Q&A: Defining 'autonomy' and 'competence' for patients

Q: How are "autonomy" and "competence" defined in case management when describing patients?

A: The terms “autonomy” and “competence” are often confused. Autonomy involves the rights of clients to make decisions about their own medical care, without their healthcare provider trying to influence the final decision. The provider can educate the client on essential information (e.g., medications, experimental protocols, prognosis), but final decisions are up to the client. The respect for autonomy is a basic right of all human beings: the ability to be independent and self-directing, as in the client being able to make choices about care providers or discharge planning options. But just because a client is able to self-direct care does not necessarily mean the client is competent with all decision-making.

Defining whether clients are legally competent to make decisions about their own treatment requires an assessment of their mental capacity. A psychiatrist or other type of behavioral health professional (e.g., clinical psychologist, licensed clinical social worker, licensed professional counselor) may be consulted to be involved in this process. However, the court renders the final decision. To be deemed competent, the client must have the mental capacities to reason and deliberate, hold appropriate values and goals, appreciate his or her circumstances, understand the information given, and be able to communicate a choice.

For more information, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management.