Personal Autonomy Research Articles

THE CONCEPT OF MEDICAL LAW AND ITS PLACE IN THE SYSTEM OF BRANCHES OF LAW

The scientific work is devoted to the legal nature and regulation of medical law as a branch of law. There is little scientific literature and judicial practice on medical disputes in Georgian realities. Therefore, the study aims to intensify discussion in this direction. The problem becomes even more relevant in the context of technological development in the medical field. The purpose of the research is to determine the object of regulation of medical law, the place of medical law in the legal system, and the relationship between medical law and medical ethics. To achieve this goal, it is necessary to answer the following questions: What relations are included in the scope of regulation of medical law? What is its method of regulation? Where is the place of medical law – is it included in civil law, is it part of criminal and administrative law, or does it represent a certain unity of all three areas? From this point of view, the subject and method of regulating medical law should be studied. Also of interest is a brief analysis of documents reflecting the international context in the medical field, especially in the area of protecting the personal autonomy of the patient. Research confirms that medical law is an interdisciplinary field. It includes law and other branches of science, such as bioethics, medicine, and psychology. Thus, there is a close relationship between medical law and medical ethics. It is also possible that a violation of medical ethics entails a violation of the law and corresponding liability. In addition, it appears that medical law includes parts of public (administrative) law, criminal law, contract law and tort law. The role of contract and tort law in effectively protecting the interests of the patient is special.

Hemşirelerin Sosyotropi ve Otonomi Kişilik Özelliklerinin Duygusal Habitus Bağlamında İncelenmesi

The study was designed to investigate of nurses’ sociotropy and autonomy personality features in the context of emotional habitus.
 The study was carried out in accordance with the qualitative research design and was supported by quantitative data. Information Form, Sociotropy-Autonomy Scale were applied to 10 nurses. Also, semi-structured thorough individual interviews were made with them. 
 Seven nurses have voluntarily chosen their profession and the others are not. Five nurses stated that nursing is appropriate for their personal character. Six nurses stated that nursing influenced the positive development of personal character. According to the findings, nurses who have developed autonomous personality characteristics and chose willingly the profession did so since it is a profession that is compatible with their individual identities or their primary habitus. Nurses claimed that the nursing profession suited their personalities also reported that the profession had a positive effect on their personalities. The findings revealed the significance of developing both autonomy and sociotropy personality characteristics. The nurses reported that their nursing profession brought them with sociotropy personality characteristics. If there are differences between the social identities of nurses and their nursing identities (the emotional habitus examined in this study), nurses tend to adopt the identity of the nursing profession. The nurse is motivated in this manner because he/she enjoys this different habitus, which makes his/her life, communication, and nursing career simpler. These advantages drive his/her to adopt this different habitus and incorporate it into his/her social identity. In this context, the researchers' investigation of nurses' personality traits in the context of their emotional habitus will positively affect the quality of care.

Autonomy and Coping with Stress in Persons with ASD

This article presents empirical analysis of selected issues related to autonomy of persons with ASD, along with the psychosocial conditions of its development. This analysis is an attempt to determine direct causes and particular types of conditions necessary for the development of autonomy in people with autism, manifested in the capacity of coping with stress. The theoretical basis for the research is the three-component model of autonomy, under which autonomy is an internal attribute of each person, manifesting itself in the qualities of authorship (the person feels to be the author of his/her own behaviour), interest-taking (reflection on internal and external events), and absence of the perceived sense of pressure or control.
 The research problems in this study concern the level of autonomy in people with ASD, the level of their psychosocial functioning in the dimension of coping with stress, and the potential correlations between the two parameters.
 A diagnostic survey method was used to obtain the research material, which employed the following research tools: Index of Autonomous Functioning, The Autism-Spectrum Quotient, Coping Inventory, the author’s own Interview Questionnaire, developed for the purposes of our study regarding age, gender, marital status, residence, education, income, past therapy and current health conditions.

