Problematika autonomie v psychiatrii

• Title in English: Issue of autonomy in psychiatry
• Authors: HOŘÍNKOVÁ Jana
• Year of publication: 2014
• Type: Article in Proceedings
• Conference: Perspektívy profesijnej etiky
• MU Faculty or unit: Faculty of Medicine
• Field: Psychiatry, sexuology
• Keywords: autonomy; psychiatry; ethics
• Description: Respect for autonomy is one of the basic principles of medical ethics. It implies respect for an individual´s decisions about personal care. It is the foundation for the concept of informed consent – an important document in current medicine. However, autonomous decisions require understanding, maturity, responsibility and discernment. Since aforementioned human properties are disturbed in psychiatric disorders, often severely so, the question is raised: how far is it possible to respect autonomy in treating the mentally ill? We present the specific case from psychiatric practice – the case report of a young male with the first onset of a schizophrenic disorder. Presence of the psychiatric disorder in form of psychotic symptomatology, formal thought disorder and concurrent lack of insight (which resulted in inability to critically evaluate the disorder) impaired autonomy of the patient. To protect patient's interests, the court ordered a short-term involuntary detention. By this act of paternalism the principle of beneficence outweighed the principle of autonomy. In presented case this approach can be considered to be ethically sound. Adequate therapy led to an improvement in patient's condition, the insight into illness was gradually created and patient's ability of autonomous decision making was re-established. It can be stated that the principle of autonomy should be respected, however in exceptional cases it is ethically acceptable to allow the principle of beneficence to prevail over the principle of autonomy. This act of apparent temporary disregard of autonomy can be understood as a mean to fully re-establish patient's faculty of autonomous decision-making.