Bioethics, autonomy, and self-determination in patients admitted to a teaching hospital for treatment of substance use disorder

Authors

  • Lucas Franca-Garcia Universidade Federal do Rio Grande do Sul
  • Fernanda da Rocha Trindade Hospital de Clínicas de Porto Alegre
  • Alessandra Mendes Calixto Hospital de Clínicas de Porto Alegre
  • José Roberto Goldim Universidade Federal do Rio Grande do Sul

Abstract

The aim of this article is to evaluate moral-psychological development, autonomy, and self-determination in patients with substance use disorder (SUD). Moral-psychological development was assessed using a tool to determine individuals’ decision-making ability. Our qualitative approach was based on ethnographic research and participant observation. Fifty per cent of the patients (n = 9) were found to be in the conformist stage, 39 per cent (n = 7) were in the conscientious stage, and 11 per cent (n = 2) were in the autonomous stage, according to Loevinger’s stages of ego development. Our field observations revealed issues of social belonging, symbolic aspects of the treatment, distinction between autonomy and self-determination, and re-signification of the meaning of autonomy. All patients were considered able to make decisions in their best interests, taking into account their stage of moral-psychological development according to Loevinger’s stages. They were also equipped to produce moral arguments to legitimize their actions.

Keywords:

bioethics, substance use disorder, personal autonomy