Respect for Autonomy as a Prima Facie Right: Overriding Patients' Autonomy in Medical Practice
Journal of the Colleges of Medicine SA (CMSA). Vol.53 (1) Jan-Jun 2009. pp. 38-42
Posted: 24 Feb 2013
Date Written: January 1, 2009
Abstract
Prima facie, every competent adult has the right to decide whether to consent or refuse any medical treatment, even if such refusal could lead to death. However, this right to respect for autonomy is a rebuttable right, which could be overridden where there is temporary or permanent mental incapacity, such as due to unconsciousness, infancy, or mental retardation. On these occasions, an individual’s right to informed consent could be overridden based on the doctrines of best interests, necessity, therapeutic privilege, or as a matter of public policy. In view of ongoing controversies and contemporary ethical dilemmas surrounding the withdrawal of life sustaining nutrition and hydration from patients in a persistent vegetative state (PVS), compulsory immunization of children, and detention of mental health patients. The quarantine and treatment of patients with infectious diseases, such as extremely drug resistant tuberculosis (X-DR TB), or during routine management of unconscious patients in medical emergencies. It is imperative that physicians and healthcare users are aware of those circumstances, where a patient’s right to respect for autonomy may be ethically and legally overridden, without descending down the ‘slippery slopes’ of medical paternalism. This essay analyzes the relevant case law and ethical principles, to find instances where an individual’s right to respect for autonomy may be considered to have only a prima facie standing and could be overridden when in conflict with other equally compelling moral considerations.
Keywords: Autonomy, Medicine, Patients, Overriding, Ethics
JEL Classification: K19
Suggested Citation: Suggested Citation