Theories Of The Self And Autonomy In Medical Ethics

This book engages in a critical discussion on how to respect and promote patients’ autonomy in difficult cases such as palliative care and end-of-life decisions. These cases pose specific epistemic, normative, and practical problems, and the book elucidates the connection between the practical implications of the theoretical debate on respecting autonomy, on the one hand, and specific questions and challenges that arise in medical practice, on the other hand. Given that the idea of personal autonomy includes the notion of authenticity as one of its core components, the book explicitly includes discussions on underlying theories of the self. In doing so, it brings together original contributions and novel insights for “applied” scenarios based on interdisciplinary collaboration between German and Serbian scholars from philosophy, sociology, and law. It is of benefit to anyone cherishing autonomy in medical ethics and medical practice.

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.

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 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.

A timely, authoritative discussion of an important clincial topic, this useful book outlines the history, function, nature and requirements of informed consent, focusing on patient autonomy as central to the concept. Primarily a philosophical analysis, the book also covers legal aspects, with chapters on disclosure, comprehension, and competence.

Bioethics tells a heroic story about its origins and purpose. The impetus for its contemporary development can be traced to concern about widespread paternalism in medicine, mistreatment of research subjects used in medical experimentation, and questions about the implication of technological developments in medical practice. Bioethics, then, began as a defender of the interests of patients and the rights of research participants, and understood itself to play an important role as a critic of powerful interests in medicine and medical practice. Autonomy and the Situated Self argues that, as bioethics has become successful, it no longer clearly lives up to these founding ideals, and it offers a critique of the way in which contemporary bioethics has been co-opted by the very institutions it once sought (with good reason) to criticize and transform. In the process, it has become mainstream, moved from occupying the perspective of a critical outsider to enjoying the status of a respected insider, whose primary role is to defend existing institutional arrangements and its own privileged position. The mainstreaming of bioethics has resulted in its domestication: it is at home in the institutions it would once have viewed with skepticism, and a central part of practices it would once have challenged. Contemporary bioethics is increasingly dominated by a conception of autonomy that detaches the value of choice from the value of the things chosen, and the central role occupied by this conception makes it difficult for the bioethicist to make ethical judgments. Consequently, despite its very public successes, contemporary bioethics is largely failing to offer the ethical guidance it purports to be able to provide. In addition to providing a critique, this book offers an alternative framework that is designed to allow bioethicists to address the concerns that led to the creation of bioethics in the first place. This alternative framework is oriented around a conception of autonomy that works within the ethical guidelines provided by a contemporary form of virtue ethics, and which connects the value of autonomous choice to a conception of human flourishing.

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.

The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy—which was inspired by other rights-based movements of the 1960s—was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine. Tauber examines the historical and philosophical competition between facts (scientific objectivity) and values (patient care) in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a "topology" of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care.