Autonomy is an American value. It is the ability to make decisions for oneself, also known as self-government. We hold great respect for individual rights and equate freedom with autonomy. Our system of democratic law supports autonomy and, as such, upholds the right of individuals to make decisions about their own healthcare.
Respect for autonomy requires that patients be told the truth about their condition and be informed about the risks and benefits of treatment in order for them to make informed decisions. Under the law, they are permitted to refuse treatment even if the best and most reliable information indicates that treatment would be beneficial, unless their action may have a negative impact on the well-being of another individual. These conflicts set the stage for ethical dilemmas Principles of Healthcare Ethics.
The concept of autonomy has evolved, from paternalistic physicians who held decision-making authority, to patients empowered to participate in making decisions about their own care, to patients heavily armed with Internet resources who demand their own choice in any decision-making. This transition of authority has been slower to evolve in the geriatric population but, as the baby boomers age, they will assert this standard of independence.
Autonomy, however, does not negate responsibility. Healthcare is a partnership between the provider and the recipient of care. Each owes the other a position of partner and respect in healthcare decision-making (Veatch, 2016). An ethical surety is that the physician, or any other healthcare professional, cannot make a unilateral healthcare decision without the consent of that competent adult, or emancipated minor Principles of Healthcare Ethics.
Emancipated minors are persons under the age of 18 who can make legal decisions for themselves without a parent’s consent. Emancipation can occur in several ways, including (1) reaching age of majority [age 18], (2) emancipation by court order, (3) by marriage or parentage, or (4) by active military service. What makes someone an emancipated minor includes being under the age of 18 and legally married, financially independent, a parent, or responsible for his or her own housing, or having been kicked out of a home by abusive parents (Larson, 2018). Healthcare professionals need to be familiar with these legal issues in advocating for patients who fall within the emancipation category. Case managers may need to advocate for emancipated minors in healthcare issues Principles of Healthcare Ethics.
The beneficent practitioner provides care that is in the best interest of the patient. Beneficence is the act of being kind. The actions of the healthcare provider are designed to bring about a positive outcome. Beneficence always raises the question of subjective and objective determinations, of benefit versus harm. A beneficent decision can only be objective if the same decision would be made regardless of who was making it.
Traditionally the ethical decision-making process and the ultimate decision were the determination of the physician. This is no longer the case; the patient and other healthcare providers, according to their specific expertise, are central to the decision-making process. For example, case managers have expertise in quality-of-life issues, and in this capacity can offer much to the discussions of lifestyle and life-challenging choices, particularly when dealing with terminal diseases and end-of-life dilemmas (Leuwenburgh-Pronk et al., 2015) Principles of Healthcare Ethics.
Nonmaleficence means doing no harm. Providers must ask themselves whether their actions may harm the patient either by omission or commission. The guiding principle of primum non nocere, “First of all, do no harm,” is found in the Hippocratic Oath. Actions or practices of a healthcare provider are “right” as long as they are in the interest of the patient and avoid negative consequences.
Harm by an act of omission means that some action could have been done to avoid harm but wasn’t done. Omission would be failing to raise the side rails on the patient’s hospital bed, upon which the patient fell out and was injured. An act of Commission is something actually done that resulted in harm. An example of an act of commission would be delivering a medication in the wrong dose or to the wrong patient.
Case managers can be accused of maleficence by omission if they failed to coordinate a patient’s care correctly—for example, discharging a patient to an inappropriate level of care or leaving a patient in a dangerous living situation.
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