La autonomía del paciente

Respecting the patient's autonomy is one of the fundamental principles on which biomedical ethics is based. The principle of autonomy considers the patient's freedom and responsibility, who decides what is good for himself/herself, although this is not shared by the physician. In the field of medical research, there are codes and guidelines that guarantee the protection of persons as research subjects. In Spain, recognition of the right of the patient's autonomy has been included in different legal and deontological guidelines. Law of Patient's Autonomy 4½002 (LAP) is a response to the growing important in our society of the patients' rights as basic axis of the clinical-health care relationships. Different regional communities have also enacted legal guidelines that regulate the persons' autonomy to decide about that affecting his/her health, physical integrity, or life as well as the assumption by others of the decisions of representation or previous instructions. The basic paradigm of autonomy is the informed consent. The LAP establishes the obligation of obtaining the free and voluntary consent of the patient prior to any type of intervention, after offering him/her the adequate information. This basic guideline specifies the situations in which the informed consent is given in writing as well as the exceptions to this consent. Finally, the LAP details when the informed consent is advisable by representation, closely linked to the patient's capacity as well as the regulation of previous instructions.