The application and understanding of default autonomy in ethically dilemmatic cases presented by Czech medical doctors: An empirical study
Abstract
Beauchamp and Childress proposed a theory of autonomous action that is currently considered the default concept of autonomy in bioethics. According to their theory, the following conditions need to be met for action to be truly autonomous: (i) the agent acts intentionally, (ii) with understanding, and (iii) without any controlling influences that determine their action.
It has been established that the concept of default autonomy (DA) should be the basis of the doctor-patient relationship. The presented empirical study aims to assess the ability of Czech medical doctors to meet the concept of DA in ethically dilemmatic cases.
Fifty-two out of sixty-nine cases were evaluated utilizing an interpretative phenomenological analysis and the Four Boxes model to determine whether (i) all cases met the criteria of default autonomy; (ii) if not, which criteria were omitted; and (iii) what was the most commonly omitted criterion of DA. Then we classified the cases into three categories based on the number of criteria fulfilled.
We found that only 21% of cases met all three criteria of DA. The criteria omitted most frequently included intentionality (35%), understanding (26%), and voluntariness (25%).
Twenty-one percent of cases were classified as a "white zone", meaning that all criteria of DA were met; sixty percent of cases were classified as a "black zone", where at least one criterion was not met; and nineteen percent of cases were classified as a "grey zone", where we could not determine whether all criteria had been met or not.