"I don't have a telephone to the fetus": Clinicians' conceptions of fetal patienthood in maternal-fetal surgery counseling

RationaleMaternal fetal surgery (MFS) has developed rapidly since the 1960s and centers for fetal diagnosis and therapy (CFDT) have proliferated. As a result, CFDT clinicians have intervened with fetuses through pregnant bodies for decades, yet the patienthood status of the fetus and its implications for the pregnant person's autonomy have been relatively unexamined. ObjectiveOur overall research aims were threefold: (1) to explore how clinicians train for and provide counseling for MFS; (2) to examine how clinicians assess fetal patienthood and its implications; and (3) to understand clinicians’ professed needs and their recommendations for education and training for the provision of MFS counseling. This focuses on aim two. MethodIn this qualitative study, conducted using in-depth interviews, we examined how 20 clinicians from 17 different sites understood fetal patienthood, how that affected their counseling of pregnant patients, and whether they drew on extant ethical frameworks for guidelines. ResultsWe identified three major themes: 1) Clinicians entered fetal surgery consultations with assumptions about fetal patienthood (frequently informed by beliefs about fetal viability, maternal attachment, and disciplinary perspectives); 2) they consciously assessed their pregnant patients' connections to their fetus to inform or re-calibrate their own understandings of fetal patienthood; and 3) they used a threshold -based conceptualization whereby the fetus achieved patienthood after crossing a symbolic boundary, often related to the clinician's ability to intervene. ConclusionsFew clinicians invoked an extant ethical framework to determine fetal patienthood; most asserted that they did not view directive counseling toward MFS as appropriate, instead working diligently to protect pregnant patients’ autonomy and rights to self-determination.

ENGAGEMENT OF FAMILY IN ASSISTED LIVING: SECONDARY QUALITATIVE ANALYSIS USING THE ADAPTIVE LEADERSHIP FRAMEWORK

Abstract Assisted living (AL) residents are at high risk for safety issues (e.g., falls) and poor quality of life (QoL) because they can lose their personal preferences and autonomy in personal care or social activities once they enter AL. Family engagement (FE) plays a significant role in addressing these challenges while considering residents’ needs and preferences. The purpose of this study was to explore family caregivers’ perspectives about FE strategies in AL and contextual factors influencing FE. This study used a secondary analysis of the interview data from a larger study investigating 34 family caregivers’ opinions on AL safety and strategies to increase FE. The Adaptive Leadership Framework guided our directed content analyses to identify how family caregivers address the challenges with AL residents and staff. Family caregivers described adaptive leadership strategies pertaining to getting the residents to recognize the seriousness of their health status, finding available resources to support them, and planning for potential challenges. Family caregivers also described adaptive and collaborative work (with AL residents or staff) strategies such as advocating for resident needs, involvement in direct care or social activities, shared understanding of care plan, and making decisions together. We also found that contextual factors such as fear of speaking up and retaliation, previous experiences in FE, influenced family caregivers’ engagement in AL safety. These findings highlight the important role of family caregivers in addressing AL resident safety challenges. Also, our study provides the rationale for developing practical FE strategies to enhance residents’ safety and QoL.

Case Study

When older patients enter the healthcare system, determining the origin of injuries requires differentiating accidental from nonaccidental, or neglect-related causes. The involvement of a forensic nurse is invaluable, as the foundational education and expertise help in the assessment and documentation of the person's capacities and competence. Distinguishing between effective care planning and considering the risk of further harm occurs throughout the entire process, where the preservation of the older person's integrity, autonomy, and dignity includes delicately listening to statements made, and confirming the sources of injury. Adopting a trauma-informed person-centered care approach to care and recovery is the goal, creating an environment where older persons feel safe, supported, and understood. In a fast-paced healthcare setting, challenges in addressing lesser-known or less frequently discussed diseases reflect limited knowledge, complicating the care provided. Therefore, ongoing education and training expose the forensic nurse to the latest medical advancements, diminishing misdiagnoses or delayed treatments as outcomes. Critical and accurate communication, coupled with seamless collaboration among interprofessional and community members, serves as the cornerstone to establish a comprehensive and cohesive plan of care. Working together, all members of the interprofessional team ensure that the older person's presenting condition is thoroughly assessed, treated, and supported in the services by the community of providers.

