Autonomy Competency

1
Autonomy Competency

• and the importance of Relationships

2
Respect for Patient Autonomy

• Not equivalent to Informed Consent
• Not an abstract principle to respect
• Autonomy Competence (Meyers, 1989)
• Suite of skills and abilities
• Developed and deployed to variable extents
• A relational account of autonomy
• May be enhanced or undermined in relationships
• Requires a degree of self-trust
• Requires a belief that you have options

3
Undermining or fostering Autonomy

• Ethical dimension to every aspect of our
  relationships.
• Our approach, demeanor, time, respect, compassion
  all matter.
• So do our attitudes and beliefs.
• Does one respect the parents (different, but
  legitimate) authority, decision-making capacity,
  choices? Or not.

4
Why enhance autonomy competence?

• 1. Because we respect peoples right to live
  their life.
• 2. Its good for people (thats a value
  judgment).
• 3. Facilitates sound clinical decision-making
• ? Optimises health care, effectiveness
• 4. Impaired autonomy competence may be part of
  the problem.

5
Relationships Our Capacity for Harm

• The relationship is the locus of our work
• Gather evaluate information
• Weight up potential risks and benefits
• Decision making the problems, ? solutions
• Implementing management plans
• Motivating change, decisions, actions
• Evaluating progress ? Whats next?

6
Relationships Our Capacity for Harm - 2

• Also the locus where children are cared for
• And where parents are supported, and support one
  another
• Where our identities are shaped
• Where our autonomy competences develop
• Undermine the relationship, and you undermine the
  parents capacity to care, and to receive
  help(from you, family, others)

7
Outcomes vs Process

• To get outcomes we want we need to be attentive
  to process
• Cannot use the process or our relationship
  instrumentally needs authenticity.
• If not getting outcomes attend to the process
• Need for critical reflection and for apologies

8
What counts as a failure with FTT?

• Damaging peoples relationships
• Undermining their autonomy competency
• Thinking that the problem is just food
• Poverty
• Disempowerment
• Unable to give effect to choices
• Violence
• Giving up, its just too hard