Autonomy and decision-making capacity

The principle of respect for autonomy requires the assessment of the ability to make decisions of patients.

Although autonomy is not the same as capacity, the two are closely related. Autonomy refers to self-government and self-management and can refer to the physical and movement sphere or to the free choice of values and behaviors that shape the personality of everyone. For its part, capacity refers to the possibility of making decisions based on certain skills and includes the weighting, analysis, and communication of one's own choices. Similarly, capacity differs from competition and although there is no universal consensus on the terms, most of the time competition is a term with more legal than ethical and / or medical connotation and refers to the conditions that allow make decisions before the law.

As we said before, the decision-making capacity bases the principle of autonomy and strengthens the doctor-patient relationship, in this lies the need to have instruments for its measurement since, if a person lacks capacity, it will be difficult to obtain an informed consent and, perhaps, even an adherence to the indicated treatment. On the other hand, if it is measured and it is determined that the person is diminished in their capacity, it is possible to proceed to analyze the causes of this result and eradicate them to provide the patient with more elements for a free, conscious, and considered decision-making.

It should also be mentioned that, despite the need to have instruments to measure decision-making capacity, this is directly related to the type of treatment or intervention to which the patient is going to undergo, that is, it is not the same capacity that is required to decide on a low-risk blood transfusion as coronary bypass surgery where the risk is much higher and the implications in the short, medium, and long term. This is of special interest for it is therefore complex to use a single measuring instrument for all patients and for all types of medical treatment.

Establishing, therefore, objective, and valid measurements of standards for decision-making will reinforce the free and responsible decision of patients regarding their treatments. It is the task of Clinical Bioethics and Bioethics consultants to adopt international measurement scales adapted to local contexts and to encourage, whenever possible, that the patient, together with the doctor, make decisions that represent a good for both.