| Course | PAC 415 Healthcare Ethics |
|---|---|
| Module | Module 2 |
| Paper type | Autonomy and capacity analysis |
| Length | About 1,011 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | September 2026 |
Free sample paper for PAC 415 Module 2
Whose Choice, and When? Autonomy and Decision-Making Capacity in Addiction Care
Student Name
Psychology and Addiction Studies Program, Aspen University
PAC 415: Healthcare Ethics
Instructor Name
Month Day, Year
Whose Choice, and When? Autonomy and Decision-Making Capacity in Addiction Care
At 2 a.m. a composite 38-year-old man was brought to the emergency department at Cedar Hollow Health's partner hospital after drinking heavily and falling. He was loud, unsteady and insisted on leaving before a head scan. Two days later, sober and frightened by a letter from his employer, he came to the clinic's addiction program asking for help. A week into outpatient treatment, he told his counselor he wanted to stop treatment and try to cut back on his own. Each moment raised the same question in a different form: when should his choices be respected, and when might they not be his to make? This paper examines autonomy and decision-making capacity in addiction care through these three moments.
Respect for Autonomy
Respect for autonomy means honoring a person's right to make informed, voluntary decisions about their own life and care (Beauchamp & Childress, 2019). In addiction care it has particular weight, because people with substance use disorders are often treated as incapable of choosing, and because treatment that is imposed rarely lasts. Respecting autonomy is not the same as abandoning people to harmful choices; it means treating them as the authors of their own lives while offering information and support.
What Capacity Requires
Autonomy assumes the capacity to decide. Appelbaum (2007) set out four abilities clinicians examine when judging whether a person can consent to or refuse treatment: expressing a choice, grasping the relevant facts, recognizing how those facts bear on the person's own circumstances, and weighing the options logically. Capacity attaches to a particular decision: someone can be fit to make one choice and not another, and the same person's capacity can shift from hour to hour. The more serious the consequences of a decision, the more carefully capacity should be assessed.
How Substances Affect Capacity
Intoxication can impair all four abilities temporarily, particularly understanding and reasoning. Withdrawal, especially severe alcohol withdrawal with confusion, can do the same. Neither a diagnosis of substance use disorder nor a history of poor choices means a person lacks capacity when sober. Clinicians must therefore separate the person's capacity at a given moment from judgments about their lifestyle, and must reassess as intoxication clears.
Three Moments, Three Assessments
The table applies the four abilities to the man at each moment.
| Moment | Decision | Capacity assessment | Ethical response |
|---|---|---|---|
| Emergency department at 2 a.m., intoxicated after a fall | Leave before a head scan | Could state a choice; could not show understanding of the risk or reason about it | Delay departure briefly under emergency authority; reassess as he sobers |
| Clinic two days later, sober | Enter outpatient treatment | All four abilities present | Respect the choice; begin treatment with informed consent |
| One week into treatment | Stop and try to cut back alone | All four abilities present; disagrees with counselor | Respect the choice; explore reasons, offer options, keep door open |
The Emergency Department
In the emergency department, the man's intoxication and possible head injury meant he could not appreciate the risk of leaving or weigh it. Emergency clinicians may briefly hold a person who lacks capacity when there is a serious risk of harm, and reassess as intoxication clears. The ethical justification is protecting a future autonomous self from a choice made while capacity was impaired. Once sober, if he still wished to leave after understanding the risks, his choice would have to be respected.
Choosing to Stop Treatment
The third moment is harder for the counselor emotionally but easier ethically. The man was sober, understood the risks and gave reasons: cost, time off work and a belief that he could control his drinking. His choice was one the counselor thought unwise, but disagreeing with a decision is not evidence of incapacity. The counselor's role was to explore his reasons, share her concerns honestly, offer alternatives such as a lower-intensity schedule, and make clear that he could return at any time.
Involuntary Commitment for Substance Use
Many states allow family members or others to seek court-ordered involuntary treatment for a person with a substance use disorder. Jain et al. (2018) noted that these civil commitment laws are appealing as a response to overdose deaths, but that statutes vary widely, ethical concerns about depriving people of liberty persist and outcome data are limited and often not generalizable. Commitment overrides autonomy entirely, so it requires strong justification: serious risk, lack of capacity or failure of less restrictive options, and evidence that it helps.
Supporting Autonomy
Respecting autonomy is active. Counselors support it by giving clear information, exploring the person's own goals, offering choices among treatment options, avoiding coercion and pressure, and recognizing that ambivalence is normal. Practical wisdom in this area means knowing when a choice reflects the person's settled values and when it reflects a temporary state, and responding to each appropriately.
Pressure From Families
Families often press counselors to override a client's choices, asking them to insist on residential treatment or to share information the client has not authorized. Their worry is real and often justified. Respecting autonomy means listening to families, explaining what the counselor can and cannot do, and, with the client's consent, involving them in treatment, rather than acting on their wishes against the client's. When a family believes a client lacks capacity or is in danger, the counselor can explain the options, such as an emergency evaluation, that exist for those situations.
