Informed consent - 2008

Abstract

The traditional Hippocratic belief that one could do almost anything on a patient as long as the principles of beneficence (best interests) and non-maleficence (no harm) were upheld has been considerably revolutionised over the last century. Paternalism, the belief that the health care practitioner should protect or advance the interests of the patient even if contrary to the patient's own immediate desires or freedom of choice, no longer has a place in the health care context. Pursuant to the Nuremburg Trials, the Universal Declaration of Human Rights and several other codes and guidelines emanating from international bodies such as the World Medical Association underscore, among other ethical tenets, the value of autonomy and self-determination. Autonomous actions are the outcome of deliberations and choices by rational agents as persons in the moral sense. Rational persons meet the criteria necessary to decide what is in their own best interests. Health care practitioners have a duty to recognise and respect this value in their patients. Not to do so would not only violate their patients' autonomy, but would be synonymous with treating them as less than persons. An autonomous person is someone who has the ability to deliberate about personal goals and to act under the direction of such deliberation. Respecting autonomy denotes valuing the autonomous person's considered opinions and choices and refraining from obstructing their actions unless they are clearly detrimental to others.