Autonomy Of Others Research Articles

Coercing Future Freedom: Consent and Capacities for Autonomous Choice

In this paper I examine some of the significant moral concerns inherent in cases of treatment refusal involving patients with psychotic disorders. In particular, I explore the relevance of the principle of autonomy in such situations. After exploring the concept of autonomy and explaining its current and historical significance in a health care setting, I argue that because autonomous choice depends for its existence upon certain human functions such as the ability to reason, judge, and assess consequences, patients cannot be said to be making free and autonomous decisions if these capacities are compromised. I contend further that because psychotic disorders have the potential to compromise these functions in the future, it is appropriate, in some limited cases, to coerce patients with psychotic disorders to undergo treatment in order to preserve their future decision-making capacities and to protect their ability to recognize and respect the autonomy of others.

Clinical research: Protection of the “vulnerable”?

In this age of evidence-based medicine, clinical research is critical for developing new therapeutics and determining the best way to use these therapies. To perform appropriate clinical research, researchers must adhere to ethical standards. These standards have developed in large part as a response to egregious violations of ethically appropriate behavior. In this respect certain populations have been identified as at risk of being treated inappropriately in medical research. Current ethical guidelines prohibit or severely limit what types of research can be performed involving these "vulnerable" populations. Although this might protect these populations, the lack of research on them might actually do harm in limiting their access to life-saving therapies. We explore the historical underpinnings of protecting the vulnerable populations and whether a newer ethical paradigm that would allow for protected research on these populations should be adopted by society.

Group Membership and Morally Risky Epistemic Conditions

Johann Gottlieb Fichte argues that one semantic presupposition of claims about our entitlements is the idea that others are capable of autonomy. Individuals cannot demand anything from others, even submission, unless they also presuppose-although perhaps without acknowledging this to themselves-that others are free agents. Thus, the autonomy of others is a pre-condition of our exercise of autonomy. Why do indivictuals and groups often try to justify their own entitlement to rights at the expense of the freedom of others, thereby simultaneously assuming and denying their freedom? This paper investigates what constitution of group agency gives individual members of the group the best chance to develop and sustain a moral character consistent with the ideal of equal autonomy. I argue that liberalism fosters the sort of group agency that improves individuals' chances to acquire epistemically reliable beliefs about the moral status of others. I apply my findings to the discussion of court decisions in Gaines, Brown, and the race nuisance cases.

Autonomy and Leadership: Political Formations among the Ashéninka of Peruvian Amazonia

This article examines notions of hierarchy and leadership among Ashéninka people in Peruvian Amazonia. It considers the apparent disjunction between individuals' preference for a peaceful and autonomous everyday existence and the Ashéninka's renowned ability to form large-scale cooperative groups under powerful leaders. Responding to recent anthropological writings that recognise the variability of political forms both across and within Amazonian societies, the article focuses on the social and political preoccupations that can be seen to underlie both social forms among the Ashéninka. It argues that individuals believe that peaceful social reproduction is best achieved by acting independently and respecting the autonomy of others but that aggregation and differentiation remain an option in circumstances where individual action would be ineffectual. The article also examines how the Ashéninka use outsiders as effective organisers that also symbolise the problems of coercive power.

EU's Numerous Contradictory Approaches to Minority Protection: Internal-External Paradox and Mutually Exclusive Pre-Accession Standards

The paper makes a sketch of the available European minority protection standards, discussing the most important of them as well as focusing on the relations between the standards available. While a number of legal instruments potentially able to contribute to the elaboration of an EU minority protection standard are available they are mostly limited to guaranteeing simple non-discrimination, which is not enough to ensure minority protection stricto sensu, as outlined e. g. by the PCIJ in the Albanian Schools case. The lack of any viable internal minority protection standard did not prevent the EU from treating minority protection as one of the key-elements of the pre-accession exercise leading to the fifth enlargement, reinforcing the internal - external competence divide and reducing the effectiveness of minority protection in the EU. Although minority protection was one of the Copenhagen political criteria and thus was at the core of the conditionality principle presupposing a fair assessment of the candidate countries' progress on the merits, the Commission clearly used minority protection in a discriminatory way, tolerating the standard of assimilation in one group of the candidate countries (Latvia, Estonia) and backing cultural autonomy in others. Thus, alongside with the internal toleration or simple denial of minority problems, the Commission simultaneously promoted two contradicting approaches to the issue: de facto assimilation (prohibited by art. 5(2) of the Framework Convention) and cultural autonomy, bringing to life a complicated web of partly overlapping - partly contradicting standards. Out of such practice myriad problems arose. An imminent need to change this approach is obvious.

