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

02 December 2023
Volume 15 · Issue 12


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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