Principle Of Respect For Autonomy Research Articles

Human Dignity, Capital Punishment, and an African Moral Theory: Toward a New Philosophy of Human Rights

In this article I spell out a conception of dignity grounded in African moral thinking that provides a plausible philosophical foundation for human rights, focusing on the particular human right not to be executed by the state. I first demonstrate that the South African Constitutional Court's sub-Saharan explanations of why the death penalty is degrading all counterintuitively entail that using deadly force against aggressors is degrading as well. Then, I draw on one major strand of Afro-communitarian thought to develop a novel conception of dignity as the view that what is special and inviolable about human nature is our capacity for harmonious relationships. I argue that a principle of respect for the dignity of such a capacity entails that the death penalty is an indignity but that deadly force in self- or other-defense need not be, and I contend that this African-inspired principle promises to do no worse than the more Western, Kantian principle of respect for autonomy at accounting for a broad range of human rights.

Ethical Issues in Managing the Pregnancies of Patients with Schizophrenia

Objective: This paper identifies factors that contribute to the vulnerability of pregnant patients with schizophrenia and discusses the ethical issues in preventing and terminating pregnancies, managing labor and delivery, and treating psychosis during pregnancy. Method: PubMed and PsychINFO databases were searched using combinations of search terms including ethics, pregnancy, perinatal period and schizophrenia for relevant articles. In addition, an ethical framework was developed that was based on professional virtues, ethical principles of respect for autonomy and beneficence, the ethical concept of fetus as patient, and assisted and surrogate decision-making. Results: The processes of assisted decision-making constitute key components of the ethical framework and of professional responses to impairment in autonomy. These processes, which include education, skill training in problemsolving strategies, and treatment of psychosis and related conditions help women to regain capacity and to make prudent decisions based on their own long-standing values and beliefs. Psychiatry, family planning and sexual health services are integrated and coordinated to provide the requisite assessment, monitoring and protection of patients. Conclusions: Implementation of these recommendations should reduce the vulnerability of pregnant patients with schizophrenia and protect them from unwanted pregnancies and adverse pregnancy outcomes. Keywords: Schizophrenia, pregnancy, perinatal period, assisted decision-making, ethics

Ethical Issues in Fetal Management: A Cardiac Perspective

The ethical issues behind the management of a fetus with a serious abnormality and the decisions made in relation to the outcome of the pregnancy are complex. This reflective paper deals with the ethical principles of managing a pregnancy with a congenital anomaly, with particular emphasis on the fetus with a serious cardiac abnormality. One major ethical concern is whether the fetus is or is not independent being to whom obligations of beneficence are owed. We review the debate on this matter, and suggest that it is ethically more appropriate for physicians who are involved in management of fetal abnormality not to adopt and insist on their own position on this matter. Rather, the appropriate course is to respect the pregnant woman's own view of her fetus and how it should be regarded. This is an application of the principle of respect for autonomy. Within this framework, we discuss the difficulties in counselling a pregnant woman or expectant couple in this situation, and recommend three key steps in ethically sound counselling.

Making decisions about nutritional support for adults via a gastrostomy

A growing number of people receive nutritional support via percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) (Noble, 2008). Sally Roberts explains indications, insertion techniques, advantages and complications, as well as the ethical issues involved in deciding whether to provide nutritional support via a gastrostomy. Such decisions need to reflect ethical principles of respect for autonomy, beneficence, non-maleficence and justice. If necessary, a deprivation of liberty safeguard authorization may be obtained; however, a multidisciplinary nutrition support team needs to work with patients, carers and patient advocates to ensure decisions weigh up ′rights′ and ′risks′ and how the quality of a patient′s life will be affected.

Bodies, organs and saving lives: old respects and new dilemmas

Attitudes to death are non-rational and culturally determined. This is relevant to concerns about shortages of organs for transplantation. Consent is not possible from a dead donor and the term 'resumed consent' offends against the principle of respect for autonomy that underpins consent. Consent is the fundamental principle of the Human Tissue Act 2004 in considering use of organs after death. These legal and ethical concerns create difficulties to be explored in a subsequent paper.

