Open AccessThe price of autonomy
Author(s) -
Baum Michael,
Vaidya Jayant S.
Publication year - 1999
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1046/j.1369-6513.1999.00029.x
Subject(s) - autonomy , beneficence , economic justice , informed consent , value (mathematics) , limiting , psychology , social psychology , actuarial science , political science , law and economics , economics , law , medicine , computer science , alternative medicine , mechanical engineering , pathology , machine learning , engineering
The randomized controlled trial produces a clash of ethical principles with the need for informed consent (autonomy) in conflict with the principles of beneficence and justice. Informed consent is one of the major rate‐limiting factors of recruitment and this delays the discovery of life‐saving treatments indirectly. Whilst supporting the concept of non‐exploitation we wish to challenge the prevailing dogma by asking the awkward question ‘what is the price of autonomy?’. Using breast cancer as an example we have developed a decision model with explicit assumptions allowing numerical values to be fed into a mathematical equation, which calculates the cost in lives. With conservative assumptions we estimate that the price of autonomy is 2500 lives over a 10‐year period in the United Kingdom alone. We issue the challenge to health policy makers and ethicists to survey public opinion to determine the value placed on autonomy in the war against cancer.