Autonomy

It is not uncommon for autonomy to be considered by many to be the most important ethical principle in medicine; the idea that a person has an inherent right to make their own informed decisions about their health care. The responsibility of upholding a patient’s right to autonomous decision-making often falls on the shoulders of the clinician delivering that care. This presupposes that the patient has the capacity to understand the information presented to them and to make those decisions. This chapter explores the significance of autonomy in the delivery of pain care, detailing the clinician’s role in navigating the relationship between autonomy, communication, trust, and truth. Additionally, this chapter examines clinician autonomy; the ability to make independent decisions about treatment choices offered to the patient based on an ethical obligation based on the patient’s best interests. It is not difficult to find clinicians caring for people with pain who express feelings of frustration with respect to the current pain care climate and their autonomous ability to do so. This often involves not only consideration of the “appropriateness” of opioid analgesic therapy from the perspective of safety and efficacy, but also the choice of other potential treatment options, an inherent desire to avoid contributing to the overdose epidemic, the need to obtain a referral or consultation to other clinicians, and fear of scrutiny from regulatory agencies, the media, and the public. The relationship between both patient and clinician autonomy is intimate, bidirectional, and critically important to managing pain.