A Retrospective Study about Autonomy of the Patients with Neurological Disorders: A Record base Analysis
Abstract
In the case of neurological disorders, patient autonomy is a fundamental principle which must be taken into consideration. In the case of this pathology, fluctuating mental deterioration is encountered most frequently in the case of mild forms of dementia. In the case of severe forms of dementia, the patient loses any autonomy and requires permanent medical care, as well as a permanent legal representative.
Aim of this study was to know autonomy of the patients with certain neurological disorders about ability of making decisions for their medical care.
Material and method: It is a quantitative retrospective observational study and data for which is gathered from the observation charts of 323 patients attended in either emergency or outpatient, between April to December 2006, in “Prof. Dr. Nicolae Oblu” Clinical Hospital of Emergency, Iasi, Romania. Study subjects were split into 2 groups: Group 1 (with a number of 215 cases) – a group of patients with the diagnostics of acute cerebrovascular accident, aphasia and dementia. Group 2 (with a number of 108 cases) – patients known or recently diagnosed with amyotrophic lateral sclerosis, multiple sclerosis and myasthenia gravis. Consent informed given by patient in the observation charts of above two groups was observed and number of patients who has given consent was compared in both the groups.
Results: On the cases under study, only for 13.6% of the patients of the first group there is consent informed in the observation chart, while for the patients in the second group this percentage was slightly smaller (9.3%).
Conclusions: As very few patients have given written informed consent and more sever the neurological disorder less the chances to have written informed consent by patients. So it can be concluded that medical performance brings indisputable benefits, however it should be done by a careful selection of the subjects and by following ethical principles.
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Introduction
Autonomy principle1 is sometimes broken to the benefit principle, especially when the persons with psychiatric and neurological disorders are at a risk of harming themselves or those around them. However, breaking patient autonomy can be the source of numerous ethical and legal conflicts2,3 . Respecting autonomy has been a priority in the recent years4 and the patient increasingly becomes an active participant in taking decisions related to his health. Thus, in the 21st century, doctor-liberal patient pattern has been more and more promoted.
Conclusion
Recently, things that “revolutionised” the medical world, advanced techniques maneuvres, new therapeutic approaches have happened but they have produced reactions regarding the ethics of their practicing and their moral consequences. It was found that ethical issues like signing of written inform consent was not taken place in most of cases here which should be taken care of. Medical performance brings undeniable benefits, however its accomplishment must be done through a careful selection of the subjects and respecting the ethical principles. The purpose of the accomplishment must always be the best interest of the patient and must never create any slippery slope thinking that, actually, showing the “good” only as a purpose, it is acted as using the patient as a “tool” to getting performance.