Posner Meets Hayek: The Elements of an Austrian Law & Economics Research Program

Abstract To date, Friedrich Hayek is the only winner of the Nobel Prize in Economics who also holds a law degree. The role of law is central to Hayek’s work and prominent in the research program of the Austrian School of Economics generally. Although Hayek’s contributions to jurisprudence are manifest, as are the influence of his economics ideas, his influence on the field of law and economics has remained modest. This lecture, delivered as the Keynote Lecture at the 2023 Asian Law & Economics Association Annual Meeting, provides an introduction to the fundamentals of an Austrian Law & Economics research program in contrast to the mainstream, Chicago-school research program that has dominated the field since its early history. Compared to the neoclassical approach, Austrian thinking provides a more insightful approach to many of the key concepts generally associated with the economic analysis of law: the nature and success of the common law as a system of law, the importance of stability and simple rules in the law, and the strong preference for private ordering via contract, personal autonomy, and voluntary exchange exhibited in the common law. I identify and briefly describe six key distinguishing characteristics of the Austrian school that distinguishes it from neoclassical law and economics: (1) Methodological individualism, (2) Utility and Costs are subjective, (3) the division of knowledge, (4) spontaneous order, (5) competition as a discovery procedure, and (6) the nature of economic equilibrium. I will also highlight some of the ways in which examining law and economics through an Austrian framework provides valuable insights about law and economics.

Is it getting too personal? On personalized advertising and autonomy

It has recently been suggested that personalized advertising is often more an affront to a person's autonomy and thus more morally worrisome than its generic counterpart precisely because it involves or takes advantage of such personalization. This paper argues that central reasons that have been forwarded to support this claim are unpersuasive and that generic and personalized advertising should therefore be treated as morally on par in terms of their potential to undermine consumer autonomy. The paper then suggests that, if this is true, it presses scholars who wish to maintain there to be a moral asymmetry between personalized and generic advertising in terms of their effect on consumer autonomy to choose between three argumentative avenues, but that none of these is likely to be particularly attractive for a defender of the asymmetry.

Adolescents' personhood and the effects of their institutionalization

This paper aims to make a comparison of personality disorders in adolescents in residential care versus adolescents raised in natural families. The aim is to identify differences in personality traits and personal autonomy between adolescents living in residential care and those living in natural families, and to compare personality traits between the two groups, including by gender and age.

Managers and future educational managers-character traits

This paper represents the synthesis of some investigations presented in the literature, regarding the character traits of managers and future educational managers. Numerous authors have demonstrated that at the basis of good educational management, a primary role is played by the profile and character traits of the person in charge of the leadership position at the level of the school unit. The paper also contains the results of a personal research, through which I proposed to investigate self-esteem, perseverance, personal autonomy, self-acceptance and acceptance of others, and, within current managers and future educational managers. The research was carried out using a set of questionnaires containing: personal autonomy assessment questionnaire, Rosenberg self-esteem interpretation questionnaire, 1965, the scale of acceptance of others, and, the Emanuel M self-acceptance scale. Berger and the interpretation questionnaire of the level of perseverance. The research was attended by 40 people of different ages, including 20 current managers and 20 emerging managers. The paper is organized in three chapters, the first two of which approach the theoretical part, related to character, character traits, but also what it means to be an educational manager, and the third is the practical part, the research part, where we presented the objectives, the assumptions, the sample, the methodology used and the results of the research, the, where we compared the results obtained by managers and future managers in terms of character traits.

