles of nonmaleficence and beneficence. The principle of medical priority is not mentioned in the chapter and pertains to treating the most medically needy patients first, which is not at issue here. 

Varela, F. J. (1979). Principles of Biological Autonomy. North Holland/Elsevier. 

Although discussed in detail elsewhere in this book, the two ethical principles guiding informed consent are those of autonomy and equipoise. Autonomy is the concept that the patient is an individual that is under no duress, whether subtle or obvious, actual or inferred, and is competent to make a choice according to his or her free will. Clinical trials conducted on persons in custody, or on subordinate soldiers, may both be violations of the patient s autonomy. Equipoise is the concept that the investigator, and those sponsoring the trial, are truly uncertain as to the outcome of the study in practical terms, this is a guarantee to the patient that an unreasonable hazard cannot result from unfavorable randomization because the treatment options are not known to be unequally hazardous. 

All of these can impinge, directly or indirectly, on the autonomy of patients, and deflect hospital care from the best principles of beneficence for each individual case. Furthermore, Bernard Lo,24 a physician and bioethicist at UCSF, discusses possible pitfalls of ethics committees There can be excessive pressure to reach agreement, impairment rather than improvement of decision making and the broader dangers of Group-think , that is attraction toward consensus overcoming the voicing of independent, and possibly discordant, points of view. 

One might think that the health professional and the patient make, in accordance with the principles of nonmaleficcncc and autonomy, the decisions they find to be pertinent. The third parties put them into practice, as if these were means or instruments to reach an end the health professional-patient decision. But the third parties are structures with their own entity. So much so that they are guided by a third principle distinct from that of the health professionals nonmaleficence principle and that of the patient s autonomy. The principle of the third parties or that of the society is that of justice. The principle of justice has embodied itself in a political tradition. 

Despite the fact that the new codes of pharmaceutical ethics include the basic principles upon which bioethics is based (i.e., beneficence, autonomy, and justice), they are not complete enough to serve as a framework for making decisions in concrete situations where the basic principles come into conflict. In this case, an ethical foundation and a method are necessary. 

Bioethics, basing itself on the moral canon of the human being and on the necessity, as a rational being, to morally justify one s own acts, adopts the four ethical principles autonomy and beneficence which pertain to the private sphere of the individual and nonmaleficence and justice which pertain to the public sphere."" ... 

The a priori moment The prima facie principles of autonomy, beneficence, nonmaleficence, and justice. 

A conflict can arise between the standard of evidence considered necessary by the administration, the randomized and controlled clinical study (RCT), and the desire of the patient to participate in an open trial, compassionated use (CU). This would mean a conflict between the principle of autonomy (patient) and that of beneficence (administration). 

Rationing of therapies that are thought to be neither suitable nor nonsuitable (there is no proof for or against) which are restricted or denied due to their elevated cost. The conflict in this situation comes about between the principle of beneficence (if the physician orders the treatment) or the principle of autonomy (the patient wants the therapy) and that of justice. No conflict exists if the patient finances his/her own treatment, but it does exist if it is financed by the public health service. Generally, the principle of justice prevails over the other two, and all exceptions should be justifiable. For decisions for rationing to be just (distributive justice), they need to be adopted by the Health Administration. 

The Belmont Report (1979) contains the ethical principles on which the federal regulations for protection of human subjects are based. The three basic principles are respect for persons, beneficence, and justice. Respect is reflected by the consent process. As a result the term autonomy is used in the research and healthcare context. A patient is normally regarded as autonomous if he or she can make his or her own judgments and decisions. In the absence of such ability, for example, as in the case of children, prisoners, and those with mental disorders, the person must be protected. In the Belmont Report and Beneficence, beneficence is the process of minimizing harm (risk) and maximizing possible benefits (usually for the community as a whole). Justice is the term used for the criterion that subjects must be fairly drawn from a variety of ethnic, social, and other groups. 

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