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Why might a patient’s refusal of life-saving treatment create a conflict between autonomy and beneficence?
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Bioethics
A Roman bust of Hippocrates, copied from a Greek original, c. 3rd century bce; in the collection of the Antichità di Ostia, Italy.
In the field of bioethics, a conflict between autonomy and beneficence arises when a competent patient refuses life-saving medical treatment.1
This tension is rooted in the fundamental principles of medical practice:
- Autonomy: This principle asserts that health care professionals must respect the self-determined, informed decisions of competent adults regarding their own bodies and medical care.21
- Beneficence: This principle requires practitioners to act in the best interest of their patients, which traditionally includes the duty to preserve life and promote health.21
When a patient rejects a life-saving intervention, the physician’s duty to promote the patient's well-being (beneficence) directly clashes with the obligation to honor the patient's right to self-determination (autonomy). While the American Medical Association and legal precedents have established that honoring a competent patient's refusal is consistent with ethical medical practice, the situation remains a primary example of the difficulty in prioritizing competing moral principles in clinical settings.12