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.