Autonomy and advance directives in psychiatry patients in India-Mental Healthcare Act 2017 perspective

Abstract

The autonomy of the patient is a derivative of the natural law right to self-determination. The principle autonomy emphasized the predominant role of the patient in making treatment decisions, and the doctor's role is limited to providing the information regarding the disease, its complications, types of treatment available, and prognosis. The patient can refuse the treatment in toto. The doctor is not in obligation to accept the patient's choice if it is futile or not by beliefs of the treating doctor. However, the doctor cannot impose treatment on the patient through coercion of any means. Traditionally doctors had a significant role in the treatment decisions of patients. Patients had minimal involvement in treatment decision making. It was based on the Hippocratic principle "I will use treatment to help the sick according to my ability and judgment."[1] In the above-said principle, the physician's belief in the treatment choice that is of beneficence to the patient had superiority over the autonomy of the patient in choice of treatment. Hippocrates' principles of medical ethics do not talk about the patient's autonomy. Human rights movements post-World War II had an impact on the rights of patients in the medical field. World medical association adopted a new physician pledge as an ethical guide for the practice of medicine, at 2nd Annual conference in Geneva 1948, and the latest amendment to the pledge at its 68th annual meeting in Chicago USA. This pledge states as a physician, "I WILL RESPECT the autonomy and dignity of my patient." This paradigm shift from doctor's paternalism to shared decision-making model, giving a primary role to the patient in his treatment choice is a result Nazi doctors atrocities during World War II.[2] This paradigm shift from doctor's paternalism to a shared decision-making model is a result of Nazi doctors' atrocities in World War II.