title: Respect for autonomy in the healthcare context: observations from a qualitative study of young adults with cerebral palsy.
abstract: BACKGROUND
  Respect for patient autonomy is a cornerstone of contemporary medical ethics and clinical practice. In its different shapes and forms (e.g. being informed, being engaged in discussions and decisions about medical care and being supported in developing healthcare preferences and choices), patient autonomy has been fostered by both paediatric and adult professional societies. The transition from paediatric to adult care creates a complex situation where autonomy for medical decisions shifts to the developing adolescent. More specific challenges to respect for autonomy may be experienced by young adults with cerebral palsy in the transition period where, for example, language and motor impairments may affect communication skills and this may be conflated with cognitive disability.
  
  
  OBJECTIVE
  To characterize perspectives towards autonomy in the healthcare context for young adults with cerebral palsy.
  
  
  METHODS
  We carried out semi-structured interviews with 14 young adults (aged 18-25) with cerebral palsy. The audiotaped interviews were transcribed verbatim and analysed using a conventional thematic qualitative content analysis.
  
  
  RESULTS
  Participants displayed a range of attitudes towards autonomy, suggesting that the value of autonomy is considered in light of competing values and of context. Testimonials from participants demonstrated that both contextual (e.g. ill-adapted health care, lack of specialized public transport) and relational (e.g. attitudes towards parental involvement in decision making) factors negatively or positively impact autonomy.
  
  
  CONCLUSIONS
  We observed that there were four key elements interwoven in participants' characterization of autonomy: the coupling of decisional and physical autonomy, the influences of family and society on autonomy, the influence of healthcare professionals on autonomy and the need for preparation for autonomy.
authors.affiliation: Neuroethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), Montréal, QC, Canada; Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada; Departments of Neurology and Neurosurgery, Medicine & Biomedical Ethics Unit, McGill University, Montréal, QC, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Racine
authors.forename: D
authors.initials: D
authors.lastname: Larivière-Bastien
authors.forename: E
authors.initials: E
authors.lastname: Bell
authors.forename: A
authors.initials: A
authors.lastname: Majnemer
authors.forename: M
authors.initials: M
authors.lastname: Shevell
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002547:Cerebral Palsy / Q000523:psychology*; D002755:Choice Behavior; D003657:Decision Making; D004992:Ethics, Medical; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D026684:Personal Autonomy; D060305:Transition to Adult Care; D055815:Young Adult