Abstracts Category : Other

Autonomy and Informed Consent

by Eileen F Baker

The process of obtaining informed consent is designedto operationalize respect forautonomy. Informed consent requiresthat the agent have capacity for decision-making, that the agent beinformed, and that the agents decision be voluntary. Under mostcircumstances, patients are presumed competent, and the onus isupon the practitioner to prove otherwise. I argue that informedconsent, in its current practice, fails to ensure respect forautonomy.Complacency on the part of both patients and practitionersleads to four flaws that have the potential either to underminepatient autonomy or to presume competence where it is absent.Practitioners must do their due diligence in assessing patients forcompetence, above and beyond the minimum required in the consentdocument. I call this process Rigorous Informed Consent.I proposetwo solutions for improving the informed consent process. The firstutilizesinformed consent specialists to ensure that patients areproperly informed. The second implements informed consent codingto define the level of capacity required for a given clinicalsituation, on a numerical scale.Next, I analyze four domains ofinfluence upon authenticity and describe potential red flags forauthenticity issues. I present my own formulation of what elementsare required for autonomous agency and introduce the concepts ofSubstantial Autonomy and Threshold Competence. Full autonomy orideal autonomy is not always possible, nor is it always necessaryto attain.The exceptional cases, are when agents are assumed tobe incompetent, simply because they are refusing the treatment thatis recommended by their practitioners. I cite studies that showthat that suicide is no more prevalent in the terminally ill thanin the general population, that depressed patients maintain bothcapacity and appreciation of their situation, that preferences forthe end of life amongst depressed patients are similar to thosewithout depression, and that patients preferences are stable overtime, even after treatment for depression. I explain how ThresholdCompetence can be applied to depressed patients and argue that mildto moderate depression does not significantly alter patientspreferences, so the wishes they express should be taken as reliableand authentic.Advisors/Committee Members: Weber, Michael (Advisor).