Principle Of Respect For Autonomy Research Articles

Follow-up in the field of reproductive medicine: an ethical exploration

Research questionWhat ethical implications, issues and concerns play a role in conducting follow-up studies of children born after assisted reproductive technologies (ART)? DesignLiterature study and relevant experiences of academic medical centres in Brussels, Belgium, and Maastricht, the Netherlands were used to identify and analyse the most pertinent ethical implications, issues and concerns. ResultsAccording to recommendations from the European Society of Human Reproduction and Embryology, follow-up (ideally long term) of children conceived through medically assisted reproduction (MAR) should be an integral part of introducing new ART. With potentially risky new ART on the horizon, these recommendations need to be taken more seriously. Apart from practical barriers, such as funding, challenges for follow-up include securing active involvement of families of children conceived through MAR, starting with parents of young children, and ideally involving consenting adolescents and adults during a large part of their lives, possibly even into the next generation. ConclusionsFrom an ethical viewpoint, the most pertinent issues include the proportionality of the inevitable burdens and risks for families of children conceived through MAR, and the implications of the principle of respect for autonomy. The proportionality requirement is most critical when it concerns incompetent children, who should not be included in research with more than minimal burdens and risks if there is no reasonable expectation of benefit for themselves. With respect for autonomy, we argue that, when seeking voluntary consent for participating in follow-up studies that meet the condition of proportionality, professionals may encourage members of families of children conceived through MAR to partake in follow-up research.

Response to Commentaries.

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement with our commentators and respond to their critical evaluations.

Understanding Autonomy: An Urgent Intervention.

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be ‘curtailed’, ‘constrained’, or ‘overridden’ by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly ‘thin’ notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant ‘principlist’ model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a ‘thick’, historically grounded notion of autonomy and show what we could gain by taking it seriously.

Bioethics of Translating Limited Evidence into Clinical Practice: Case Study of the Cerebroplacental Ratio.

Bioethics can help address the challenges of translating research into clinical practice in the twenty-first century. The cerebroplacental ratio in obstetrical ultrasound provides a case study of how bioethical principles can help advance practical approaches when evidence is limited. This can help clinicians use cerebroplacental ratio when additional risk factors are present in critical cases that warrant increased surveillance; disclose limited information appropriately; allocate resources; and weigh benefits against risks. Balancing the key ethical principles of respect for autonomy, beneficence, non-maleficence, and justice within this context illuminates how bioethics can assist health care providers as well as help set a research agenda. Such analyses are essential to improving clinical care, given the rapid pace at which medicine is evolving.

Withdrawing treatment from patients with prolonged disorders of consciousness: the wrong answer is what the wrong question begets

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness (PDOC) make it impossible to prove that the withdrawal of life-sustaining treatment can be...

Key Issues of Medical Research Ethics

Ethics is an understanding of the nature of conflicts arising from the moral aspects that come with regard to certain elements as well as the ideal way to deal with them. As in the other fields, ethics in medical research deals with conflicts of interest at different levels. The fundamental principles of bioethics are: the principle of respect for autonomy, the principle of doing good, the principle of not doing harm and the principle of justice. These principles have been extremely influential in the field of medical ethics and are fundamental to understanding the current ethical assessment approach in healthcare. The most important problem from this point of view is the risks presented by some research methodologies on the persons under investigation.

Do Researchers in Empirical Ethics Studies Have a Duty to Act Upon their Findings? Case Study in End-of-Life Decision Making.

The outlined empirical study on the decision-making process concerning the limitation of life-prolonging treatment (DLT) in patients with advanced cancer at a University hospital setting triggered some new questions for research ethics with respect to studies using empirical methods in medical ethics. The analyzed data of the study showed that less than half of the patients were involved in DLT. Deciding against CPR (cardiopulmonary resuscitation) and transferal to the ICU (intensive care unit) without informing and explaining it to the perfectly competent patient can be regarded as a violation of the ethical principle of respect for autonomy. This is what the embedded researcher witnessed throughout the study recruitment and data acquisition, as the noninvolvement of patients was not just a result of the final data analysis. The ethical question raised in this situation was as follows: Does the embedded researcher has a moral duty to intervene when she witnesses that ethical standards are not upheld?