Saving lives is more important than abstract moral concerns: financial incentives should be used to increase organ donation.

Ever since organ donation became clinically feasible, there have not been enough organs to go around. Figure 1 shows the rate of change from a base value in 1995 through 2008, of three variables: (1) the number of deceased donors, (2) the number of patients with end-stage organ failure who are waiting for an organ, and (3) the number of waiting list patients who either die before an organ becomes available (ie, death on the waiting list or after removal from the waiting list as “too sick to transplant”) [1]. The number of potential recipients on transplant waiting lists has more than doubled, and now stands at over 100,000, whereas the number of deceased donors has increased by only half. Meanwhile, the numbers of deaths related to the organ shortage, which is now greater than 9,000 a year, has grown in parallel with the waiting list. Thus, the gap between supply and demand has grown every year for the past 15 years. Fig 1 Relative change (from 1988 baseline data) in the number of patients on organ waiting lists, deaths on the waiting list, and number of donors each year, 1988–2008. Graph derived from Organ Procurement and Transplantation Network data [1]. Approximately two thirds of the waiting list patients suffer from end-stage renal disease. Because the kidney is a paired organ, living individuals can donate one kidney, and several thousand donate every year, mostly to relatives with whom they have an emotional bond. The problem underlying the organ gap is not a lack of medically suitable organs from patients dying from severe brain damage; if all such patients became donors, the waiting list would shrink rapidly, yet only half of potential deceased donors actually donate, and many potential living donors are medically unsuitable or are unwilling to donate, so not enough organs are donated to satisfy the need for them. How can we increase the number of donors? When a difficult or dangerous job has to be done, such as working on high-rise construction projects, we give workers an added incentive to take these jobs by offering them more benefits, such as salary supplements. Perhaps offering a financial incentive for organ donation would increase the number of willing donors. But if offering people financial incentives could increase the supply of organs, should we do it? Would it be morally appropriate? Kidneys are by far the most common transplants and can come from either a deceased donor (two kidneys) or from a living donor (one kidney). Making the case for providing financial incentives to living donors is much more difficult than for deceased donors, so if that case can be made, the arguments can cover virtually all donations, from both living and deceased donors. Although this is a cardiothoracic surgery journal, the current debate centers on living donors of kidneys. This is more appropriate than might be obvious at first, because the arguments for and against financial incentives for organ donation can be generalized easily to both living and deceased donors, and therefore these can apply to the therapies of most immediate concern to cardiothoracic surgeons (ie, heart and lung transplantations). The debate is rendered more concrete by focusing on the case of a United States senator who has a decision to make.

A bioética da proteção e a compaixão laica: o debate moral sobre a eutanásia

The bioethical debate on euthanasia (good death) has been classically polarized between the principles of sacredness of life--the argumentation against--and the quality of life, represented by the vicarious principle of respect for autonomy--the argumentation in favor. In both cases the question is built around the pertinence and moral legitimacy--or not--of the individual possibility to decide about the termination of ones own existence, demanding for oneself a good death. Undoubtedly, euthanasia always implies besides the self, the other, who will either carry out the action--or hold to non-action--culminating in the abbreviation of life. To propose a discussion about this last referred issue, based on the bioethics of protection theoretical references and the concept of laic compassion is the scope of the present essay.

