This is the single most important word and concept the reader of this book must grasp. Philosophically, it refers to the fundamental principle that all humans are independent moral agents with the personal capacity to make moral decisions and act on them. To the largest extent, life is about choice, your choices.

The word derives from the Greek autonomia, meaning “self-rule.” In modern days, autonomy most often equates with the phrase, self-determination. Individuals are autonomous when their actions are truly their own without coercion or inappropriate influence.

Sometimes when judges hand down decisions, they really hit the spot. Sometimes their words are not too legalistic and they nail the beauty, power and scope of their decisions in terms most can understand.

Certainly one would think all legal decisions are important. However, one of the core principles in western thought and law, one of the guiding lights of our constitution and absolutely one of the most anchoring truths in both caring for cancer patients and being cared for is patient autonomy.

Often in the book, you will hear me use the expression that the patient is the one with the disease. In the final analysis, after all the health care system can do to make information and access to care available, the final decision of the competent adult is theirs. That is how it should be and physicians, families, and patients must never forget it.

Listen to how beautifully American judges state this. “No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law [Union Pacific R. Co. vs. Botsford, 141 U.S. 250 (1891)].

Here is another ruling that clearly distills it down on the issue of medical decision-making. “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits assault, for which he is liable in damages [Schloendorff vs. Society of New York Hospital, 105 N.W. 92 (1914)].


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