What's Missing in Our Thinking About Quality of Life in VCA?

Drawing on the principles of respect for autonomy and beneficence, many scholars have argued that despite significant drawbacks of immunosuppression and surgery, vascularized composite allotransplantation (VCA), such as hand and face transplantation, has the potential to enhance the lives of patients who meet appropriate criteria and are well supported. This article provides a brief overview of the literature on VCA with a focus on hand transplantation (HTx) and offers a critique of the lack of empirical data on HTx patients' perspectives.

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.

Getting Obligations Right: Autonomy and Shared Decision Making

AbstractShared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician‐patient relationship because it fulfils the ethical imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy.

看護ケアにおける自律性尊重原則の軽視について―独我論・独在論－言語ゲームの世界観との関連性において―

看護ケアにおける自律性尊重原則の軽視について―独我論・独在論－言語ゲームの世界観との関連性において―

Decision-making through the lens of a pediatric cancer case

It is crucial to obtain a competent individual’s informed consent in any medical process, including cancer treatments. However, when it comes to incompetent children, it seems to be favourable, but not necessary, to obtain their assent in medical practice.1 This paper considers Christine Harrison’s example of Samantha, an eleven-year-old girl that was treated for osteosarcoma in her left arm. Samantha had previously been treated by amputation and a course of chemotherapy. This cancer later metastasized to her lungs, decreasing her chances of remission with aggressive treatment to 20%. Although she wanted to refuse treatment, she was deemed incompetent to make decisions about her cancer care, and her parents adamantly wanted her to continue treatment.7 This paper considers physicians’ moral obligations in pediatric cancer cases such as Samantha’s. I will define assent, the principles of autonomy, beneficence, and competence as it pertains to children. I consider arguments of two opposing views–a child’s rights view that argues in favour of Samantha’s decision, and a paternalistic view that opposes her. After reviewing the bioethical literature on the risks and benefits of children’s decision making in health care, I argue that Samantha’s wishes to stop treatment ought to be respected.Throughout the paper, I will use the bioethical principles of respect for autonomy and beneficence to defend my position. Finally, I address potential objections my position may face and conclude.

Formulating the Code of Professional Responsibilities in Providing Rehabilitation Services based on a Narrative Review Study

Introduction: Rehabilitation is one of the most important components of health, and includes a set of services to empower people with disability. The first step in providing a secure framework for professional ethics, is identifying the needs and rights of persons with disabilities based on the evidence and scientific documentation, and also the use of experiences from developed countries. Therefore, the aim of this study was to examine the available evidence of professional ethics through a narrative systematic review study designed to provide the basis for professional ethics in Iranian rehabilitation services. Materials and Methods: This was a narrative systematic evidence-based review study. All Persian and English articles published in the past 10 years with the main focus of ethical issues related to the provision of rehabilitation services in physiotherapy, occupational therapy, and orthotics and prosthetics were considered. A structured search of the peer-reviewed literature catalogued in major electronic databases (Scopus, PubMed, and Web of Science) was conducted using the following words and their derivatives (Rehabilitation, Human right, Patient right, Professionalism, Justice, Autonomy, Responsibility, Ethics, Bioethics) Results: The initial search by two reviewers yielded 1260 papers. Following review of title and abstract, 98 articles were considered relevant. 67 articles had full text. Full text review reduced this number to 24. To categorize the articles, four principles of biomedical ethics in principlism method. Conclusion: A set of professional responsibilities for the rehabilitation services were categorized in four principles of respect for autonomy, beneficence, non-maleficence, and justice, and also 10 titles outlined in the charter of physicians.

