Let's first of all think
about respect for autonomy.
So this goes back to the philosophical notion that
you have reasoning, you have reasoning ability,
you're a rational agent, and a patient is going
to be capable of making their own decisions.
You as the clinician, you know, you're also capable of making
your own decisions and how you're going to perform your actions.
But when we're thinking about respect for autonomy, it's
usually thought about in terms of the patient's autonomy.
And we want to respect
The first idea is that, you know, being
able to choose your own decisions,
you know, that's an idea of
self-rule or self-determination.
How do we want to govern ourselves in our world
and make sure that we're being true to ourselves?
There is this notion
of liberty rights.
So not making sure the people are
interfering with your liberty,
your ability to have freedom of
will, make your own choices.
That's another element
of respect for autonomy.
It also means that you don't want
other people to control your actions,
so being free of controlling
interference by others.
So each person can, you know, you
can swing your fist in the air,
but once it hits another person you are not
respecting that other person's autonomy.
So being free of controlling
interference by others.
And then lastly and
especially in medicine,
we have to have freedom from limitations
such as inadequate information.
So one of the roles of the physician
in terms of doing informed consent,
that we'll hear about in a future lecture, is
this idea of giving them enough information
so they can make decisions,
so they can be self-ruling.
Now, there are going to be some limits on
the principle of respect for autonomy.
So we're always thinking about in terms of rationality
and a person being able to reason themselves
through getting information
and making decisions.
But in illness, people are vulnerable and there
may be times when some choices are non-rational.
Doesn't mean that they're irrational, but they just are
not on the realm of being on, you know, reasoning.
This idea of, you know, making a decision out of love.
Is that a rational reason?
No, you're making it on behalf
of let's say a family member.
A patient that is, you
know, has advanced cancer
and they have to make a decision whether to
go through another round of chemotherapy.
They themselves may say "No, I don't
wanna go through this again."
But their loved ones really want them to
try to continue to fight the illness.
There that choice is non-rational, it's not being
reasoning through the risks and the benefits,
but it's out of love for
their family member.
Another concern with the principle of respect
for autonomy is this issue of authenticity,
which we'll hear about in a future lecture
in terms of advanced care planning.
So the decisions I make today, how relevant
are they going to be in my future self?
You know, is there an issue of am I making
authentic choices now that are gonna be the same
when I perhaps, you know, have your
serious illness that I have to confront.
Next, there is going to be this way of which choices are
purely self-regarding, none of us live in isolation.
None of us are automatons that, you
know, just think about ourselves.
We generally have a sphere of others in our
lives that we are also thinking about.
So sometimes our decisions are
not purely self-regarding,
but are also taking into account our loved
ones or acquaintances or friends and so on.
There may also be times when autonomy has jurisdictional
limits and we certainly saw that in the pandemic
where people may make autonomous
choices of, you know,
deciding for themselves or whether
or not they want to wear a mask.
But there might be needs for public
health of restricting a person's autonomy
and there may be ways that the law influences where
the person can truly make autonomous choices.
And that also then leads to this idea
of the collective body, you know,
so there might be elements of thinking about the
larger society and its interest in making choices
and sometimes limiting a person's autonomy
in the interest of the larger community.
And there's also this question of
when we say okay you live your life.
Is that idea of non-interference really
facilitating or hindering autonomous choices?
If you know a person is going into a very risky
situation and you want to warn them against it,
do you just say, you know, do what you want.
Or do you actually pause and say
"You know I respect you enough, I wanna make
sure you're able to make future decisions.
I think I need to warn you about
going into this risky situation."
So, a lot of us think about, you know, respect for autonomy
and the autonomous choices that patients may make.
But I also think it's important to think about
respect in terms of respecting the person.
Respecting the idea that each person has an inherent
dignity that is not just based on their reasoning ability,
but that just being a person
they are owed respect.
And that is that they have unconditional value that
this person is important just for being a person,
just for their humanity and we should
recognize that and respect that.
It also means that respect
should be applied to everyone.
This idea then, you know, gets
us into thoughts about justice.
So, applying respect to
everyone we encounter.
Not favouring one patient over
another but respecting all patients.
And then lastly, it's not just how we act
towards a person, how do we show them respect,
but do we actually believe, you know, is it a core
value for us that respect should be owed to everyone?
So both in our actions and in our beliefs and our
thoughts we are going to demonstrate that respect.
And then, it's not just the individual patient, but
also respecting that patient comes from a culture
and all of us have different attributes,
different cultures that we,
you know, all combine
into to be who we are.
And culture basically is the idea of shared
meanings, values, rituals, ways of interacting.
You know everything that comes in to
being in ones culture and that idea,
that combination of things then influences how
people understand and make sense of the world.
So, we think about, you know, how you've been raised,
the family is one place where you learn your culture.
You, maybe, have
That when you then go into, you
know, the healthcare arena,
you're a patient that's sick you
bring your culture with you.
And the clinicians are going to have
to respect your cultural attributes
and know how best to serve you based
on your cultural understandings.
It may influence how the patient
interprets their symptoms.
So, how did they make sense of what they're
feeling physically or emotionally?
Is that part of, you know, what the
culture says about having a disease?
It may influence how they
cope with their symptoms.
If they're sick, you know, are there different rituals
that cultures might adhere to in terms of the sick role
and how other people need
to take care of them.
It may influence a person's
ability to even seek healthcare.
You know, what is their
approach to health?
Are they thinking about physical fitness as
a, you know, core element of their culture?
Do they sort of neglect their
health and think about other things
that are more important based on
their cultural underpinnings?
That can then influence how they then approach, you know,
the healthcare setting and thinking about care planning.
You may have heard of, you know, patients
that are reluctant to go see the doctor
and only with the encouragement of a significant
other do they actually seek medical care.
That might be based on
It also may influence the
choice of treatment.
So, are things more or less
acceptable to one's culture?
A classic example would be the Jehovah's Witness religious
tradition would say they would not want a blood transfusion.
So does that cultural underpinning
influence their choice of treatment
whether they would accept or decline a
blood transfusion if they have anemia?
And also the culture may speak
to their adherence to treatment.
So, how accustomed are they to taking pills
and following the doctor's orders as it were?
How are they going to adhere to the
treatment or might they be in a place
where they decide not to seek treatment or
adhere to what's being suggested for them?