The influence of mental hygiene on communication styles in couples

A couple represents a bond formed between two people that develop and evolve together, which have the common objective of forming a family. We ask ourselves which are the factors which influence the communication style of the partners in the relationship. This work has the general objective of determining possible correlations between some variables which define the mental hygiene of the individual and the communication styles in the couple. In this regard 78 people, male and female, within the ages of 19 and 66 years old have been tested. I provided this objective with special importance as it involves all directions of research. Likewise, I consider that this research highlights the importance of communication in a couple at any age. The hypotheses of the research consider the different correlations between nonassertive, aggressive, manipulating and assertive communication styles and the psychologic factors such as the types of personal autonomy: cognitive, behavioral, emotional and value. Unhappiness in the couple and marital conflict have also been targeted. I also followed a comparison related to the dominance of a communication style between sexes. Following the correlations and the comparison made, I found the following aspects: a high level of cognitive autonomy leads to an assertive communication style in a couple, a low level of value autonomy determines unhappiness in a couple, a low level of behavioral autonomy leads to a nonassertive communication style in a couple, a high level of marital conflict does not determine a manipulative communication style, men communicate more aggressively in a couple compared to women, and a low level of conscientiousness determines a nonassertive style in couples.

Shame, health literacy and consent.

This paper is particularly concerned with shame, sometimes considered the 'master emotion', and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity.

The Locus of Agency in Extended Cognitive Systems

AbstractThe increasing popularity of artificial cognitive enhancements raises the issue of their impact on the agent’s personal autonomy, and issues pertaining to how the latter is to be secured. The extended mind thesis implies that mental states responsible for autonomous action can be partly constituted by the workings of cognitive artifacts themselves, and the question then arises of whether this commits one to embracing an extended agent thesis. My answer is negative. After briefly presenting the main accounts on the conditions for autonomous agency, and analyzing how the latter can be protected from threats posed by the use of cognitive artifacts, I argue that autonomous agency is essentially tied to conscious experience and intentionality, which in turn can only be attributed to the human part of any extended cognitive system. I present both theoretical (conceptual) and practical arguments against recognizing the entire extended system, composed of one human and an artifact, as an autonomous agent.

Working towards convergence of the clinical management of differences of sex development/intersex conditions and the human rights framework: A case study.

Medical treatments that aim to modify the appearance of the genitals in children who are born with a difference of sex development/intersex (DSD/I*) condition are highly controversial. Human Rights bodies worldwide have argued that such treatments are conflicting with the child's right of personal autonomy and should be legally restricted to the unique situation where the child's physical health is in danger. We here review the current status of legal initiatives in Europe that have addressed the issue of medical treatments in minors who have a DSD for which they have not been able to give personal informed consent due to their young age. The management of a 3 years old child who has congenital adrenal hyperplasia (CAH) and grows up with atypical-looking genitals is discussed. In spite of extensive psychosocial support to the child and family from birth onwards, and good medical control of CAH, the child develops signs of emotional distress, suspected to be attributable to the genital difference. Our discussions include perspectives from the multidisciplinary DSD team caring for the child, a human rights specialist, and an intersex activist. From our discussions, we conclude that with evolving medical care, new ethical and human rights challenges are raised. A truly holistic human rights approach should not only consider physical but also mental health and psychosocial and psychosexual adaptation of the child to the medical condition, when reflecting on the acceptability of medical treatments in minors for which no personal informed consent can be obtained due to their young age. In addition it is paramount to include the meaningful participation of the child in the clinical management at the earliest possible stage. Continued convergence of clinical management and the human rights framework can be realised based on constructive discussions involving all stakeholders, and with the best interest of the child - and adult that they will become - as a common goal.

Personal Autonomy and (Digital) Technology: An Enactive Sensorimotor Framework

Many digital technologies, designed and controlled by intensive data-driven corporate platforms, have become ubiquitous for many of our daily activities. This has raised political and ethical concerns over how they might be threatening our personal autonomy. However, not much philosophical attention has been paid to the specific role that their hyper-designed (sensorimotor) interfaces play in this regard. In this paper, we aim to offer a novel framework that can ground personal autonomy on sensorimotor interaction and, from there, directly address how technological design affects personal autonomy. To do this, we will draw from enactive sensorimotor approaches to cognition, focusing on the central notion of habits, understood as sensorimotor schemes that, in networked relations, give rise to sensorimotor agency. Starting from sensorimotor agency as a basis for more complex forms of personal autonomy, our approach gives us grounds to analyse our relationship with technology (in general) and to distinguish between autonomy-enhancing and autonomy-diminishing technologies. We argue that, by favouring/obstructing the enactment of certain (networks of) habits over others, technologies can directly act upon our personal autonomy, locally and globally. With this in mind, we then discuss how current digital technologies are often being designed to be autonomy-diminishing (as is the case of “dark patterns” in design), and sketch some ideas on how to build more autonomy-enhancing digital technologies.

