Association for Public Policy Analysis & Management

Respect for autonomy is one of the fundamental guidelines of clinical ethics. Autonomy in medicine is not simply allowing patients to make their own decisions. Physicians have an obligation to create the conditions necessary for autonomous choice in others. For a physician, respect for autonomy includes respecting an individual’s right to self-determination as well as creating the conditions necessary for autonomous choice. Individuals come to doctors for guidance in making choices because they do not have the necessary background or information for making informed choices. Physicians educate patients so that they understand the situation adequately. They calm emotions and address fears that interfere with a patient’s ability to make decisions. They counsel patients when their choices seem to be disruptive to health and well-being. Respect for autonomy also includes confidentiality, seeking consent for medical treatment and procedures, disclosing information about their medical condition to patients, and maintaining privacy.

Personal autonomy is about self-rule. It incorporates the freedom to make a meaningful choice in accordance with a self-devised plan of action. A person of diminished autonomy is incapable of deliberating in accordance to his or her full capacity. For example, a significant number of elderly do not have the capacity to make decisions with regard to their health care. Many studies have evaluated the prevalence of patient preferences for the liberal individualist interpretation (Stiggelbaut et al., 2004). According to Kantian ethics, autonomy is based on the human capacity to direct one’s life according to rational principles. Individuals taking responsibility for their own lives is based on extreme individualism. Yet under diminished autonomy, one may be dependent on decisions of others. I argue for an agent-based algorithm that can harness data mined from patient health records, social media platforms, and individuals who are close to the patient, in order to estimate the consent given to a treatment or life extending measure. Currently, medical decisions of a person of diminished autonomy only considers a small cohort, which mainly consists of family members. This cohort incorporates a hierarchical decision-making tree.