An Investigation Of Coercion And Autonomy In Medical Care. How much choice do patients really have?

The experience of coercion in health care is controversial. Coercion is likely to promote negative attitudes towards clinical care. People’s attitudes to health care potentially impacts on health outcomes and future interactions with the health system. In contrast, attending to patient autonomy is likely to enhance patients’ positive attitudes to healthcare. The relationship between coercion and autonomy is not entirely clear but intuitively coercive care seems to oppose the principle of autonomy. Similarly, possessing autonomy limits coercion. Patient autonomy is heralded as an important concept in current medical practice. A detailed literature search failed to identify any previous study that considered the association of perceived coercion with autonomy preference. The majority of clinical studies on coercion have focussed on the experience of psychiatric patients whereas very few have considered the perception of coercion during medical admission, and none were found that related to coercion in a New Zealand medical setting. Past psychiatric research has shown the perception of coercion is not exclusively associated with compulsory status and is actually more closely associated with procedural justice. It is likely, but previously unproven in a New Zealand context, that some medical patients will feel invalidated during admission and hence report their experience as coercive. This study attempts to understand the relationship between autonomy preference and perceived coercion. It also aims to measure the amount of perceived coercion reported by patients during a medical admission to a general hospital. Perceived coercion and patient autonomy were measured in a cross-sectional survey of 86 general medical patients in the Medical Assessment and Planning Unit (MAPU) of a tertiary hospital in New Zealand. The socio-demographic characteristics of the sample, and perceived coercion and autonomy preferences, were evaluated using the “Admission Experience Survey” to measure the perception of coercion at admission, and the “Autonomy Preference Index” to measure the patients’ desire for information about their health status when making healthcare decisions. Almost all survey participants showed a strong desire for information about their healthcare and treatment, although wide variations in their desire to make decisions about their health were apparent. Over one third of participants reported feeling coerced during their admission. No significant association between perceived coercion and autonomy preference was found. This research shows that perceived coercion is not restricted only to psychiatric care and is relatively commonly reported by patients during medical admission. Confirmation that coercion exists in routine medical care may reflect on the persistence of paternalism in current general medical practice. The long term outcomes of patients who believe they were coerced during a medical admission are unknown but could influence the willingness of these patients to seek health care in the future