The next IAP-UNCA Joint Meeting on Medical Ethics will be held on Wed., Sept. 8, 1999, at 7:30 pm at the Kellogg Center, 11 Broyles Rd. just west of downtown Hendersonville off route #64.

The topic for discussion will be Patient Autonomy. Our presenter will be Ms. Mary Caldwell, Chaplain at St. Joseph-Mission Hospital in Asheville.

Autonomy is an important aspect of medical ethics. It refers to 'self-governance' and the right to choose for oneself, what one feels is best for himself or herself. Autonomy is considered an ethical principle, something that must be encompassed in making ethical decisions and in proposing ethical theories. This is why autonomy is often conidered fundamental and essential to all other ethical systems and theories. They are also considered prescriptive, that is, they attempt to tell us how we ought to address and resolve ethical problems; they tell 'how things ought to be done'.

Ethical principles are more specific that ethical! Respect for patient autonomy influences medical practice very heavily since modern medicine involves the use of many drugs and procedures which can have both beneficial and harmful consequences. These are often offered and accepted on statistical grounds, the odds being X that you will have Y results and/or Z complication.

One can see how respect for and attention to patient autonomy initially seems straight-forward and simple, especially when patients are mentally comptetent, intelligent, and informed. It is easy when they are concerned enough about their own care to become knowledgeable and involved in decision making. It is simple when the patient is capable of truly understanding the nature of their problem, the actions of drugs and the risks of available procedures .

They must understand the goal of treatment, what can reasonably be expected from the treatment. This has led to heavy emphasis on 'Informed Consent.

But, can physicians really transform patients into mini-doctors in the short time available for discussion? After four years of medical school and four to five years of postgraduate training in the 'language of medicine' and in the language of some subspeciality, can the untrained or uneducated patient, in a very short time, be said to become informed and truly understand the nature of their own illness? And if they can't, how do we handle respect for their autonomy? What about the zone between being absolutely competent and being clearly mentally incompetent? When does one lost his/her autonomy?

After the initial presentation by Mary Caldwell, we will have two respondents: Dr. Paul Hartman, a radiation therapist from Athens, GA., who practiced for over 25 years, and Mr. Richard Rhea, presently Chaplain at the state's Alzheimer's center in Black Mt., NC. Each will bring his own perspectives on the issues and stimulate our thought and discussion.

I know many of you have been personally involved in this subject by having had to make decisions about older parents, or other dependents who have lost the ability to be autonomous. When does profound ignorance, or lack of intellectual capacity to understand render one incompetent? When is autonomy lost or when should it be disregarded, as it often must be with dependent children? What about the attitude of Paternalism? These and many more concepts can be discussed.

Thanks to Dr. Gordon Wilson for the last excellent presentation!