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PERSPECTIVE
Supporting Patient Autonomy: The Importance of Clinician-patient Relationships
Vikki A. Entwistle, PhD1, Stacy M. Carter, PhD 2,3, Alan Cribb, PhD 4, and Kirsten McCaffery, PhD3
1Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK; 2Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia; 3Sydney School of Public Health, University of Sydney, Sydney, Australia; 4Centre for Public Policy Research, Kings College London, London, UK.
Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care.Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy.
KEY WORDS: personal autonomy; professional-patient relations; clinical ethics; relationship-centred care.
J Gen Intern Med 25(7):7415DOI: 10.1007/s11606-010-1292-2 Society of General Internal Medicine 2010
tional insights for clinical contexts. These understandings highlight the importance of social relationships for autonomy capability. We believe they could help clinicians to recognise how their interactions and relationships with patients can either enable or impair patients autonomy.
RESPECT FOR AUTONOMY: PREVAILING IDEAS
Considerations of respect for autonomy in health care contexts tend to focus on situations in which decisions need to be made about health care interventions. A principle of respect for autonomy is also invoked in discussions about confidentiality, fidelity,...