Has the autonomy pendulum swung too far?

Abstract

This paper aims to contribute to the discussion about patient-centred care in surgery. It is contended here that the paradigm shift towards patient-centred decision-making in health care does not mean that patient values alone (or those of their proxies) should, uncritically, be the lead decision makers in determining surgical care. In support of that contention, three clarifications to our conception of autonomy will be offered. First, autonomy may not be best positioned as the lead principle guiding healthcare decision-making. Second, arguably, our traditional understanding of autonomy, as it might be applied to health care, is incomplete. Third, where autonomy is vested is contentious, and proxy decision makers can further complicate the decision-making process. It will be argued that an approach of inclusive, non-coercive and reflective dialogue seeking a consensual decision amongst all those affected is more appropriate for moral decision-making in surgery. This dialogue is set in the actual reality of the patient's illness. During the discourse, each participant has equal rights to contribute and to be heard, equal duties not to coerce and equal co-responsibilities to share the perspectives of others in the discourse, with an aim to reach consensus.