Polskie prawo karne wobec problemów etycznych związanych z transplantologią

The purpose of this publication is to systematize the present ethical problems relating to transplantation and to confront them with penal legislation, from which norms prohibiting certain types of conduct with regard to transplantations may be derived. The starting point for the analysis is a consideration of the fundamental ethical values required both in the treatment process as such and in transplantation in particular (principle of respect for autonomy, nonmaleficence, benevolence, and justice). Therefore, the problem of admissibility of transplantology as such must be touched upon, along with its tenets and preconditions and, most importantly, with commercialization of the organs intended for transplantation. In the Polish legal system, transplantation is regulated by the 2005 Act on the Removal, Storage and Transplantation of Cells, Tissues and Organs. The Act is a specific Polish response to the doubts and dilemmas relating to transplantation. In this context, special significance attaches to the penal provisions which impose liability for transplantation-related crimes. It is noteworthy that criminalization of paid activities relating to transplantation has a rather complex and specific history. It follows from the evolving evaluation of the social harmfulness of prohibited acts, which in itself gives rise to certain controversies. There are also doubts as regards the object of protection of some crime definitions and the scope of criminalization.

Autonomy Challenges in Epigenetic Risk-Stratified Cancer Screening: How Can Patient Decision Aids Support Informed Consent?

Information of an individual’s epigenome can be useful in cancer screening to enable personalised decision making on participation, treatment options and further screening strategies. However, adding this information might result in complex risk predictions on multiple diseases, unsolicited findings and information on (past) environmental exposure and behaviour. This complicates informed consent procedures and may impede autonomous decision-making. In this article we investigate and identify the specific features of epigenetic risk-stratified cancer screening that challenge the current informed consent doctrine. Subsequently we describe current and new informed consent models and the principle of respect for autonomy and argue for a specific informed consent model for epigenetic risk-stratified screening programmes. Next, we propose a framework that guides the development of Patient Decision Aids (PDAs) to support informed consent and promote autonomous choices in the specific context of epigenetic cancer screening programmes.

Beyond autonomy: Care ethics for midwifery and the humanization of birth.

The bioethical principle of respect for a person's bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife-institution relationship over a midwife-woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.

Ethical Dilemmas Encountered by Health Care Providers Caring for Marshallese Migrants in Northwest Arkansas.

Marshallese migrating to the United States face numerous challenges in accessing health care and managing illness and chronic disease. This study explores health care providers' perceptions of and experiences with ethical dilemmas as they care for Marshallese patients. Utilizing a qualitative research design, we interviewed 21 providers to explore the ethical dilemmas they encountered while treating Marshallese patients. We used the framework of bioethical principlism to categorize and describe the ethical dilemmas reported by those providers. When explicitly asked whether they experienced such situations, approximately half (10/21) affirmed that they had, and analysis of the qualitative data indicated that all interviewees described an ethical dilemma at least once during their interviews. We characterized providers' ethical dilemmas in terms of conflicts that arise when prioritizing different ethical principles in the care of this complex patient population, including the principles of respect for autonomy, nonmaleficence, beneficence, and justice.

How Can Ethics Support Innovative Health Care for an Aging Population?

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative.

Voices of moral authority: parents, doctors and what will actually help

The public often believes that parents have a right to make medical decisions about their child. The idea that, in respect of children, doctors should do what parents tell them...

Ethical Challenges of Embryo Donation in Embryo Donors and Recipients.

Background:Embryo donation, as one of the novel assisted reproductive technologies (ART), has remained a controversial issue. This is due to this methods' need for individuals from outside the family circle. Their presence can cause many ethical issues and complicate the designing and planning of the embryo donation process. The present study was conducted with the aim to assess the ethical challenges of embryo donation from the view point of embryo donors and recipients.Material and Methods:This descriptive, cross-sectional study was conducted on 192 couples (96 embryo donators and 96 embryo recipients) referring to Isfahan Fertility and Infertility Center and Royan Institute, Iran. The subjects were selected through convenience sampling. The data collection tool was the researcher-made Ethical Challenges Questionnaire. Data were analyzed in SPSS software.Results:Embryo donors and recipients expresses the most important ethical challenges of embryo donation in the principle of justice (70.20%) and respect for autonomy (42.57%), respectively.Conclusions:The four ethical principles are important in the view of embryo donors and recipients; however, they highlighted the importance of the principle of respect for autonomy considering the existing barriers in the services of infertility centers. Legislators and relevant authorities must take measures toward the development of guidelines for this treatment method in the framework of ethics principles and incorporate all four principles independently.