Perspective actuale în cercetarea copingului la vârsta adultă

The article presents the results of the experimental research of the cognitive, emotional and behavioral coping mechanisms. The connection between coping mechanisms and dimensions of adult personal autonomy is investigated, common factors of coping mechanisms and personality factors from the alternative five-factor model are identified, the extent to which coping mechanisms can become predictors of favorable impression is investigated, the connection between coping and emotional self-control of the adult and the difference between the coping of the young adult (22 – 29 years) and the middle-aged adult (30 – 65 years).

Modifying Our Genes: Theology, Science and “Playing God”

Modifying Our Genes: Theology, Science and “Playing God”

Vaccine Mandates: Weighing the Common Good vs Personal Conscience and Autonomy.

COVID-19 is a serious illness with significant morbidity and mortality. Vaccines to immunize against it were developed in record time. Mandates followed. The question to be considered is when mandates are ethical. Mandates can be used to prevent spread of an infection, prevent overwhelming the healthcare system, or protect public safety, thereby protecting the vulnerable and allowing for full flourishing of the common good. At the same time, one must be careful about respecting autonomy by allowing those who consciences do not allow them to be vaccinated to refuse. Because COVID-19 knowledge is rapidly changing as more information is known and the virus mutates, the conditions under which mandates are ethical change as well. At present, since vaccines prevent severe infection and death in high-risk individuals with added benefit for those who are vaccinated and have a history of infection, mandates can be imposed on those individuals. With an estimated 95% of the US population believed to have been infected and prior history of infection shown to be as effective as vaccination, with immunity lasting at least 500 days, and ability to prevent spread unknown at present but limited at best in the past, the vaccines therefore cannot be ethically mandated for those who are low risk for the versions released September 2023 based on information as of October 2023.

The Autonomy-Based Account of Chinese Trust Laws

Abstract There has been considerable discussion concerning the key values or goals underpinning the express trust device in English law. However, there is as yet no existing scholarship that explores the normative values of Chinese trust law since its enactment in 2001. This Article examines Chinese trust law from the perspective of personal autonomy. It identifies three dimensions of the conception of personal autonomy and explores how the trust law rules engage with each dimension. It finds that, in China, individuals have the autonomy to use the express trust device to arrange their property plans. However, such autonomy is limited in that it can only be exercised in alignment with the state’s regulatory goals. This is in stark contrast to its English counterpart, which allows individual autonomy to the largest possible extent. This Article considers the implications this analysis has for the reformation of Chinese trust law. It discusses some reform proposals that have been intensely debated in recent literature and highlights the insights the autonomy-based analysis can offer.

Joy, Compassion, and Job Satisfaction: Insights into the Canadian Prison Chaplaincy.

This paper presents an exploratory study about the experiences of 25 inter-faith chaplains in five Canadian provinces. It utilizes a focus groups methodology. The goal of this qualitative research was to highlight the voices of the chaplains. Hence, the focus groups explored the unique and challenging experiences of chaplains' work in Canadian prisons. Data from all seven focus groups indicated that despite multiple challenges and obstacles, the correctional chaplains remain dedicated to their work and are committed to making a positive impact on their prisoners. Based on the data provided by the chaplains about the intrinsic rewards and various challenges they face in their day-to-day work, the paper makes several research and policy recommendations. The objective of such recommendations is to maximize the role that religion and/or spirituality could play in prisoners' positive adaptation, and eventual criminal desistance in a context of confinement characterized by loss of personal autonomy and self-identity.