Respecting autonomy: Prioritizing patient-centered care and decision-making capacity for stronger doctor–patient relationships

Dear Editor,

In my 25 years as an attending psychiatrist, I have observed multiple instances where physicians have provided care to patients with limited understanding while minimizing the importance of the patient’s preferences, values, and goals.[1] Unfortunately, this can lead to an impaired doctor–patient relationship, as patients do not feel heard or valued as partners in their healthcare. As a result, it is crucial that healthcare professionals prioritize patient-centered care to ensure that patients are treated with dignity and respect, and that their unique needs and preferences are taken into account.

As healthcare professionals, it is our duty to ensure that we respect and promote the autonomy of our patients. When dealing with patients who may have impaired decision-making capacity, it is crucial that we approach the situation with great care and attention.

According to the American Medical Association’s Code of Medical Ethics, decision-making capacity refers to “the ability of a patient to understand and appreciate the nature and consequences of a proposed treatment or procedure, to make a reasoned choice among treatment options, and to communicate that choice.”[1] This is a complex issue that requires careful assessment by healthcare professionals.

To ensure that a patient has decision-making capacity, healthcare professionals should consider several factors. First, they must determine whether the patient can understand the information presented to them. This includes the nature of the illness, the risks and benefits of treatment, and any alternatives that may be available. Second, healthcare professionals must assess whether the patient is able to appreciate the consequences of their decision, including the potential risks and benefits of treatment. Finally, healthcare professionals must determine whether the patient is able to communicate their decision in a clear and coherent manner.[1,2]

If a patient is deemed to have impaired decision-making capacity, healthcare professionals must take steps to ensure that their autonomy is still respected. This may include involving family members or legal guardians in the decision-making process or seeking a second opinion from another healthcare professional. However, it is important to remember that patients who have impaired decision-making capacity still have the right to be involved in the decision-making process to the greatest extent possible.[1]

It is also essential that healthcare professionals avoid any actions that may be seen as coercive. Coercion refers to any actions or words that may unduly influence a patient’s decision-making process. This can include using threats, manipulation, or withholding information from the patient. Healthcare professionals must be aware of the power dynamic that exists in the patient–provider relationship and take steps to ensure that the patient feels empowered to make their own decisions.

Practical challenges and limitations exist in implementing patient-centered care and respecting autonomy. Healthcare providers often face time constraints, limited resources, and complex medical conditions, which can make it challenging to thoroughly assess decision-making capacity in every patient encounter. Additionally, cultural and language barriers, as well as varying levels of health literacy, can further complicate effective communication and shared decision-making.

To address these challenges, healthcare organizations can provide training and education to healthcare professionals on patient-centered communication, shared decision-making, and cultural competency. Implementing standardized tools or checklists for assessing decision-making capacity may also be beneficial. Collaboration with interdisciplinary teams, including social workers and ethics consultants, can help navigate complex cases where decision-making capacity is unclear.

Furthermore, healthcare policies and reimbursement structures should support and incentivize patient-centered care and shared decision-making. Adequate time for thorough discussions, provision of decision aids and written materials, and reimbursement for these activities can encourage healthcare providers to prioritize patient autonomy.

In conclusion, decision-making capacity is a complex issue that requires careful assessment by healthcare professionals. It is crucial that we approach this issue with great care and attention and take steps to ensure that the autonomy of our patients is respected. By doing so, we can promote the well-being of our patients and foster trust in the healthcare.

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Conflicts of interest

There are no conflicts of interest.