Documenting capacity assessments matters too, since a note that records the four abilities at a given moment shows why a choice was honored or briefly overridden.
Conclusion
Autonomy in addiction care is neither absolute nor easily set aside. Capacity, defined by the abilities to communicate a choice, understand, appreciate and reason, is specific to decisions and moments, and intoxication can impair it temporarily. The same man lacked capacity to refuse a scan at 2 a.m., had it when he chose treatment and still had it when he chose to leave treatment. Respecting his choices when he could make them, and protecting him briefly when he could not, is what respect for autonomy requires.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Jain, A., Christopher, P., & Appelbaum, P. S. (2018). Civil commitment for opioid and other substance use disorders: Does it work? Psychiatric Services, 69(4), 374-376. https://doi.org/10.1176/appi.ps.201800066
Reading the PAC 415 Module 2 assignment instructions
Autonomy heads the list of concerns in Aspen's PAC 415 description, and this module usually asks how it applies in addiction care. With the Module 2 wording provided to enrolled students, this example analyzes autonomy through one man's changing situation. Explain what respect for autonomy means and why it matters particularly in addiction care. Describe how decision-making capacity is assessed, using a recognized framework. Show that capacity belongs to a particular decision and can shift, especially with intoxication. Apply the framework to more than one moment so the difference is visible. Address the hardest limit on autonomy, involuntary treatment, with evidence. Finish with how professionals can actively support autonomy rather than merely tolerate it.
Inside the PAC 415 Module 2 example
The paper opens with the man's three moments. It explains respect for autonomy and why imposed treatment rarely lasts, then describes the four abilities: communicating a choice, understanding, appreciating and reasoning. A section explains how intoxication and severe withdrawal impair capacity temporarily without making a sober person incapable. A four-column table applies the abilities to each moment and names an ethical response. The emergency department section justifies a brief hold to protect his future self. The treatment exit section distinguishes disagreement from incapacity. A section on civil commitment summarizes a Psychiatric Services review of its variable statutes and limited evidence. Pressure from families and ways to support autonomy close the paper.
Reading the PAC 415 Module 2 grading rubric
Autonomy papers are graded on accurate concepts, careful application, attention to limits and practical guidance. This example uses the four abilities correctly and shows capacity changing with the man's state, which is the insight instructors most want. Its three APA sources are Appelbaum's New England Journal of Medicine article on assessing competence, a Psychiatric Services review of civil commitment for substance use and Beauchamp and Childress's Principles of Biomedical Ethics. The table makes the reasoning at each moment easy to follow. Distinguishing a client's unwise choice from incapacity avoids a common error, and treating involuntary commitment cautiously, with evidence, shows the balance expected in a course on practical wisdom.
Common PAC 415 Module 2 mistakes, and how to avoid them
Students often treat people with substance use disorders as generally lacking capacity, or treat any choice as untouchable. Use a recognized framework and apply it to specific decisions and moments. Another error is confusing disagreement with incapacity; a sober client can make a choice you think unwise. Explain what happens when intoxication impairs capacity and why reassessment matters. Discuss involuntary treatment with evidence, not only opinion. Include what professionals can do to support autonomy, such as offering choices and information. If your case is drawn from work, change details. If the difference between understanding and appreciating seems slight, a tutor can walk through examples with you until it is clear.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More PAC 415 and Psychology and Addiction Studies sample papers
- PAC 415 Module 1: Practical Wisdom in Ethics
- PAC 415 Module 3: Beneficence and Client Goals
- PAC 415 Module 4: Justice and Access to Treatment
- PAC 415 Module 5: Confidentiality and Its Limits
- PAC 415 Module 6: Harm Reduction Ethics
- PAC 415 Module 7: A Complex Case, Several Principles
- PAC 415 Module 8: Reflection on Practical Wisdom
- PAC 310 Module 5: Boundaries and Dual Relationships
- PAC 115 Module 2: Building and Decoding Terms
PAC 415 Module 2 questions, answered
What does PAC 415 Module 2 usually ask for?
Aspen's PAC 415 examines autonomy among the fundamental concerns of medical ethics in addiction-related cases, so a paper on autonomy and capacity is a typical second assignment. Follow your classroom prompt.
What are the four abilities of decision-making capacity?
Communicating a choice, understanding relevant information, appreciating how it applies to oneself and reasoning about the options.
Does a substance use disorder mean a person lacks capacity?
No. Intoxication or severe withdrawal can impair capacity temporarily, but a diagnosis or history of poor choices does not by itself mean a sober person cannot decide.
Where can I find a free PAC 415 Module 2 sample paper?
The full paper is above, following one man through three moments with a four-column table assessing his decision-making capacity at each.
Can a person who is intoxicated refuse medical care?
If intoxication prevents them from understanding or weighing the risks, clinicians may briefly delay their departure under emergency authority and reassess as they sober.