Respect for Autonomy
The principle of respect for
autonomy is based on a person's right to self-determination. We respect our
patients' right to make their own decisions based on their personal values and
beliefs. In order for patients to make decisions about their health care, they
must be provided with the appropriate information necessary to make the
decision. Informed consent is derived from this principle. Before treating a
patient it is necessary that you discuss your treatment plans and goals with the
patient, so that your treatment is directly related to the patient's goals, not
yours. This is a basic respect for your patient's autonomy.
Other examples of respecting patients' autonomy include truth-telling, respecting their privacy, and protecting their confidential information. Unless a patient is told the truth about the treatment, the patient will not be able to make a fully informed decision. Omitting information about the treatment also limits a patient's ability to make informed decisions. An example of this in today's managed care environment might mean that the patient should be informed if a certain treatment technique or modality will not be covered by the patient's health plan so that the patient can decide whether to proceed with the treatment. Further, if patients are placed in a situation in which they do not feel comfortable giving you complete information, in other words, their privacy is not respected, you will not be able to provide them with the most complete treatment options.
Medical records must be handled carefully from a legal standpoint in order to maintain the confidentiality of patient information. While the legal concerns are indeed important, consider the ethical ramifications of the issue of confidentiality. By not revealing a patients' private information, you protect and respect the patients' right to autonomy and further build a relationship of trust.
Managers and administrators should also honor this principle of respect for patients' autonomy by developing the appropriate policies regarding informed consent, truth-telling, handling a mistake, and information management. Not only should policies and procedures be written, but they also should be discussed regarding their ethical basis. More importantly, they must be reviewed and enforced. Unless discussions and chart reviews are performed, informed consent only becomes a policy on paper. Sit in your waiting room or in your treatment area and discover how much private information is made public. If you were the patient, how much information would you want to discuss with the receptionist in the waiting room? The owners or managers set the ethical tone of the physical therapy clinics or departments. For example, when a staff member makes a mistake with a patient, how the situation is handled reflects the ethical environment of the clinic. If the manager of a department has established an environment based on open communication and honesty, staff members will openly report and document a mistake. They will know the procedures to follow and will follow the examples set by those in leadership positions. Managers influence the ethical awareness and behavior within the clinic.
What is the prevailing ethical environment in the following case?