Dialetics of balanced autonomy in disagreements between patients and oncological surgeons.
OBJECTIVE
To comprehend different logics of autonomy that are present in conflicts between surgical prescriptions and the expectations of patients with diagnoses of cancer.


METHODS
This is a qualitative study in which 11 semistructured interviews were conducted with oncological surgeons specializing in head and neck tumors, in the city of Rio de Janeiro, Southeastern Brazil, between 2000 and 2005. The participants were selected by means of chain sampling and the fieldwork was halted in accordance with the criterion of saturation. The discourse analysis technique was used to identify the premises that structured the concept of autonomy and would constitute the discursive dialectics within the context of patients who fight against undergoing surgery that is considered to be of mutilating nature.


RESULTS
At first, the surgeons expressed standardized statements centered on deontological concepts of autonomy. As they narrated their experiences, self-questioning that brought out contradictions regarding the routine concept of "informed resectability" was observed. At this point, the standardized discourse became permeated by self-questioning about the need to return to the existential balance that had been harmed by the cancer.


CONCLUSIONS
The narratives expressed demands for "balanced autonomy" in the form of a semi-project that is not aprioristically idealizable but is dependent on mutual interactions. The results indicated the need for reflection on the concept of autonomy as a linear, categorical and individual premise that, although superficially elaborated, governs everyday actions.
Vasconcellos-Silva
Paulo Roberto
PR
Escola de Medicina e Cirurgia, Departamento de Medicina Especializada, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. bioeticaunirio@yahoo.com.br
Nolasco
Paula Travassos de Lima
PT
D026688:Bioethical Issues; D003142:Communication; D034462:Dissent and Disputes; D006258:Head and Neck Neoplasms / Q000523:psychology / Q000601:surgery*; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008495:Medical Oncology / Q000941:ethics*; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D036301:Qualitative Research; D016312:Treatment Refusal / Q000941:ethics*