Healthcare Ethics

Autonomy in General Internal Medicine and Sport Medicine

Autonomy is the personal ability to make decisions concerning one’s life, and such decision must be free from other interference and personal limitation. Besides, someone acting autonomously may be doing what they wants to do at will, but it must also be on the basis of conscious thought and reasoning. In this article, I will discuss autonomy and paternalism in healthcare by focusing on general internal medicine and sport medicine.

Respect for autonomy is a basic ethical principle in healthcare. This requires health professionals to do their best to preserve and enhance the autonomy of their patients. They must not interfere or constrain the autonomy of their patients, unless the exercise of such autonomy will harm others. Also, to mislead patients is to fail to give them the necessary information required to make autonomous choices. Besides, knowledge is an essential component of autonomy. A patient may have little understanding of the cause and effect of their medical conditions and the treatment they will receive; thus such patient cannot make an autonomous decision. Also, illness can have a disorienting effect on the individual, especially if it has obvious psychological consequences. In that case, patient may have little or no ability to make an autonomous decision.

At a purely practical level, even if the patient can form a perfectly autonomous intention, illness or disability can prevent such intention from being physically implemented. Finally, serious life-threatening conditions, such as a strong concussion or dementia, can cause some patients to lose their ability to make autonomous decision. Thus others will have to make decisions for them with little participation on their part. However, an individual can be truly autonomous, but exercising excessive autonomy. For instance, an athlete taking unnecessary performance-enhancing substance which have serious side effects. In such case, if that athlete’s doctor is aware of that substance use, the doctor may have to persuade the athlete to discontinue the use of the substance. That persuasion, however, is for the athlete’s best interest. But then again, the doctor has infringed the athlete’s autonomy, and this is the basis of what is known as paternalism.

There are two types of paternalism. The first is weak paternalism, this is when a non-autonomous person’s decision is override in order to protect them from harm or promote their best interest. The second is strong paternalism, this is when an autonomous person’s decision is override in order to protect them from harm or promote their best interest. By and large, paternalism is unacceptable for many, because it is an act of interference in the lives of others, with the health professionals overriding their patients autonomy. However, those who consider paternalism acceptable—like the athlete’s doctor above—argue that, in some cases it is the only action which can protect the welfare of the patients. In spite of that, autonomous patients must be allowed to exercise some level of autonomy in general internal medicine and sport medicine, as long as they’re not hurting another person.

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