Patient rights are part of human rights standardized across care settings, and guided by ethical principles - beneficence, autonomy, nonmaleficence, and confidentiality. Autonomy represents in different forms where ethical principles are involved. In a healthcare era which is patient centric, patient autonomy is viewed as a partnership between the patient and the provider of care. Further, patient autonomy empowers patients and serves as an opportunity to learn about a condition or procedure, and the intended care plan.
Geography: Global; Focus Area: Human rights in healthcare delivery
Olejarczyk and Young (2022) define patient rights as a subset of human rights. Human rights refer to the minimum standards that a human expects to be treated by fellow humans. Rights are guided by ethical principles to standardize care across healthcare fields. Patient rights empower them to improve health, strengthen relationships with healthcare providers, and help deal with insurance companies for matters related to health coverage.
The Correlations of Patient Autonomy with Traditional Ethical Principles
The core ethical principles that define patient rights include beneficence, autonomy, justice, nonmaleficence, inviolability of human life, and trusting relation between patient and provider. In the absence of a legal standard, care providers can prioritize ethical principles to achieve a favorable outcome for the patient (Olejarczyk & Young, 2022). Patient autonomy may coincide with other ethical principles in several ways as explained below:
- Beneficence refers to a provider doing what is best in the interest of the patient. The principle conflicts with patient autonomy, which makes it necessary to assist the patient in understanding the predictable consequences of the decision, and in the case of disagreement, the care provider is responsible for explaining reasons for recommendations to help the patient make an informed decision.
- Autonomy empowers a patient to make healthcare decisions and defend judgements when it does not coincide with what the physician argues is beneficial. In the case when the patient refuses treatment in accordance with autonomy, the physician can still attempt to inform the patient of the consequences of acting against medical advice. A patient’s right of autonomy is violated when, in a non-emergency situation, the healthcare team or family of the patient coerce the patient to act without the patient’s permission.
- Nonmaleficence ensures that the patient will not be worse after treatment. When a treatment has unintended harm, the physician may inform the patient prior to taking risk to provide an opportunity to accept or decline risk, in which case patient autonomy may be exercised.
- The patient-provider trust relationship entails the patient’s belief in the physician and protecting information that could be taken advantage of to harm the patient (confidentiality). Patient-provider relationship has an imbalance of power, given the higher level of skills, knowledge, and experience of the provider. The patient places faith, confidence, and reliance in the provider, however, the ideal scenario entails a deliberative relationship involving collaboration between the provider and the patient for the best healthcare outcomes. This is in contrast with the provider deciding for the patient (paternalistic - patient is passive), provider providing information to the patient without influencing the patient (informative -patient is the active decision maker), or the provider discerning patient goals and then offering options to achieve those goals (interpretive - patient is passive)
- Informed consent combines the right to be informed of potential harm to one’s body and the right to autonomy. In informed consent, patient autonomy supercedes the care provider’s desire for beneficence. A patient has the right to refusal of treatment as part of informed consent even when the provider acts out of beneficence. A patient may choose future relationships with providers or maintain health beyond the healthcare setting (care continuity) by exercising autonomy.
Promotion: Autonomy and Clinical Medicine: Renewing the Health Professional Relation with the Patient (International Library of Ethics, Law, and the New Medicine Book 2) 2000th Edition, Kindle Edition by J. Bergsma (Author), David C. Thomasma (Author)
Perspectives on Autonomy in Patient Care
Physician-Patient Partnership in the Era of Enlightened Care
Over the years, care delivery has shifted from the physician taking all decisions and the patient complying, to the patient contributing equally to decision-making in the delivery process, the latter considered as a form of “enlightened care” (Bernstein, 2018). Involving patients and helping them understand treatment options entails collaborative work to achieve health and wellness goals. Sometimes, physicians do not encourage patient involvement in the decision-making process, either by preventing them from contributing their opinion or researching their condition. Although physician expertise and high level of clinical knowledge is to be respected, it is also important to understand that patients have a level of awareness about their bodies, treatment tolerance, and preference for receiving care. Experts recommend finding the right doctor who will understand their style of receiving care and respect their preferences fully. Choosing the right doctor and participating in medical decision-making are important aspects of patient autonomy.
The Several Facets of Patient Autonomy that Empower Patients
A patient exercises the right to autonomy by learning more about a condition, performing research about alternative treatment options, discussing alternative treatment options with the care provider, preparing questions for the provider prior to the visit, getting a second opinion from a specialist, discussing tolerance for a specific treatment, and expending effort to find the right doctor for a condition (MediFind, n.d.). For example, a woman who is not satisfied with the level of care has the right to change her gynecologist. When she is not satisfied with the outcome of a surgical procedure, she has the right to request surgical notes and pursue additional consultation and differential diagnosis. These acts of exercising autonomy are likely to resolve her symptoms spontaneously.
Therefore, patient autonomy gives the patient the right to make decisions about their care without the care provider influencing their decisions. The provider can educate the patient but cannot make decisions for the patient. It does not support the act of promoting patient’s welfare when patient autonomy is compromised.
Promotion: Advance Directives: 54 (International Library of Ethics, Law, and the New Medicine) Hardcover – 5 November 2013 by Peter Lack (Editor), Nikola Biller-Andorno (Editor), Susanne Brauer (Editor)
Keywords
ethical principles, patient-provider trust, differential diagnosis, informed consent, enlightened care, confidentiality, refusal of treatment, second opinion, Autonomy, empowered patient, care continuity
References
Bernstein, C. A. (2018). Take control of your health care (exert your patient autonomy). Harvard Health Blog. https://www.health.harvard.edu/blog/take-control-of-your-health-care-exert-your-patient-autonomy-2018050713784
MediFind. (n.d.). Why is Patient Autonomy Important? MediFind. https://www.medifind.com/news/post/why-is-patient-autonomy-important
Olejarczyk, J. P., & Young, M. (2022). Patient Rights and Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/
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