What Does Respect for the Patient's Autonomy Require?

Abstract

Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows.

Cognitive Style and Frame Susceptibility in Decision-Making

“…Several studies have explored the relationship between NFC and framing effects. For example, Smith and Levin (1996) found that participants high in NFC showed no framing effect on multiple decision tasks, whereas participants low in NFC showed framing effects (see also Carnevale et al, 2011 ). However, Simon et al (2004) in a between-subjects design found that being high in NFC alone was insufficient to eliminate framing effects.…”

Concordance and Patient-Centered Care in Medicaid Enrollees’ Care Experience With Providers

“…This finding may reflect the demographic composition of Medicaid, which is strongly skewed toward groups known to have a preference towards seeing concordant providers, such as racial minorities and other disadvantaged groups ( 12 , 25 ). Such preferences may often be less about sharing a specific core identity than a desire to have fulfilling interactions with providers that are respectful, comprehensible, linguistically unchallenging, and imbued with trust, for which a concordant identity may simply act as a rough proxy ( 26 – 29 ). While these findings support policies that seek to expand access to concordant providers, it is important to note that once we controlled for demographic and other confounders, Medicaid enrollees did not have a lesser chance of seeing a concordant provider compared to Medicare or privately insured enrollees.…”

Negative decision outcomes are more common among people with lower decision-making competence: an item-level analysis of the Decision Outcome Inventory (DOI)

“…We found good construct validity, a pattern that has borne up in a unique longitudinal data collection effort that followed the sample for 11 years (Parker et al, 2014 ). Other research has also linked performance on decision-making competence tasks to various cognitive abilities (e.g., Stanovich and West, 2000 , 2008 ; Peters et al, 2006 ; Finucane and Gullion, 2010 Del Missier et al, 2012 , 2013 ), need for cognition and other cognitive styles (e.g., Carnevale et al, 2011 ; Smith and Levin, 1996 ), less regret (Parker et al, 2007 ), and fewer suspensions among students (Stanovich et al, 2003 ). Moreover, decision-making competence has been improved as a result of targeted decision education among high-school students (Jacobson et al, 2012 ).…”