Supporting patient autonomy: the importance of clinician-patient relationships - PubMed (original) (raw)
Review
Supporting patient autonomy: the importance of clinician-patient relationships
Vikki A Entwistle et al. J Gen Intern Med. 2010 Jul.
Abstract
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.
Comment in
- From the editors' desk: patient autonomy and medical decisions: getting it just right.
Feldman MD. Feldman MD. J Gen Intern Med. 2010 Jul;25(7):639. doi: 10.1007/s11606-010-1391-0. J Gen Intern Med. 2010. PMID: 20473641 Free PMC article. No abstract available.
Similar articles
- Respect for rational autonomy.
Walker RL. Walker RL. Kennedy Inst Ethics J. 2009 Dec;19(4):339-66. doi: 10.1353/ken.0.0301. Kennedy Inst Ethics J. 2009. PMID: 20191948 - Does shared decision making respect a patient's relational autonomy?
Lewis J. Lewis J. J Eval Clin Pract. 2019 Dec;25(6):1063-1069. doi: 10.1111/jep.13185. Epub 2019 May 31. J Eval Clin Pract. 2019. PMID: 31148321 - Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.
Murgic L, Hébert PC, Sovic S, Pavlekovic G. Murgic L, et al. BMC Med Ethics. 2015 Sep 29;16(1):65. doi: 10.1186/s12910-015-0059-z. BMC Med Ethics. 2015. PMID: 26420014 Free PMC article. - Relational autonomy or undue pressure? Family's role in medical decision-making.
Ho A. Ho A. Scand J Caring Sci. 2008 Mar;22(1):128-35. doi: 10.1111/j.1471-6712.2007.00561.x. Scand J Caring Sci. 2008. PMID: 18269432 Review. - Ethics for the pediatrician: autonomy, beneficence, and rights.
Cummings CL, Mercurio MR. Cummings CL, et al. Pediatr Rev. 2010 Jun;31(6):252-5. doi: 10.1542/pir.31-6-252. Pediatr Rev. 2010. PMID: 20516238 Review. No abstract available.
Cited by
- Ethical and Legal Challenges in Caring for Older Adults with Multimorbidities: Best Practices for Nurses.
Alodhialah AM, Almutairi AA, Almutairi M. Alodhialah AM, et al. Healthcare (Basel). 2024 Aug 9;12(16):1585. doi: 10.3390/healthcare12161585. Healthcare (Basel). 2024. PMID: 39201144 Free PMC article. - Exploring factors impacting patient decisions in hemorrhoid surgery: A questionnaire survey in Taiwan.
Chen PC, Chen CI. Chen PC, et al. Surg Open Sci. 2024 Jul 22;20:214-221. doi: 10.1016/j.sopen.2024.07.009. eCollection 2024 Aug. Surg Open Sci. 2024. PMID: 39156488 Free PMC article. - Parents Experiences of Racism in the Neonatal Intensive Care Unit.
Smith O, Karvonen KL, Gonzales-Hinojosa MD, Lewis-Zhao S, Washington T, McLemore MR, Rogers EE, Franck LS. Smith O, et al. J Patient Exp. 2024 Aug 14;11:23743735241272226. doi: 10.1177/23743735241272226. eCollection 2024. J Patient Exp. 2024. PMID: 39148749 Free PMC article. - Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients.
De Las Cuevas C, Benadero O. De Las Cuevas C, et al. Patient Prefer Adherence. 2024 Aug 5;18:1629-1640. doi: 10.2147/PPA.S469579. eCollection 2024. Patient Prefer Adherence. 2024. PMID: 39131691 Free PMC article. - Using symbiotic empirical ethics to explore the significance of relationships to clinical ethics: findings from the Reset Ethics research project.
Redhead CAB, Frith L, Chiumento A, Fovargue S, Draper H. Redhead CAB, et al. BMC Med Ethics. 2024 May 28;25(1):66. doi: 10.1186/s12910-024-01053-9. BMC Med Ethics. 2024. PMID: 38802832 Free PMC article.
References
- Beauchamp TL, Childress JF. Principles of biomedical ethics. 6. New York: Oxford University Press; 2009.
- Pellegrino ED, Thomasma D. The virtues in medical practice. New York: Oxford University Press; 1993.
- Sherwin S. A relational approach to autonomy in healthcare. In: Sherwin S, and the Feminist Health Care Ethics Research Network, editor. The politics of women's health: exploring agency and autonomy. Philadelphia: Temple University Press; 1998. pp. 19–47.
- Schneider CE. The practice of autonomy. New York: Oxford University Press; 1998.
- Dodds S. Choice and control in feminist bioethics. In: Mackenzie C, Stoljar N, editors. Relational autonomy: feminist perspectives on autonomy, agency and the social self. New York: Oxford University Press; 2000. pp. 213–35.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical