References

Measuring the four principles of Beauchamp and Childress. 2012. https//tinyurl.com/r2rldaq (accessed 31 March 2020)

Avery G. Law and ethics in nursing and healthcare: an introduction, 2nd edn. London: Sage Publications; 2017

Barcham C, Bogg D. The pocketbook guide to Mental Capacity Act assessments.London: Open University Press; 2019

Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th edn. New York (NY): Oxford University Press; 2013

Bolam v Friern Hospital Management Committee. 1957;

Brazier M, Lobjoit M. Protecting the vulnerable: autonomy and consent in health care.New York (NY): Routledge Publishing; 1991

British Medical Association. Autonomy or self determination. 2018. https//tinyurl.com/zhvqzl8 (accessed 31 March 2020)

JRCALC clinical guidelines 2019. In: Brown SN, Kumar DS, James C, Mark J (eds). Bridgwater: Class Professional Publishing; 2019

Buka P. Patients' rights, law and ethics for nurses, 2nd edn. Boca Raton (FL): CRC Press; 2015

Medical consent: what do human rights have to do with it?. 2017. https//eachother.org.uk/medical-consent-human-rights/ (accessed 31 March 2020)

Clarke V, Harris G, Cowland S. Ethics and law for the paramedic, 2nd edn. In: Blaber AY (ed). Buckingham: Open University Press;

Collen A. Decision making in paramedic practice.Bridgwater: Class Professional Publishing; 2017

Deakin S, Johnston A, Markesinis B. Markesinis and Deakin's tort law, 7th edn. Oxford: Oxford University Press; 2007

Mental Capacity Act 2005: code of practice.London: The Stationery Office; 2007

Department of Health and Social Care. Liberating the NHS: No decision about me, without me. 2012. https//tinyurl.com/y8dhuvww (accessed 31 March 2020)

Devi v West Midlands Area Health Authority. 1980;

Dodd JW, Getov SV, Jones PW. Cognitive function in COPD. Eur Respir J. 2010; 35:(4)913-922 https://doi.org/10.1183/09031936.00125109

Equality and Human Rights Commission. The Human Rights Act. 2018. https//www.equalityhumanrights.com/en/human-rights/human-rights-act (accessed 31 March 2020)

Evans JS. In two minds: dual-process accounts of reasoning. Trends Cogn Sci. 2003; 7:(10)454-459 https://doi.org/10.1016/j.tics.2003.08.012

Fairbairn G. Suicide and justified paternalism. In: Brazier M, Lobjoit M. New York (NY): Routledge Publishing; 1991

Finch J. Health services law.London: Sweet and Maxwell; 1981

Gillon R. Research on the vulnerable: an ethical overview. In: Brazier M, Lobjoit M. New York (NY): Routledge Publishing; 1991

Goodall S, Twomey R, Amann M. Acute and chronic hypoxia: implications for cerebral function and exercise tolerance. Fatigue. 2014; 2:(2)73-92 https://doi.org/10.1080/21641846.2014.909963

Greaney N, Morris F, Taylor B. Mental capacity: a guide to the new law, 2nd edn. London: Law Society; 2008

Greaves I, Porter KM. The law and pre-hospital care.New York (NY): Oxford University Press; 2007

Health and Care Professions Council. Standards of proficiency—paramedics. 2014. https//tinyurl.com/rmj2yxn (accessed 2 April 2020)

Health and Care Professions Council. Standards of conduct, performance and ethics. 2018. https//www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/ (accessed 2 April 2020)

Health and Social Care Act. Health and Social Care Act. 2012. http//www.legislation.gov.uk

Hochachka PW, Clark CM, Brown WD The brain at high altitude: hypometabolism as a defense against chronic hypoxia?. J Cereb Blood Flow Metab. 1994; 14:(4)671-679 https://doi.org/10.1038/jcbfm.1994.84

Hung WW, Wisnivesky JP, Siu AL, Ross JS. Cognitive decline among patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009; 180:(2)134-137 https://doi.org/10.1164/rccm.200902-0276OC

Continuing professional development: ethical aspects of consent, duty of care, and negligence in paramedic practice. J Paramedic Pract. 2016; 8:(11)1-13 https://doi.org/10.12968/jpar.2016.8.11.CPD1

Continuing professional development: legal issues in paramedic practice. J Para Pract. 2015; 1-9 https://doi.org/10.12968/jpar.2011.3.7.CPD1

Kahneman D, Frederick S. Representativeness revisited: attribute substitution in intuitive judgment. In: Gilovich T, Griffin SW, Kahneman D (eds). New York (NY): Cambridge University Press; 2002

Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis. 2011; 6:199-208 https://doi.org/10.2147/COPD.S10611

Kent v Griffiths. 2001;

The duty of care of healthcare professionals. 2013. http//www.publicworld.org/files/Duty_of_Care_handbook_April_2013.pdf (accessed 2 April 2020)

Komrad MS. A defence of medical paternalism: maximising patients' autonomy. J Med Ethics. 1983; 9:(1)38-44 https://doi.org/10.1136/jme.9.1.38

Kukla R. Conscientious autonomy: displacing decisions in health care. Hastings Cent Rep. 2005; 35:(2)34-44 https://doi.org/10.2307/3527761

Lindley R. Informed consent and the ghost of Bolam. In: Brazier M, Lobjoit M. New York (NY): Routledge Publishing; 1991