Nursing and Euthanasia: a Review of Argument-Based Ethics Literature

This article gives an overview of the nursing ethics arguments on euthanasia in general, and on nurses' involvement in euthanasia in particular, through an argument-based literature review. An in-depth study of these arguments in this literature will enable nurses to engage in the euthanasia debate. We critically appraised 41 publications published between January 1987 and June 2007. Nursing ethics arguments on (nurses' involvement in) euthanasia are guided primarily by the principles of respect for autonomy, nonmaleficence, beneficence and justice. Ethical arguments related to the nursing profession are described. From a care perspective, we discuss arguments that evaluate to what degree euthanasia can be considered positively or negatively as a form of good nursing care. Most arguments in the principle-, profession- and care-orientated approaches to nursing ethics are used both pro and contra euthanasia in general, and nurses' involvement in euthanasia in particular.

Communicating with Muslim parents: “the four principles” are not as culturally neutral as suggested

The “four principles approach” has been popularly accepted as a set of universal guidelines for biomedical ethics. Based on four allegedly trans-cultural principles (respect for autonomy, nonmaleficence, beneficence and justice), it is supposed to fulfil the need of a ‘culturally neutral approach to thinking about ethical issues in health care’. On the basis of a case-history, this paper challenges the appropriateness of communicating in terms of these four principles with patients with a different background. The case describes the situation in which Muslim parents bring forward that their religion keeps them from consenting to end-of-life decisions by non-religious paediatricians. In a literature analysis, the different meanings and roles of the relevant principles in non-religious and Islamic ethics are compared. In non-religious ethics, the principle of nonmaleficence may be used to justify withholding or withdrawing futile or damaging treatments, whereas Islamic ethics applies this principle to forbid all actions that may harm life. And while the non-religious version of the principle of respect for autonomy emphasises the need for informed consent, the Islamic version focuses on “respect for the patient”. We conclude that the parties involved in the described disagreement may feel committed to seemingly similar, but actually quite different principles. In such cases, communication in terms of these principles may create a conflict within an apparently common conceptual framework. The four principles approach may be very helpful in analysing ethical dilemmas, but when communicating with patients with different backgrounds, an alternative approach is needed that pays genuine attention to the different backgrounds.

Complications, Errors, and Surgical Ethics

In their article titled The Ethics of Surgical Complications, Adedeji and colleagues explore the ethical dimensions of surgical complications [1]. Although there are numerous ways that one could explore the ethical aspects of such complications, these authors have used the four widely known ethical principles of respect for autonomy, beneficence, non-maleficence, and justice as the prism through which to consider surgical complications. Through this line of analysis, we see how general principles can be applied in specific situations to help guide surgeons’ behaviors. The authors have done an excellent job of showing the relevance of the ethical principles for guiding action. They have also shown how focusing on a specific aspect of surgical ethics, such as complications, can help define the surgeon’s proper role. Critical to the entire manuscript is the definition of a surgical complication. The authors accept the definition of ‘‘complication’’ that was recently proposed in the World Journal of Surgery: ‘‘A surgical complication is any undesirable, unintended and direct result of surgery affecting the patient, which would not have occurred had the surgery gone as well as could reasonably be hoped’’ [2]. Using this definition of a surgical complication, the authors begin with the principle of respect for autonomy to explore the implications for surgeon behavior. It is immediately apparent that in order to respect the autonomy of patients, surgeons must disclose the possibility of complications when they obtain the patient’s informed consent. The authors go on to emphasize that respect for autonomy also requires that complications, when they occur, must be disclosed to patients. Although the definition of a surgical complication does not carry with it any concept of error, the authors do raise this important issue when they state: ‘‘a surgeon who has made a mistake may attempt to disguise it by calling the error a surgical complication, thereby relying on the inference that this eventuality is inevitable. This is deceptive and paternalistic.’’ I agree that to suggest that an error is merely a complication would be misleading. However, it is not clear from the article how errors and complications are actually related. We will return to this issue below. The authors then turn to the principle of beneficence and explore the implications for surgeon behavior in applying this principle. The importance of ensuring the appropriateness of surgery can be derived from beneficence—that is, doing good for patients. Furthermore, the maintenance of a surgeon’s skill and knowledge is required by the principle of beneficence. The authors also suggest that a surgeon’s responsibility to address the material needs of the health care system can also be derived from the principle of beneficence. This issue may be of greater concern to surgeons working within a national health system. Finally, the important concept of surgical innovation is even addressed as being an essential aspect of furthering the good of patients. The principle of non-maleficence, or avoiding harm, is next addressed. The authors suggest that many aspects of avoiding complications such as exercising good judgment, recognizing the limits of one’s competence, infectioncontrol measures, and quality improvement programs can P. Angelos (&) Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, 5841 S. Maryland Avenue, MC 4052, Chicago, IL 60637, USA e-mail: pangelos@surgery.bsd.uchicago.edu

