Partners towards autonomy: risky choices and relational autonomy in rehabilitation care

Abstract

Purpose. A common source of ethical challenge for health care professionals (HCPs) in rehabilitation is situations when patients wish to make risky choices not related or contrary to rehabilitation goals. We explore the potential contribution of a relational understanding of autonomy for orienting clinical practice when patients wish to enact choices with associated risks for the patient or others.

Method. We provide a theoretical analysis that is oriented by an examination of risk and a relational conception of autonomy, as relevant to rehabilitation care. We illustrate our analysis through the examination of a clinical case.

Results. Relational autonomy assumes that the patient, and the patient's decisional autonomy, is situated and shaped by relationships. From this perspective, HCPs can engage in a process of communication and deliberation with the patient about the risky choices at issue, leading towards improved patient autonomy.

Conclusions. Relational autonomy can contribute to understanding patients' risky choices and guiding HCPs as they partner with patients towards autonomy. Such an approach supports patient-centred rehabilitation care. Ultimately, as clinicians respond to a patient who wishes to enact a risky choice, they should aim for a partnership towards autonomy with the patient and family.

Keywords:

• Risk
• ethics
• autonomy
• relational autonomy

Declaration of interest: The first part of this essay's title, ‘Partners towards autonomy,’ is drawn from the title of the Code of Ethics of the Jewish Rehabilitation Hospital in Laval, Quebec, Canada. Matthew Hunt is supported by a post-doctoral fellowship from the Canadian Institutes of Health Research. Carolyn Ells was Visiting Scholar in the Department of Bioethics, Dalhousie University during the preparation of this article.