Accordingto the first teammate, “autonomy through vulnerability isrecognizing, accepting and including infirmity and powerlessness intoour care. It is then, we understand its meaning. The autonomyprinciple reminds us that every individual person has values,reasons, and standards.” His definition of autonomy appeals to theauthority of healthcare providers. This definition is aligned to theethical decision provided by ANA (2015) which states that theprinciple of autonomy implies “an agreement to respect anindividual’s right to self-determination, a course of action, andto some extent, it encompasses support of independent decision makingoffered to an individual by others.”
Teammate1 observes that whether autonomy allows one to harm the other is afunction of an individual’s religious and moral beliefs. Moreover,he notes that the factors that motivate individuals to harm self orothers are as unique as they are personal. From an ethicalperspective, this observation is not true. This is because ethicaldecisions pertaining to the exercise of the principle of autonomytake cognizance of the individual and more so societal context(Entwistleet al, 2010).Additionally, the principle of autonomy is limited in scope as itconcerns doing harm to ones’ self or others since it is governed bythe overarching rulesof reciprocity and good will(Gallin & Ognibene, 2012). In this respect, Teammate 1’sobservation that the extent to which the principle of autonomy can beexercised such that it incorporates harm to self or others isgoverned by the religious and moral beliefs is ethically inaccurate.
Accordingto the definition provided by Teammate 2, that is, autonomy is “thecapacity to act on your decisions freely and independently”(Purtilo & Doherty, 2011). The principle of autonomy impliesmaking independent decisions that ought to be respected. Thisdefinition conforms to UCSF (2015) which defines the principle muchmore strictly positing that it is the personal rule of the self thatis often independent from not only external controls but alsoindividual constraints that may inhibit meaningful independentdecision-making.
Concerningwhether his principle allows one to commit harm to self or others,Teammate 2 notes that “the moral standard should allow a person tobe in control of making their own choices, and should only berestricted when they promise to harm someone else (Purtilo &Doherty, 2011).” Further, he notes “people should not be allowedto harm others.” From an ethical perspective, the patients, inpracticing the principle of autonomy, are expected to play by therules of reciprocity in which they are not to subject the physiciansor other parties involved in unnecessary psychological pain to “havetheir way” (Fiester, 2012). For this reason, the response byTeammate 2 is ethically justified since ethical principles providefor the independent decision making while at the same time settingthe limits beyond which the principle cannot be adhered to whichentails where harm to self or others is imminent. Additionally, Teammate 2 posits that “Everything I do is a choice and has an effecton the world around me. So, at the very least, I should be a littlecautious about what I choose. However, I do not have the ability orthe right to choose the consequences for those choices too.” Inthis statement lies the ethical point that separates the action andincidence. Ethically, autonomy is limited in principle sinceindividuals have the freedom to decide, but cannot have control ofcertain impacts of the decisions they make (Smith, 2013).
Teammate3 adopts a more comprehensive approach to autonomy, that is,“individual freedom or ones right to make decisions without beingcoerced. It is the concept of social, political and ethical moralsthat give individuals the rational right to make their own informedchoices (Ask.com, 2015).” He categorically notes that self-harm isnot justified ethically, but recognizes the independence of thepatient in decision-making. Moreover, Teammate 3 notes thatproviding he patient with the necessary information concerning theissues on which decision are to be made is a key factor in upholdingthe autonomous decision made by the patient.
Froman ethical perspective, saying that self-harm is not justified istrue as it is false, since the principle of autonomy requires thatonce the patient is found to be of sound mind, their decisionspertaining to the treatment procedures they select have to berespected no matter what the consequences might be to themselves(Pecorra & Urman, 2014). In this regard, patients can makedecisions that have to be respected. Ethical principles are mute asto whether the decision causes harm to the patient or not. Teammate 3relegates a great role in the provision of information to the patientin decision-making and determining arm which is an important ethicalrequirement. This holds true since ethical principles applied in therealm of patient autonomy prescribe that physicians counsel patientswhen the patient’s decisions are found to be harmful to their livesof disruptive to other’s wellbeing (Smith, 2013). In other words,Teammate 3 considers the provision of full information to patient asthe major factor that should be considered in assessing theprescriptions of the autonomy principle as to whether they lead toself-harm or harm to others.
Teammate4 bases his argument on a more restrictive definition of autonomy,that is, “Autonomy is the personal rule of the self that is freefrom both controlling interferences by others and from personallimitations that prevent meaningful choice. Autonomous individualsact intentionally, with understanding, and without controllinginfluences (Steve Pantilat, 2008).” Further, Teammate 4 advanceshis arguments on a distinctive plane, noting that the ethicalprinciple of autonomy is based only on the decisions that affect anindividual’s life rather than those that affect others. More aptly,he notes that “Harming another person is not autonomous for themthey haven’t chosen to be harmed. So autonomy can include harmfulchoices, if the individual is thoroughly informed. Also, autonomycannot directly harm another party”
Ethically,the principle of autonomy refers to the respect for autonomousdecisions made by individuals (BMA, 2012). The observation thatautonomy pertains decisions that affect an individual only is narrowsince autonomous decisions often involve other parties like familymembers or physicians who often act as “implementers” of theautonomous decisions and sometimes bear incidence to the impacts ofsuch decisions (Brody, 2012). Additionally, the observation that“autonomy can include harmful choices, if the individual isthoroughly informed” is not ethically accurate since physicians areoften tasked with providing accurate information to ensure safety ofpatients. More aptly, according to ANA (2015), the physicians areallowed to practice the principleof paternalismwhere autonomous decisions are likely to result in harm over thepatient or other parties involved in a treatment procedure. In thisrespect, the physician is allowed some discretion over what hebelieves is the best for the patient in light of conflictinginterests. Here, the doctor exercises his “power over the patient”(ANA, 2015)
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