Respekt vor Patientenautonomie und Achtung der Menschenwürde

Abstract The study investigates the »Four Principles of Biomedical Ethics« published by Tom Beauchamp and James Childress (1979, 52001) with a particular concern for the principle of respect for autonomy. The leading question is in which philosophical background autonomy is dealt with by Beauchamp/Childress and by the enlightenment philosopher Immanuel Kant, while the more emipirical theoretical framework of Beauchamp/Childress and the rationalistic framework of Kant are being analyzed. After having considered the foundation of autonomy both in Beauchamp/Childress and Kant, the study turns to the relationship of autonomy and human dignity by exploring the implicit extension of autonomy, human dignity and being human, and asks which consequences have to be drawn from a theological point of view.

How Many Principles for Public Health Ethics?~!2008-02-04~!2008-05-01~!2008-06-10~!

General moral (ethical) principles play a prominent role in certain methods of moral reasoning and ethical decision-making in bioethics and public health. Examples include the principles of respect for autonomy, beneficence, nonmaleficence, and justice. Some accounts of ethics in public health have pointed to additional principles related to social and environmental concerns, such as the precautionary principle and principles of solidarity or social cohesion. This article provides an overview of principle-based methods of moral reasoning as they apply to public health ethics including a summary of advantages and disadvantages of methods of moral reasoning that rely upon general principles of moral reasoning. Drawing upon the literature on public health ethics, examples are provided of additional principles, obligations, and rules that may be useful for analyzing complex ethical issues in public health. A framework is outlined that takes into consideration the interplay of ethical principles and rules at individual, community, national, and global levels. Concepts such as the precautionary principle and solidarity are shown to be useful to public health ethics to the extent that they can be shown to provide worthwhile guidance and information above and beyond principles of beneficence, nonmaleficence, and justice, and the clusters of rules and maxims that are linked to these moral principles. Future directions likely to be productive include further work on areas of public health ethics such as public trust, community empowerment, the rights of individuals who are targeted (or not targeted) by public health interventions, individual and community resilience and wellbeing, and further clarification of principles, obligations, and rules in public health disciplines such as environmental science, prevention and control of chronic and infectious diseases, genomics, and global health.

The Ethics of Implementing First-trimester Risk Assessment

Abstract First trimester risk assessment has become a reliable screening tool for trisomy 21, replacing age-based risk assessment. On the basis of the ethical concept of the physician as fiduciary, the professional virtues of integrity and self-sacrifice, and the ethical principles of respect for autonomy, beneficence, and justice, we argue that the obstetrician has an ethical obligation to routinely offer pregnant women first trimester risk assessment in high quality centers. We then argue that both obstetricians and specialists in risk assessment have a strict ethical obligation to identify, responsibly manage, and disclose both economic and non-economic conflicts of interests, especially when they are hidden Ethics is an essential dimension of implementation of first trimester risk assessment for trisomy 21.

The Ethics of Information: Absolute Risk Reduction and Patient Understanding of Screening

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decision-making. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence.

The principle of respect for autonomy – Concordant with the experience of oncology physicians and molecular biologists in their daily work?

