Abstract
Background: The ethical principle of autonomy is explored as it applies to situations
in which patients' capacities to make decisions are questionable. Case Report: A 40-year-old
man presented to the Emergency Department with an epidural hematoma, and refused to
undergo emergent surgical treatment. Considering the acutely life-threatening nature
of his problem and the inability to confirm the patient's capacity in the presence
of a traumatic brain injury, the decision was made to proceed with emergent surgical
treatment without consent. Discussion: The concept of conditional autonomy is introduced,
defined, and employed to defend the process whereby a select group of patients may
be treated without full knowledge of their wishes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Schloendorf v. Society of New York Hospital, 211 N.Y. 125, 129 (1914).
- Integrity.in: Pellgrino E.D. Thomasma D.C. The virtues of medical practice. Oxford University Press, New York1993: 127-143
- Clinical issues on consent: some philosophical concerns.J Med Ethics. 2002; 28: 377-380
- Assessing patients' capacities to consent to treatment.in: Grisso T. Appelbaum P.S. Assessing competence to consent to treatment: a guide for physicians and other health professionals. Oxford University Press, New York1998: 77-100
- Assessing patients' capacities to consent to treatment.N Engl J Med. 1988; 319: 1635-1638
- Emergency determination of decision-making capacity: balancing autonomy and beneficence in the emergency department.Acad Emerg Med. 2001; 3: 282-284
- Mental capacity, legal competence and consent to treatment.J R Soc Med. 2004; 97: 415-420
- Compentency to give informed consent.JAMA. 1984; 252: 925-927
- Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings.Age Ageing. 2005; 34: 16-20
- Practice in analysis.in: Thinking with concepts. Cambridge University Press, New York1963: 142-168
- Assessing capacity.Emerg Med Clin North Am. 2000; 18: 233-242
- Achieving informed consent when patients appear to lack capacity and surrogates.Clin Orthop Relat Res. 2000; 378: 78-82
- Nonoperative treatment of acute extradural hematomas: analysis of 80 cases.Trauma. 1996; 41: 696-698
- Refusal of care and discharging ‘difficult’ patients from the emergency room.Ann Emerg Med. 1990; 19: 1436-1446
- Patients who refuse treatment in medical hospitals.JAMA. 1983; 250: 1296-1301
Tarasoff v. Regents of the University of California, 17 Cal.3d 425 (1976).
- Debating patients' capacity to decide.The New York Times, Oct 2 2001 (F5)
Article info
Publication history
Published online: April 06, 2009
Accepted:
February 6,
2009
Received in revised form:
December 16,
2008
Received:
October 28,
2008
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
