Historical And Philosophical Perspectives On Biomedical Ethics From Paternalism To Autonomy

This title was first published in 2002: This volume discusses the subject of biomedical ethics. Various views, historical and contemporary, are discussed, with the editors using the contrasting concepts in the shift from paternalism to autonomy in 20th-century medicine as a heuristic tool for the critical study of ethics in medicine.As far as the evidence in this volume goes, paternalistic medical practices and patient autonomy had an uneasy relationship by the beginning of the 20th century. A hundred years later, full autonomy in decisions on medical treatment is still subject to numerous caveats. The text pays close attention to the interplay between various players, noting how factors such as social contexts, governmental organizations and the biotechnological industry influence and shape responses to the principle of bioethics.

In recent years, the triumph of autonomy has made paternalist interventions increasingly problematic. The value of a patient's right to self-determination and the practice of informed consent are considered supremely important in present-day health care ethics. In general, the idea of 'doctor knows best' has become more and more suspicious. This has left us with a situation in which paternalist medicine seems difficult to reconcile with respect for patient autonomy. This book offers a thorough reflection on the relationship between autonomy and paternalism, and argues that, from both theoretical and practical angles, the tension between these concepts is not as acute as it might seem. In long-term care, psychiatry, and care for the severely handicapped, the principle of respect for autonomy is particularly ill-suited. This, however, does not mean that such respect is totally irrelevant, but that it should take a different shape. Good care in those cases requires us to transcend the sharp dichotomy between autonomy and paternalism. In Autonomy and Paternalism: Reflections on the Theory and Practice of Health Care various acclaimed authors present their views on this interesting and extremely relevant debate.

This work sets the stage regarding debates about paternalism and health care for years to come. The anthology is organized around four parts: i) The concept of paternalism and theoretical issues regarding the idea of anti-paternalism, ii) strategies for justifying different forms of paternalism, iii) paternalism in psychiatry and psychotherapy, iv) paternalism and public health, and v) paternalism and reproductive medicine. Medical paternalism was arguably one of the main drivers of debates in medical ethics and has led to a wide acknowledgement of the value of patient autonomy. However, more recent developments in health care, such as the increasing significance of public health measures and the commercialization of medical services, have led to new social circumstances and hence to the need to rethink issues regarding paternalism. This work provides an invaluable source for many scholars and practitioners, since it deals in new and original ways with one of the main and oldest issue in health care ethics.​

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” (concepts of) autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, biographical and social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations (both positive and negative) between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics.

Medical ethics in Imperial Germany were entangled with professional, legal and social issues. This book shows how doctors' ethical decision-making was led by their notions of male honour, professional politics and a paternalistic doctor-patient relationship rather than concern for patients' interests or the right of the sick to self-determination.

This book arises from a two-fold conviction. The first is that autonomy, despite recent critiques about its importance in bioethics and philosophy of medicine, and the traditional resistance of medicine to its "intrusion" into the doctor-patient relation, is a fundamental building block of an individual's identity and mechanisms for dealing with illness, disease, and incapacity. As such it is an essential component in the health care professional's armamentarium employed to bring about healing. Furthennore, it functions in a similar way to assist the health professional in his or her relations to the sick and injured. The second conviction follows from the fITst. Autonomy is far more complex than appears from the philosophical use of the concept. In this conviction we join those who have criticized the over-reliance on autonomy in modem, secular bioethics originating in the United States, but gaining ascendancy in other cultures. This critique relies on appeals to the richer contexts of persons' lives. Elsewhere the contemporary critique of autonomy appears in a variety of alternative ethical models like narrative ethics, casuist ethics, and contextualism. Indeed, postmodern criticism of all bioethics argues that there is no defensible foundation for claims that one ought to respect autonomy or any other principle as a way of ensuring that one is ethical.

In general, the history of virtue theory is well-documented (Sherman, 1997; O’Neill, 1996). Its relationship to medicine is also recorded in our work and in that of others (Pellegrino and Thomasma, 1993b; 1996; Drane, 1994; Ellos, 1990). General publications stress the importance of training the young in virtuous practices. Still, the popularity of education in virtue is widely viewed as part of a conservative backlash to modern liberal society. Given the authorship of some of these works by professional conservatives like William Bennett (1993; 1995), this concern is authentic. One might correspondingly fear that greater adoption of virtue theory in medicine will be accompanied by a corresponding backward-looking social agenda. Worse yet, does reaffirmation of virtue theory lacquer over the many challenges of the postmodern world view as if these were not serious concerns? After all, recreating the past is the “retro” temptation of our times. Searching for greater certitude than we can now obtain preoccupies most thinkers today. One wishes for the old clarity and certitudes (Engelhardt, 1991). On the other hand, the same thinkers who yearn for the past, like Engelhardt sometimes seems to do, might stress the unyielding gulf between past and present that creates the postmodern reaction to all systems of Enlightenment thought (1996).

Patient autonomy is a much discussed and debated subject in medical ethics, as well as in healthcare practice, medical law, and healthcare policy. This book provides a detailed and nuanced analysis of both the concept of autonomy and the principle of respect for autonomy, in an accessible style. The unique feature of this book is that it combines empirical research into hospital practice with thorough philosophical analyses. As such, it is an example of a new movement in applied ethics, that of 'empirical ethics'. The key themes are informed consent and medical decision making, personal well-being, competence, paternalism and decision making for incompetent patients. Much attention is also devoted to autonomy in non-decision making situations - patient control over small everyday aspects of care, authenticity and existential aspects of illness, autonomy and the 'ethics of care', and the relationship between autonomy and trust in the physician-patient relationship. This book will be of interest to those working or studying in the field of medical ethics and applied ethics but also to healthcare professionals and health policy makers.