Case One: Patient Autonomy and the Freedom to Act against One's Self-interest

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A 16-year-old Hodgkin lymphoma patient refuses to have his blood specimen drawn, thus canceling his scheduled oncologic treatment. As a 16-year-old, he has no legal standing as an adult. His parents are split over his decision. One supports his right to choose; the other wishes the specimen to be drawn and the chemotherapy reinstated. The physicians at the hospital are seeking legal redress to have the court order the blood specimens to be taken.

Are people uniquely qualified to decide what is in their best interest? At what age? This case raises compelling questions concerning the role of paternalism in healthcare, and the asymmetrical nature of the physician-patient relationship. A patient often willingly surrenders some autonomy to the physician who, as an expert, may be in a better position to recognize what is in the patient's best interest. Moreover, one of the legitimate aims of government is ensuring the well-being of its citizens. When we apply these positions to circumstances in which a patient does not have the ability to deliberate, such as small children and mental illness, the case for restricting patient choice seems straightforward.

However, one can advance an argument in favor of patient autonomy when the patient meets the minimum standards of rationality.¹ This argument does not defend patient autonomy by reference to the intrinsic value of the individual.² Rather, one can argue that it is the quality, not length of life that is important.³ Further, it should be up to each individual to decide what minimum…