Advertisement

Exploring the Limits of Autonomy

  • Andrew G. Shuman
    Affiliations
    University of Michigan Medical School, Ann Arbor, Michigan

    Adult Ethics Committee, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for articles by this author
  • Andrew R. Barnosky
    Correspondence
    Reprint Address: Andrew Barnosky, do, mph, Taubman Health Care Center, 1500 East Medical Center Drive — Room B1354, Ann Arbor, MI 48109-0303
    Affiliations
    University of Michigan Medical School, Ann Arbor, Michigan

    Adult Ethics Committee, University of Michigan Medical Center, Ann Arbor, Michigan

    Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for articles by this author

      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 access
      One-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 Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Schloendorf v. Society of New York Hospital, 211 N.Y. 125, 129 (1914).

        • Pellgrino E.D.
        • Thomasma D.C.
        Integrity.
        in: Pellgrino E.D. Thomasma D.C. The virtues of medical practice. Oxford University Press, New York1993: 127-143
        • Worthington R.
        Clinical issues on consent: some philosophical concerns.
        J Med Ethics. 2002; 28: 377-380
        • Grisso T.
        • Appelbaum P.S.
        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
        • Appelbaum P.S.
        • Grisso T.
        Assessing patients' capacities to consent to treatment.
        N Engl J Med. 1988; 319: 1635-1638
        • Larkin G.L.
        • Marco C.A.
        • Abbott J.T.
        Emergency determination of decision-making capacity: balancing autonomy and beneficence in the emergency department.
        Acad Emerg Med. 2001; 3: 282-284
        • Buchanan A.
        Mental capacity, legal competence and consent to treatment.
        J R Soc Med. 2004; 97: 415-420
        • Drane J.F.
        Compentency to give informed consent.
        JAMA. 1984; 252: 925-927
        • Brindle N.
        • Holmes J.
        Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings.
        Age Ageing. 2005; 34: 16-20
        • Wilson J.
        Practice in analysis.
        in: Thinking with concepts. Cambridge University Press, New York1963: 142-168
        • Miller S.S.
        • Marin D.B.
        Assessing capacity.
        Emerg Med Clin North Am. 2000; 18: 233-242
        • Wenger N.S.
        • Leiberman J.R.
        Achieving informed consent when patients appear to lack capacity and surrogates.
        Clin Orthop Relat Res. 2000; 378: 78-82
        • Bezircioglu H.
        • Ersahin Y.
        • Demircivi F.
        • et al.
        Nonoperative treatment of acute extradural hematomas: analysis of 80 cases.
        Trauma. 1996; 41: 696-698
        • Mayer D.
        Refusal of care and discharging ‘difficult’ patients from the emergency room.
        Ann Emerg Med. 1990; 19: 1436-1446
        • Appelbaum P.S.
        • Roth L.H.
        Patients who refuse treatment in medical hospitals.
        JAMA. 1983; 250: 1296-1301
      2. Tarasoff v. Regents of the University of California, 17 Cal.3d 425 (1976).

        • Tarkan L.
        Debating patients' capacity to decide.
        The New York Times, Oct 2 2001 (F5)