In order to initiate a physiotherapeutic care, the free and informed consent of the patient / client about the evaluations and interventions essential for the management of his clinical condition is required. It is an ethical principle to respect the patient’s decision-making autonomy, that is, to acknowledge his or her authority over what will or will not be done in relation to his medical care (Beauchamp and Childress, 2001), or any other health care. However, we should not only focus on the patient’s decision-making autonomy, but also on his executive autonomy, described as the patient’s ability to plan, sequence, and perform tasks associated with managing his medical conditions (Naik AD et al.,2009). Especially when dealing with chronic health conditions such as diabetes, hypertension and others. What I understand, with the little practical experience so far, is that we strive to follow the principle of beneficence, formulating physiotherapeutic interventions with predictions of the best results, based on the confidence of our knowledge and abilities, and the patient’s conscious acceptance of our intervention , But sometimes without considering the biopsychosocial conditions of the patient that interfere in the effectiveness of the results that we wish to achieve, that is, in their autonomy of execution in front of the therapy. For example, in Diabetes mellitus, as we work with the patient to control their blood glucose levels in order to prevent the complications of the disease, we encourage and almost require them to do physical activity, such as walking during the week. At first, the patient, aware of the importance of physical activity to control his blood glucose, agrees to perform the walk. However, it may be that the neighborhood or street where he lives is not suitable for walking, or that he does not feel secure in doing the activity alone or that he is responsible throughout the day for the care of a child, such as a grandchild , And can not put your treatment into practice. This means that, even with decision-making autonomy, the patient is not successful in treatment because there are barriers to executive autonomy that should have been investigated by the physiotherapist and resolved so that the therapeutic goal could be achieved. One way to achieve the expected result is to follow the International Classification of Functionality (ICF) to identify and correlate the patient’s deficiencies, limitations, constraints, environmental and personal factors in order to provide comprehensive and effective physiotherapeutic care. As students, we have learned that by using the ICF to perform the functional diagnosis we are able to see the whole context around the patient and minimize the chances of our treatment failing.
Naik AD, Dyer CB, Kunik ME, McCullough LB. Patient autonomy for the management of chronic conditions: a two component re-conceptualization. Am J Bioethics. 2009;9(2):23–30.