Mental Capacity Act. 2005. https//www.legislation.gov.uk/ukpga/2005/9/contents (accessed 2 April 2020)

Minkoff H. Teaching ethics: when respect for autonomy and cultural sensitivity collide. Am J Obstet Gynecol. 2014; 210:(4)298-301 https://doi.org/10.1016/j.ajog.2013.10.876

Moore NJ. Intent and consent in the tort of battery: confusion and controversy part of the civil procedure commons. American University Law Review. 2012; 61:(6)1585-1654

NHS. Mental Capacity Act. 2018. https//tinyurl.com/yc3384gd (accessed 2 April 2020)

NHS. Consent to treatment. Overview. 2019a. https//www.nhs.uk/conditions/consent-to-treatment/ (accessed 2 April 2020)

NHS. Consent to treatment. Children and young people. 2019b. https//www.nhs.uk/conditions/consent-to-treatment/children/ (accessed 2 April 2020)

Oxford University Press. Bolam test. 2019. https//tinyurl.com/qt6nbuy (accessed 2 April 2020)

Parahoo K. Nursing research: principles, process and issues, 3rd edn. London: Palgrave Macmillan; 2014

Decision making under hypoxia: oxygen depletion increases risk seeking for losses but not for gains. 2012. http//journal.sjdm.org/12/12306/jdm12306.html (accessed 2 April 2020)

Pilbery R, Lethbridge K. Ambulance care practice.Bridgwater: Class Professional Publishing; 2016

Re E (Medical treatment: anorexia). 2012;

Re T (Adult).: Lord Donaldson; 1992

Reyna VF. How people make decisions that involve risk. Curr Dir Psychol Sci. 2004; 13:(2)60-66 https://doi.org/10.1111/j.0963-7214.2004.00275.x

Richardson C, Hogan AM, Bucks RS Neurophysiological evidence for cognitive and brain functional adaptation in adolescents living at high altitude. Clin Neurophysiol. 2011; 122:(9)1726-1734 https://doi.org/10.1016/j.clinph.2011.02.001

Principles of consent: guidance for nursing staff. Br J Healthcare Assistants. 2017; 11:(10)498-502 https://doi.org/10.12968/bjha.2017.11.10.498

Rozhkov VP, Soroko SI, Trifonov MI, Bekshaev SS, Burykh EA, Sergeeva EG. Cortical-subcortical interactions and the regulation of the functional state of the brain in acute hypoxia in humans. Neurosci Behav Physiol. 2009; 39:(5)417-428 https://doi.org/10.1007/s11055-009-9160-4

Sedig L. What's the role of autonomy in patient-and family-centered care when patients and family members don't agree?. AMA J Ethics. 2016; 18:(1)12-17 https://doi.org/10.1001/journalofethics.2017.18.1.ecas2-1601

Stiggelbout AM, Molewijk AC, Otten W, Timmermans DR, van Bockel JH, Kievit J. Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' views. J Med Ethics. 2004; 30:(3)268-274 https://doi.org/10.1136/jme.2003.003095

UNISON. UNISON Duty of care handbook. 2011. https//www.unison.org.uk/content/uploads/2013/06/On-line-Catalogue197863.pdf (accessed 2 April 2020)

Virués-Ortega J, Buela-Casal G, Garrido E, Alcázar B. Neuropsychological functioning associated with high-altitude exposure. Neuropsychol Rev. 2004; 14:(4)197-224 https://doi.org/10.1007/s11065-004-8159-4

Whiteman J. Limiting autonomy? Mental capacity to refuse treatment in the UK. The Equal Rights Review. 2012; 9:149-153

Willis S, Mehmet N. Legal and ethical aspects of paramedic practice. In: Willis S, Dalrymple R (eds). Chichester: Wiley & Sons; 2015

case study

Respecting an autonomous decision to refuse life-saving treatment: a case study

02 December 2023
Features
02 December 2023
Volume 15 · Issue 12

Abstract

Autonomy is a key principle in biomedical ethics, giving patients the right to be involved in their own care. Professional autonomy allows paramedics to make critical decisions around patient care in an emergency, enabling them to provide life-saving treatment. A patient's autonomy can conflict with that of a paramedic, leading to complex ethical challenges, which can affect the way a paramedic performs their duty of care. An autonomous patient has the right to refuse treatment, creating ethical challenges for paramedics. An autonomous patient's decision to refuse treatment, even if it may seem unwise, must be respected in accordance with the Human Rights Act 1998.

Beauchamp and Childress (2013) originally developed four principles of biomedical ethics—autonomy, beneficence, non-maleficence and justice—to analyse and improve ethical situations in healthcare (Aldcroft, 2012). Autonomy is defined by Beauchamp and Childress (2013):

‘in which autonomous patients are choosers who act intentionally, with understanding, and without controlling influences that determine their actions’.

Respecting a patient's autonomy means acknowledging that adults who have decision-making capacity (Kukla, 2005) have the right to make informed, uncoerced decisions regarding their own care (Finch, 1981; Willis and Mehmet, 2015). It also gives them the right to take actions based on personal values and beliefs (Stiggelbout et al, 2004; Beauchamp and Childress, 2013), even when their decision challenges clinicians' advice (Sedig, 2016). Minkoff (2014) emphasised that autonomy is a key ethical principle in healthcare which takes precedence over other principles. Sedig (2016) agreed, as patient independence is one of the highest priorities in medicine. Collen (2017) discussed how autonomy develops barriers in healthcare, diminishing what is important in patient care.

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