How much should we believe in autonomy?

We’ll all remember that we are meant, with grown-ups, to allow the patient to make a choice about their care. When the patient is not really due to be in the atmosphere for another 2 months, and hasn’t quite learned to open its eyes rather let alone discuss UVC vs Groshong lines, then we’re sort of let-off that problem.

But we do have a large number of patients with the ability to make the choices about their care: may of them are teenagers. And for those who aren’t able, many will have parents or carers who may wish to be involved in decisions. How should we progress with this?

The classical model of decision making would oppose paternalism (“Take this medicine”) against choice (“This medicine might help. It might not. Take it if you want.”) But a not-so-recent article by @EntwistleV on the nature of health screening choices offers a further option, which works to describe a route where a “recommendation” is offered. This works to balance information delivery about a healthcare decision, allowing autonomy, with the expert opinion of the clinician. This is the basis of an informed discussion which then works more explicitly to combine the three aspects we know are at the heart of EBM: research evidence, clinical expertise and patient preferences.

(It’s behind a paywall but worth seeking out a friendly academic if you want to read the whole thing, Thoroughly worth it.)

– Archi

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