Ever Bigger Firms?

When the grandfather of modern economics, Adam Smith, was preparing his Wealth of Nations almost a quarter of a millennium ago, the workforce of businesses would typically be counted in single or double figures. Now the world's biggest firms, such as Wal-Mart, have a payroll of well over a million, bigger than the population of some entire nations. This paper reviews some of the reasons for this growth, and considers whether it might continue forever. Powerful evidence exists of potential scale economies, in business functions from R&D to finance, and industries from pin production to pharmaceuticals. And these do indeed translate into remarkable performance records for some industrial giants. But surprisingly, on average, bigger firms do not enjoy above average profitability and, on the whole, giant firms are not gaining on the world economy. This paper reviews some of the market and managerial constraints on size, and considers innovative efforts – ranging from the New Zealand dairy industry to the McDonald's chain – to reconcile global-level scale economies in some functions with local autonomy in others. In passing, the paper notes a disturbing array of incentives tempting some managers to expand their empire, even when that is not in the shareholders' interest.

The search for a model of effective inclusive practice through the Young Enterprise Scheme

Many practitioners are now grappling with the practical realities involved in collaborations between mainstream and special schools. Colin Gladstone is a teacher at Greenside, a special school in Hertfordshire. In this article he describes his experience of running a Young Enterprise Scheme project linking teenage students with severe learning difficulties with students from a mainstream secondary school. Colin Gladstone used a Best Practice Research Scholarship (BPRS) and his MEd studies to carry out sustained research into the processes and outcomes of this project named, by the students, ‘The Green Team’. The project was clearly a success on many levels, promoting teamwork, collaboration and friendship between the students. It led to accreditation for some and enhanced personal autonomy for others. Colin Gladstone's conclusions will be relevant to practitioners wishing to expand the curriculum for students with and without learning difficulties; to policy makers who wish to promote more active links between mainstream and special schools; and to researchers who wish to engage students in enquiry processes.

The Sociology of Emergency Medicine

The Sociology of Emergency Medicine

三菱財閥から三菱グループへの移行過程

After World War II, the dissolution orders of the zaibatsu was carried out by Occupation policy. In Mitsubishi zaibatsu, Mitsubishi-Honsha, which was a holding company, made efforts to maintain to control many operating companies in spite of its own dissolution. In zaibatsu, there used to be several kinds of committee, which were consisted of top managers and general managers among the holding company and operating companies. Mitsubishi-Honsha would continue to exist these committee informally even under the liquidation.But it had become impossible for Mitsubishi-Honsha to control operating companies, because all of them had became autonomous, independent companies owing to the dissolution of the holding company. For example, Mitsubishi Electoric Corporation carried out to revise wage system, without referring the matter to the general managers committee in advance.Each operating company did not always keep its own autonomy for others. In cases of emergency, they cooperated with others to dissolve the matter such as making stabilizing shareholders by mutual stock holdings. And it was also important for operating companies to preserve of the trade name and trade mark. Because Mitsubishi Shoji, which had preserved all of trade name and trade mark in Mitsubishi zaibatsu, was divided in many companies after the war, so there happened many troubles about them.Generally speaking, enterprise group has two factors such as top managers committee and mutual stock holdings. In case of Mitsubishi, top managers committee had been existing since before the war, differing from mutual stock holdings among operating companies after the war. So each of them had a different function, and top managers committee hardly had the function of large shareholders meeting in case of Mitsubishi in 1950's.The transfomation from zaibatsu to enterprise group in 1950's was represented as the changing of the position of operating companies. In zaibatsu, they were subject to the holding company formally. But in new enterprise group, all of them had became independent companies after the dissolution of the holding company. Therefore the function of top managers committee among members of the group had changed from the control operating companies by the holding company to the exchange of information and the interests coordination by members of operating companies.

Whose life is it anyway? A study in respect for autonomy.

Brian Clark's drama, Whose Life Is It Anyway?, explores the difficulties of applying the principle of respect for autonomy to real-life circumstances. In the play a permanently disabled patient, who wishes to be allowed to die, raises moral questions about the adequacy of the autonomous agent, respect for the autonomy of others, the authority of the law, the allocation of society's resources, and the intrinsic value of human life. After a brief review of the story and definition of respect for autonomy, this paper cites passages from the play that dramatize the tension between respect for autonomy and these other moral concerns. There follows a review of relevant commentary from the classicists Kant and Mill and the modernists Childress and Gillon. The study concludes that although classical and contemporary philosophers have clarified and elaborated upon the relationship between ethical principles, they have not provided definitive guidelines.

