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Liberty, Autonomy, Community of Choice: Know Your Rights

Autonomy is your ability to make decisions about your own life. You have the right to autonomy, including choices about your treatment. This includes your right to choose or refuse treatments. A sense of personal autonomy improves healthcare outcomes.1,2

Schizophrenia and other mental health conditions affect your autonomy. Symptoms can interfere with your decision-making. Other people’s perceptions can affect your ability to make decisions. You have the right to treatment that enhances your autonomy. Finding a doctor who respects your autonomy can help you improve control over your healthcare choices.3,4

What is autonomy?

Autonomy refers to your ability to make choices about your own life. This includes your capacity to make healthcare decisions based on your values. In general, autonomy has 2 layers:3

  • Competence – your ability to form goals and to act on them
  • Authenticity – your relation to desires and values that motivate you

A person is autonomous when they can act on their own true desires. An autonomous person can weigh different options and select preferences. For example, an autonomous person can make treatment choices based on information about options based on their preferences.3

A common misunderstanding is that autonomy requires decisiveness. Inner conflict and doubt are normal responses to many situations. You can still be autonomous while being unsure about what to believe or do.3

How are mental health conditions related to autonomy?

Your mental health affects your autonomy in both positive and negative ways. For example, your mental health can interfere with your autonomy when:3

  • Behaviors and emotions feel forced or out of your control
  • Addiction makes it impossible to resist distractions and temptations
  • Low self-perception gets in the way of pursuing goals or activities
  • Apathy causes you to lose your sense of beliefs and motivations

The stigma surrounding mental health can also affect autonomy. Stigma refers to judgment because of a perceived quality. Internalizing stigma can prevent you from pursuing your goals and managing your care.3

How does schizophrenia affect autonomy?

Symptoms of schizophrenia affect autonomy in many ways. People with schizophrenia still have values and beliefs about life. It can be harder to act on these values. Many people with schizophrenia are still capable decision-makers. But stigma and self-perception can get in the way.3

Rapid changes in how you experience reality can interfere with autonomy. Symptoms can affect your sense of self and how you relate to the world. Common ways that people with schizophrenia lose autonomy include:3

  • Decreased activity
  • Difficulty maintaining a daily routine
  • Loss of interest in activities
  • Withdrawal from social situations and relationships
  • Loss of motivation
  • Difficulty making choices

Changes in cognitive abilities also affect autonomy. People with schizophrenia often experience changes in memory, attention, and problem-solving. This can make it harder to work and live freely.3

How can I make decisions about my own treatment?

Making decisions about your own healthcare is a key part of autonomy. Everyone should be able to make choices about treatments. These choices should be informed and free from influence.1,2

Making your own medical decisions can improve your health outcomes. Most people with schizophrenia can make treatment choices in the hospital or other settings. Very few people are completely unable to make treatment decisions.1

However, doctors’ perceptions often interfere with medical autonomy. Forced hospitalizations and ignored personal preferences are common. This can worsen outcomes by causing isolation and loss of trust in mental health services.1,2

Find a doctor who respects your autonomy. Look for a doctor who:1,2

  • Answers your questions patiently and does not mind repeating themselves
  • Gives information clearly and fully
  • Supports cognitive therapy or other ways to enhance your autonomy
  • Involves you in decisions and planning
  • Empowers you to manage your own healthcare

Laws in the United States and many other countries help ensure that people with schizophrenia control their own treatment. This leads to better communication with your doctor. It also helps you be more active in your own healthcare.4-6

What are my fundamental medical autonomy rights?

We all have fundamental human rights related to our medical care. People with mental health conditions have the same legal rights as anyone else. These rights ensure you have autonomy over your care.4,6

In medicine, autonomy is the right to make informed decisions about healthcare. You have the basic right to receive treatment that enhances this autonomy. Some basic medical rights include your right to:4,6

  • Access the best available mental health care
  • Be informed of your rights
  • Live and work in your community
  • Get treatment in or near your community
  • Get treatment based on an individual plan
  • Get treatment suited to your cultural background
  • Authorize or refuse treatments with informed consent
  • Be protected from harm and abuse
  • Be free from discrimination based on your mental health
  • Have advocates to make decisions when you cannot
  • Have your interest protected at all times

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