Respect for autonomy
What is the difference between veterinary
surgeons and surgeons who treat humans? Both are trained in anatomy,
physiology, biochemistry, and the other clinical and surgical skills required to
care for the bodies of their patients. As a byproduct of employing these
skills, both invade these bodies in ways which can cause harm in order to meet
need. Finally, both work within the same duty of care — to protect their
patient’s life and health to an acceptable standard. To distinguish between
the two types of surgeon, we must ask another question. What is the major
difference between animals and humans, and how does this difference create
special
duties for human surgeons which are of no
concern for those who work only with animals?
We
can only wonder at the attributes and abilities of many animals, characteristics
which humans can only aspire to. For example, we can respect the big cats of the
sub-Saharan plains because of their strength and speed — for behaving in the
unique ways that characterise their species. The same can be said of humans.
What makes us unique as animals is our autonomy — our ability to formulate
both goals and beliefs about how they should be achieved. Humans can attempt to
plan their lives on the basis of reason and choice in ways which other animals
cannot. Therefore, when we talk of the particular type of respect which it is
appropriate to show to humans, the focus should primarily be on our autonomy
rather than our particular physical characteristics. Respect for human dignity
is respect for human autonomy.
It
is for this reason that surgeons have a duty of care towards their human
patients which goes beyond just protecting their life and health. Their
additional duty of care is to respect the autonomy of their patients — their
ability to make choices about their treatments and to evaluate potential
outcomes in light of other life plans. Such respect is particularly important
for surgeons because without it the trust between them and their patients may be
compromised, along with the success of the surgical care provided. We are
careful enough at the best of times about who we allow to touch us and to see us
unclothed. It is hardly surprising that many people feel strongly about
exercising the same discretion in circumstances where someone is not only going
to do these things but to inflict what may be very serious wounds on them as
well.
For
all of these reasons, there is a wide moral and legal consensus that patients
have the right to exercise choice over their surgical care. In this context a
right should be interpreted as a claim which can be made on others and which
they believe that they have a strict duty to respect, regardless of their own
preferences. Thus, to the degree that patients have a right to make choices
about proposed surgical treatment, it then follows that they should be allowed to
refuse treatments that they do not want, even when surgeons think that they are
wrong. For example, patients can even refuse surgical treatment which will save
their lives — either at present or in the future through the formulation of
advance directives specifying the types of life saving treatments which they do
not wish to have if they become incompetent to refuse them.