Consequences for patients of health care professionals' conscientious actions: the ban on abortions in South Australia.

The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.

Respect for Autonomy

To a great extent modern biomedical ethics emerged out of concerns about failures to respect the autonomy of patients and research subjects. Their choices often were not sought or were overridden to benefit them or others. Despite a predictable backlash against the principle of respect for autonomy, it still holds, and should hold, a central place in biomedical ethics in a liberal society in the 1990s. Debate rightly continues about the proper meaning, scope, and strength of the principle. It has been criticized in part because its proponents have often extended it beyond reasonable boundaries and claimed too much weight for it over against other principles and values. Properly interpreted, specified, and weighted, however, it still has a major role to play in modern biomedical ethics, as indicated, for example, by ongoing problems in research ethics. But a major role is not necessarily a dominant or exclusive role. Critics of the principle rightly challenge interpretations that inadequately attend to the self's location in time and community. These themes of time and community are central in several of the following points that require further attention as the role of the autonomy principle in biomedical ethics is reaffirmed but also clarified and perhaps modified. (1) Respect for autonomy is an important moral principle for research, medicine, and health care, alongside other equally important principles. The hard task for biomedical ethics is to determine the principle's range and strength relative to other moral principles in various contexts. On the one hand, it is specified in several moral rules, such as informed consent, privacy, and confidentiality. And further specification is necessary to determine its proper range and scope, especially in relation to other principles. On the other hand, while it is weighty and stringent, it is not absolute. As one among several important principles, it is prima facie binding, but it can be justifiably overridden under some conditions. (2) Respect for an agent's autonomy presupposes an interpretation of the agent's relevant actions and preferences. Too often only an agent's literal statements are admitted into evidence about his or her preferences. However, as persons are complex and the process of communication is complex, it is appropriate to consider the agent's preferences as expressed in a variety of relevant actions, not merely, for example, in signing a consent form, however decisive that may be for legal purposes. (3) Apart from the most dramatic crises, agents' choices in health care most often occur over time. For instance, consent itself is given or withdrawn over time. Hence, it is essential to consider the temporal dimensions of past, present, and future in determining an agent's preferences. (4) Critics sometimes charge that the principle of respect for autonomy is a minimalist standard. They often concentrate on agents' assertions of their own autonomy rights, rather than noting that the principle also generates significant obligations to respect the autonomy of others. …

The Morality of Mental Illness

"Mental illness" is not truly a medical diagnosis, argues Thomas Szasz. Instead, it is a moral judgment that society passes on its deviant members. "Mental illness" relieves a person of responsibility for his or her actions, but in so doing it also justifies appropriating that person's freedom of choice, the necessary prerequisite of responsible action. Psychiatry is a social tool for accomplishing these goals, the results of which are involuntary commitment and the insanity defense. For Szasz, "persons" are characterizable above all else by their autonomy. An autonomous person makes uncoerced choices and accepts responsibility for those choices. Psychiatry undermines both characteristics of autonomy. Involuntary commitment allows psychiatrists to appropriate patients' freedom of choice. The insanity defense allows persons to escape the responsibility for their actions. Both procedures turn patients into nonpersons. Szasz wishes to replace the hidden moral judgment operative in psychiatric diagnoses with an open moral judgment. Psychiatrists and patients both need to return to the moral community. Psychiatrists do this when they stop appropriating the autonomy of others while pretending to practice medicine. Patients do this when they accept responsibility for their own choices and actions. One cannot be relieved of this responsibility without losing his or her place in the moral community as well.

AIDS and sexual morality.

The author rejects the moralistic view of AIDS that distinguishes between natural and unnatural sexual behavior, attributes disease to the consequence of unnatural behavior, and maintains that the only way to deal with AIDS is by adherence to the natural expression of sexuality, namely, life-long heterosexual monogamy. Matthews argues that the purely medical model is the only rational and morally acceptable view of AIDS and that the morally relevant consideration is the obligation to relieve suffering. The triumph of moralism would promote intolerance and social division and the abandonment of compassion and respect for the autonomy of others. The author concludes that the AIDS epidemic, by its sheer horror, offers the chance to adopt more enlightened views which, in turn, are more likely to result in effective measures to control the spread of AIDS.