Patient autonomy, clinical decision making, and the Phenomenological reduction

Abstract

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making.

The nexus of social alliances and diverse moral domains: a bedrock for participatory clinical research

“…The crux of this movement is to empower clinical trial participants with the access and capability to utilize, their health data, predominantly with a focus on enhancing health data sharing. Such endeavors not only foster informed medical decision-making but also catalyze future research pursuits ( 1 ). A prime exemplar of these efforts is the Multi-Regional Clinical Trials Center ( mrctcenter.org ), dedicated to bolstering the integrity, safety, and vigor of clinical trials on an international scale.…”

Towards a concept of embodied autonomy: In what ways can a patient’s body contribute to the autonomy of medical decisions?

“…Within bioethics and moral philosophy, there have been a few attempts to provide philosophical investigations into the nature of autonomy by appealing to concepts and principles in classical phenomenology (see, e.g., Mackenzie 2008a ; Käll and Zeiler 2014 ; Hendl 2016 ; Slatman et al 2016 ; Lewis and Holm 2022 ). The aims of the most developed and substantive of these accounts (i.e., Mackenzie 2008a ; Käll and Zeiler 2014 ; Lewis and Holm 2022 ) have not only been to theoretically explain and justify the general idea that autonomy is embodied, affectively constituted, and—on the basis of phenomenological conceptions of selfhood—inherently relational, but also to situate phenomenological approaches to autonomy in relation to traditional, individualistic accounts and more recent—and increasingly common—theories of relational autonomy.…”

Respect for autonomy: Consent doesn’t cut it

“…non-cognitive) factors that have been shown to affect or constitute one's capacity for autonomy. [12][13][14][15] The main upshot of this conceptual confusion is that a patient can give valid consent and thereby be perceived to have had their autonomy respected, yet still fail to make an autonomous treatment decision (i.e. because, for instance, they've failed to satisfy certain autonomy conditions beyond those required by informed consent).…”

“…non-cognitive ) factors that have been shown to affect or constitute one's capacity for autonomy. 12–15…”