Patient agency, autonomy and consent. Catholic perspectives

Abstract

This paper seeks to review the current state of the art in Catholic thinking about respect for patient agency, autonomy, and consent. No attempt, however, is made to reach a definitive review. Indeed, we will find that the widespread support of these concepts within Catholic bioethics notwithstanding, important dissensus persists about specific aspects. First, the article provides a summary description of some important differences between the prevailing understanding of patient autonomy in secular bioethics and in Catholic bioethics. In the former, respect for patient autonomy is often understood as respecting the patient’s subjective needs and wishes even when or maybe precisely because they fall outside of
the realm of understanding of the healthcare professional. In the latter, this respect is grounded in the dignity of the individual patient, which encompasses the patient’s subjective wishes andneeds but which is essentially an objective and hence intersubjectively accessible concept. To further explicate how patient agency can be respected within such an objective frame of reference, the paper discusses different types of patient agency within the therapeutic relationship. For health care to be clinically optimal and ethically sound –as the ethical principles of beneficence and nonmaleficence demand– the patient needs to be actively engaged in 1) the assessment and diagnosis, 2) treatment planning, and
3) the actual therapy. In addition –as the ethical principle of respect for patient autonomy demands– the healthcare provider must 4) protect patient confidentiality, 5) provide patients with adequate information, and 6) obtain the patient’s consent for any intervention. The article then reviews different types of consent. In a final section, the question will be reviewed whether it is ever morally permissible for healthcare providers to force treatments on to patients whose refusal of such treatments is judged to be immoral.