Autonomy in Addiction Recovery
The Right of Autonomy in Recovery
Most humans have a strong desire to live their life as they see fit but will accept that there are certain restrictions to this. It is generally agreed that it is not possible to give people complete freedom of action. That would lead to chaos. There are laws, ethical, and religious principles to be considered. It is seen as desirable that people should be allowed to do what they like so long as they are not causing harm. Autonomy is the ethical right of people to live their life as they want to.
Those individuals who are ready to escape addiction benefit if they are able to make autonomous choices about how this should happen. They will want to make informed decisions based on the advantages and disadvantages associated with different options. It is not only that they have an ethical right to make such choices; it is also far more likely that they will find success in recovery if they have this power. People tend to feel resentful when they are coerced into choosing a certain treatment option. This negative feeling can prevent them from benefiting from what is on offer. When people choose something for themselves they will be far more committed to it. Once people achieve sobriety they can continue to make autonomous choices for how best to rebuild their lives.
Autonomy can be defined as the state of being self-governed. Autos is an ancient Greek word for self and nomos means law so autonomy is self law. It is an ethical principle that offers people the right to take responsibility for their own life. It means that they should be able to live their life according to their own motives and beliefs – in other words they have self-determination.
Autonomy is related to a number of important rights that impact people recovering from an addiction including:
* Informed consent
* The right to confidentiality
* The right to have a say in their own treatment
* The right to say no to any treatment
These rights are not always fully respected, but there is an ethical obligation (and frequently legal obligation) to uphold them.
The Difference between Autonomy and Freedom
Autonomy and freedom are related words but there can be a difference in how each is used. In most instances the word freedom will be referring to something that is limited in scope. For example, if a slave manages to achieve their freedom it does not necessarily mean that they can do whatever they like afterwards; it just means that they are now free from the obligations of a master-slave relationship. Autonomy is more about self-determination it implies more than when is generally accepted as freedom. A country can gain its freedom from foreign occupation by replacing it with a dictatorship.
Autonomy and Informed Consent
In order for the individual to remain autonomous they need to give informed consent to any procedure or treatment that is going to impact their life. This involves more than just agreeing to something. In other to give informed consent the individual needs to fully understand what they are agreeing to. This type of autonomous consent included a number of key elements including:
* A good understanding of the benefits of procedure or treatment
* Information about potential risks involved
* Information about any alternative procedures or treatment
* A full explanation of what the treatment involves
* The risks involved in not having the procedure
* Any potential benefits of not having the procedure
Conflict between Autonomy and Beneficence
Sometimes there is a conflict between autonomy and beneficence – the ethical principle that obliges people to do the right thing. A good example of how these two moral principles clash is when an individual wants to commit suicide. If this person were to mention their intention to a therapist then this professional would be put in a dilemma; they would have to choose between client autonomy and beneficence. In this example the therapist would be obligated to try and stop the individual from harming themselves even if it would mean violating personal autonomy. Their first obligation would be protect the client’s best interests.
Personal Autonomy and Rehab
Some individuals are coerced into attending rehab. The reason for why this happens is the ethical principle of beneficence. Those people who are addicted to alcohol and drugs may be unable to make rational choices. So long as they continue to abuse alcohol or drugs they will be hurting themselves and likely other people as well. It can therefore be in their best interests to coerce them into attending some type of rehab program. Getting the help they need could save their life so it does appear reasonable to override their right to self-autonomy in this instance. It often happens that when these individuals are free of alcohol and drugs for a few days they become willing participants in the treatment for their addiction.
In order for the individual to get the most out of rehab it is vital that they become a willing participant. It may be possible to force people to attend rehab but it is not possible to make them become better. It is only when they make the autonomous decision to take charge of their own recovery that success can occur.
12 Step Programs and Autonomy
Autonomy is one of the founding principles of groups like Alcoholics Anonymous. The 12 traditions guide the organization. A number of these traditions deal directly with autonomy including:
* Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
* Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
* Every A.A. group ought to be fully self-supporting, declining outside contributions. This is to prevent these outside entities from infringing on the autonomy of the organization.
* A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve. This avoids bureaucracy and further encourages autonomy.
* Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities. This helps to encourage confidentiality which respects the autonomy of the individual.
Criticisms of How 12 Step Programs Can Interfere with Autonomy
Despite the efforts of 12 Step programs to promote autonomy within the organizations there are some concerns for how it can interfere with personal autonomy including:
* This organization tends to promote the disease model of addiction. This theory of addiction is not universally accepted and an increasing number of addiction experts seem to be speaking out against it. It could be argued that groups like AA indoctrinate members into accepting the disease model. This prevents them from making autonomous decisions about their recovery because they do not have the right information.
* Many individuals have been coerced into attending 12 Step meetings following legal proceedings. This could also be considered an infringement on personal autonomy. A recent ruling by the Supreme Court in the US found that the rights of an Atheist had been violated when he was mandated into attending AA meetings.
* There can be too much pressure on AA members to accept certain beliefs and live their life in a certain way. If they fail to follow this advice they may be ostracized by the rest of the group or accused of being a dry drunk. Even if such coercion is light it can still greatly impact on personal autonomy.