Autonomy

Introduction

Respecting a patient's right to determine his/her destiny & pursuit of his/her beliefs & happiness. It implies that the patient is capable of making reasonable decisions, including the right to refuse therapy (even at the risk of death). (see competence)

From the Greek for 'self rule'
One exception to the rule of autonomy is emergency treatment. If emergency treatment for a critically ill & incapacitated patient is likely to produce substantial benefit & if delaying treatment is likely to lead to irreversible harm, emergency treatment without consent is widely accepted. However, this exception is limited when the patient has previously expressed a desire not to undergo the proposed medical intervention. A do not resuscitate ( DNR) order is acceptable when the patient has clearly stated in advance this desire.
A 2nd major exception to the rule of autonomy is called 'therapeutic privelage'. In this case, a physician may believe that fully informing a patient about his/her medical condition may do more harm than good. This practice is not widely accepted in the United States, but is widely accepted in most other cultures.

Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 582
Kapp M & Finucane T. Decision Making, In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 589
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Sudore RL, Fried TR. Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Ann Intern Med 2010; 153(4):256-261. PMID: [3]

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