BackgroundThis article presents results from a qualitative empirical investigation of how Danish oncology physicians and Danish molecular biologists experience the principle of respect for autonomy in their daily work.MethodsThis study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.ResultsWe found that that molecular biologists consider the principle of respect for autonomy as a negative obligation, where the informed consent of patients or research subjects should be respected. Furthermore, molecular biologists believe that very sick patients are constraint by the circumstances to a certain choice. However, in contrast to molecular biologists, oncology physicians experience the principle of respect for autonomy as a positive obligation, where the physician in dialogue with the patient performs a medical prognosis based on the patient's wishes and ideas, mutual understanding and respect. Oncology physicians believe that they have a positive obligation to adjust to the level of the patient when providing information making sure that the patient understands. Oncology physicians experience situations where the principle of respect for autonomy does not apply because the patient is in a difficult situation.ConclusionIn this study we explore the moral views and attitudes of oncology physicians and molecular biologists and compare these views with bioethical theories of the American bioethicists Tom L. Beauchamp & James F. Childress and the Danish philosophers Jakob Rendtorff & Peter Kemp. This study shows that essential parts of the two bioethical theories are reflected in the daily work of Danish oncology physicians and Danish molecular biologists. However, the study also explores dimensions where the theories can be developed further to be concordant with biomedical practice. The hope is that this study enhances the understanding of the principle of respect for autonomy and the way it is practiced.

Autonomy and negatively informed consent

The requirement of informed consent (IC) to medical treatments is almost invariably justified with appeal to patient autonomy. Indeed, it is common to assume that there is a conceptual link...

A eutanásia e os paradoxos da autonomia

The principle of respect for autonomy has proved very useful for bioethical arguments in favor of euthanasia. However unquestionable its theoretical efficacy, countless aporiae can be raised when conducting a detailed analysis of this concept, probably checkmating it. Based on such considerations, this paper investigates the principle of autonomy, starting with its origins in Greek and Christian traditions, and then charting some of its developments in Western cultures through to its modern formulation, a legacy of Immanuel Kant. The main paradoxes of this concept are then presented in the fields of philosophy, biology, psychoanalysis and politics, expounding several of the theoretical difficulties to be faced in order to make its applicability possible within the scope of decisions relating to the termination of life.

Palliative Sedation as Part of a Continuum of Palliative Care

Three issues seem to animate those who advocate the move toward a broad allowance of physician-assisted death. The first is the supposed failure of palliative care in extreme cases. We challenge the notion that palliative care ever fails. When palliative sedation is understood to be a routine continuation of palliative care, as opposed to a last-ditch response to a dramatic failure, then palliative care will never fail. The second focuses on helping patients maintain a sense of control in their final days and hours. We believe that continued intimate involvement in each of the final stages that is essential in the palliative care-palliative sedation continuum will be more effective palliative care and still grant control to the patient under the principle of respect for autonomy. The third issue is the charge that palliative sedation is a euphemism for physician-assisted death. We reject that charge.

Applicability of the principle of respect for autonomy: the perspective of Turkey

Turkey has a complex character, which has differences from the Western world or Eastern Asia as well as common points. Even after more than a century of efforts to modernise...

Ethical Problems with the Mental Health Evaluation Standards of Care for Adult Gender Variant Prospective Patients

The World Professional Association for Transgender Health's "Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons" (SOC) set forth standards clinicians must meet to ensure ethical care of adequate quality. The SOC also set requirements gender variant prospective patients must meet to receive medical interventions to change their sexual characteristics to those more typical for the sex to which they were not assigned at birth. One such requirement is that mental health professionals must ascertain that prospective patients have met the SOC's eligibility and readiness criteria. This article raises two objections to this requirement: ethically obligatory considerations of the overall balance of potential harms and benefits tell against it, and it violates the principle of respect for autonomy. This requirement treats gender variant prospective patients who request medical intervention as different in kind, not merely degree, from other patient populations, as it constructs the very request as a phenomenon of incapacity. This is ethically indefensible in and of itself, but it is especially pernicious in a sociocultural and political context that already denies gender variant people full moral status.