Another Look at Respecting Patients’ Autonomous Choices – In India

Although medicine based on scientific principles is gaining ground, in India, the efforts to advance the ethical principle of respect for patients’ autonomous choices appear to lag behind. Illiteracy, poverty and inexperience in making autonomous choices were given as the reasons. When the same reasons were not impediments in choosing and participating in a representative form of government, why should they matter in making autonomous choices and participating in medical decisions – jointly with health-care practitioners?Autonomy or self-determination is a Human Right. Legally, it is upheld by most constitutions around the world; ethically, it continues to receive worldwide approbation. By the virtue of this right, health-care providers are obliged to breakdown medical information enabling patients – individually or collaboratively – to choose and authorise a course of action or entrust it to the good judgment of others. Inexperience or illiteracy, as India's grand experiment in democracy proves, may be overcome by reaching out to the patients: Taking time to talk with them (instead of speed-reading) or to the extended family members and including them in crucial conversations. It is obvious that the ideals of autonomic expression and full democratic participation are yet to be realised. Our immediate obligation, it seems, is to understand the reasons why we lag behind respecting patients’ autonomous choices; at the same time, institute reasonable controls which, when conjoined with our knowledge of its binding principles, would lead us to make apposite decisions were we to apply them uniformly. A few examples are as follows: (a) a signature-line in the consent form to capture family agreement to patient's choices, (b) mandatory International Conference on Harmonisation/Good Clinical Practice training for entire teamof health-care practitioners and Institutional Review Board (IRB)/Independent Ethics Committee (IEC) members involved in research on humans and (c) empower IRB/IEC to audit clinical trials and certify compliance with Indian Council On Medical Research standards. Anything less, than this, would seem to be unethical.