Markkula Center of Applied Ethics

'A' is for Autonomy

By Margaret R. McLean, Ph.D.

Among the afflictions that haunt professional ethicists is a seemingly universal addiction to murder mysteries. Perhaps it is fueled by the need to escape the rigors of our profession or the quest for solace in a world of clear-cut good and evil--whatever the cause of our fascination with mysteries, my colleagues and I are hooked! I am particularly enamored of Sue Grafton's "alphabet mysteries" in which private sleuth Kinsey Millhone investigates her way through a murderous twenty-six letters--A Is For Alibi, B Is For Burglar, C Is For Corpse.

If we leave the burglars and corpses safely behind Grafton's dust jackets, I wonder where an investigation of a moral, rather than a murderous, twenty-six letters would take us. I make no promises that we will arrive at 'Z' in a timely manner, but as all mystery readers know, the real fun is at the beginning before we have any inkling of how it will all turn-out. And so, we begin with 'A.'

'A' is for autonomy. Autonomy is our ability to make decisions for ourselves and to carry out those decisions. It's my ability to decide that I want to read the latest Grafton mystery and to hustle over to the local bookstore and buy a copy. It's my ability to decide to have recommended surgery and the assurance that the medical team will carry out my wishes. Autonomy asks us to make decisions and requires others to respect our judgement. It honors our individuality and values us as individual human persons. In the medical world, patient autonomy partners with the knowledge, responsibility and trustworthiness of the healthcare professionals and works for the well-being of those who are sick. Indeed, medicine is at its best when patients can exercise their understanding and make decisions together with their care providers and families.

Sometimes, autonomy is lost through accident or disease. A person becomes incapable of making decisions. One thinks of people with severe head injuries, those in comas, those with advanced Alzheimer's disease. Here, another 'A' word becomes important--"advance directive." This is a document which allows you to decide now what kind of medical treatment you might want or who should make decisions for you if you become unable to decide for yourself. An advance directive allows you to exercise your autonomy now just in case you become unable to do so later. Advance directives protect patient autonomy, dispel mystery and provide needed guidance to families and medical care givers.

Autonomy allows us to choose who we wish to be and what we wish to do. But with autonomy comes responsibility--responsibility for our choices, for our futures and for the communities in which we live. 'A' is for autonomy, our ability and responsibility to choose, to plan and to act.

A version of this article appeared in the Autumn 1996 edition of the O'Connor Health News, a publication of O'Connor Hospital, San Jose, California.

Margaret R. McLean, Ph.D. is the Director at The Applied Ethics Center at O'Connor.

Copyright 1996 Margaret R. McLean, Ph.D.

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