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Patient autonomy and choice in healthcare: self-testing devices as a case in point

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Abstract

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility.

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Notes

  1. The impetus for this paper arose from an exploration of the meanings ascribed to autonomy in the philosophical literature. A review of key seminal works revealed an incompatibility with the prevailing understanding of autonomy in healthcare and prompted the particular focus of this paper.

  2. The use of the word ‘definition’ has particular significance in philosophy. Downie encourages the writer to look beyond ‘lexical’ or ‘word-word’ dictionary definitions which merely report the common usage of terms. He advocates replacing such nominal definitions with more essential definitions. The latter, he contends, can be arrived at through classification and analysis (Downie 1994).

  3. The terms liberty and freedom are used interchangeably here as reflected in the work of Berlin (1969) and Dworkin (1988).

  4. It is important to note that this genealogy of autonomy is primarily rooted in western liberal-democratic and liberal-humanistic thought. Therefore, it is important to appreciate the specific cultural context of this discussion. See Pennycook (1997).

  5. The term bioethics is described by O’Neill (2002) as a meeting ground for those who debate the legal, social and ethical implications of new advances in medicine, science and bio-technology. A detailed account of the ‘birth’ of bioethics is beyond the scope of this paper but a comprehensive historical account is found in Reich (1994).

  6. This example was constructed following a review of Kim Atkins’ paper which is discussed later in this section.

  7. Holroyd maintains that while agents may be relational entities autonomy cannot be. See Holroyd (2009). Christman (2004, p. 158), within his account of relational autonomy, raises a concern that a purely relational approach to autonomy may lend itself to an “overarching paternalism”.

  8. A recent “Liberating the NHS” (2010) white paper proposal, announced by the Secretary for State for Health in the UK, suggests a greater role for doctors in managing budgets at a local level through primary care consortia. See British Doctors to take charge of spending, http://www.ama-assn.org/amednews/2010/08/16/gvsb0816.htm (Accessed 4th April 2011).

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Acknowledgments

The authors would like to acknowledge the receipt of funding from Science Foundation Ireland, Grant No. [SFI/10/CE/B1821]. This Grant is administered by Biomedical Diagnostics Institue (BDI), Dublin City University. BDI is a Science Foundation Ireland Centre for Science, Education and Technology. The authors also extend thanks to Dr. Trevor Hussey for his comments on an earlier draft of this paper and to two anonymous reviewers, for their general comments and suggestions regarding additional literature of relevance.

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Authors and Affiliations

  1. Department of Nursing and Healthcare Studies, Institute of Technology, Tralee, Co. Kerry, Ireland

    Anna-Marie Greaney

  2. School of Nursing and Human Sciences/Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland

    Anna-Marie Greaney & Dónal P. O’Mathúna

  3. Deputy President/Registrar, Dublin City University, Dublin 9, Ireland

    P. Anne Scott

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  1. Anna-Marie Greaney
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Correspondence to Anna-Marie Greaney.

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Greaney, AM., O’Mathúna, D.P. & Scott, P.A. Patient autonomy and choice in healthcare: self-testing devices as a case in point. Med Health Care and Philos 15, 383–395 (2012). https://doi.org/10.1007/s11019-011-9356-6

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