Principle Of Respect For Autonomy Research Articles

Evaluation of Quality of Life in Obese Individuals in Terms of the Principle of Autonomy: An Example from Türkiye

Aim: In this study, it was aimed to investigate the effect of obesity on autonomy, principle of respect for autonomy (PRA) and quality of life (QOL), in other words, whether obese patients and non-obese individuals differ in terms of autonomy, PRA and QOL. Materyal Methods: The data were collected from Nutrition and Diet polyclinics in public institutions and organizations in Eskisehir /Türkiye. 708 volunteers participated in the study, of which 354 were from the case group and 354 from the control group. A survey including questions about sociodemographic characteristics, autonomy and PRA, as well as Obesity and Weight Loss Quality of Life Scale (OWLQOL) were administered to the participants. In the evaluation of the data, descriptive analyzes were made, Kruskal Wallis H, Mann Whitney U, chi-square independence tests were used. Results: A statistically significant difference was found between obesity and OWLQOL score in favor of the control group (p

What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South.

The principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures. To conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies. We conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed. Our search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients' autonomous decision-making through cultural, social, religious, or intersectional pathways. Two main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients' inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention.

Refusal of transfusion: What is the right place for the principle of respect for autonomy?

Nineteen people refusing a blood transfusion in anticipation of thoracic surgery were met at the Clinical Ethics Center (AP-HP, Paris, France). The article reflects on the right place that respect for autonomy plays in medical decisions regarding (non)transfusion when medical practice would recommend it. Three patient profiles emerge: "categorical refusals", "refusals while affirming the need to live" and "refusals accompanied by doubt". Without neglecting the arguments relating to other principles of biomedical ethics (beneficence, non-maleficence, justice), the idea is to enable healthcare professionals to better assess the different situations they face and in particular those in which respect for autonomy seems essential. If the majority of people concerned by the issue are Jehovah's Witnesses, and although this religion is sometimes stigmatized, this work sheds light on the place of their wishes hold in medical decisions on (non)transfusion. Healthcare professionals could contact ethics units and ask them to carry out this same assessment in their own different.

Could We Trust Parents? Bioethical Analysis of Biomedical Intervention on Healthy Children

This text deals with the bioethical analysis of biotechnologies and biomedical interventions for healthy children to achieve a better life for them. The study of such a situation requires that the relationship between respect for autonomy and beneficence should be considered from two perspectives: first, from the perspective of parents as holders of the right to make decisions about the treatment and improvement of their minor children (the principle of respect for autonomy). In that case, parents are guided by the principle of benevolence and paternalistically demand interventions with new bio-medical technologies to make their children's lives better, that is, to improve them. Another approach to the same problem refers to the pressure of children on their parents to provide them with a better life through medical interventions that are increasingly imposed as a social, gender, and aesthetic demand and promoted as an exit of "social suffering," to which individuals who do not meet such requirements are exposed. Bearing in mind both aspects, we analyze the possibility of solving emerging social problems through the potential transfer of the principle of autonomy (owned by parents) to the creditors of the right to make decisions regarding medical interventions for healthy children. Such concerns become particularly relevant given the complexity of the old question: Do parents see their children as an extension of their motives and ambitions? In that case, instead of the decision of the children and the family, an active role in deciding on the implementation of the interventions above should be played by independent professional and ethical commissions, which assess whether the holders of the right to make decisions aim to treat or improve healthy children and that these interventions would be possibly more adequate before some invasive application of biotechnological means.

Assisted Suicide and Euthanasia: Language Lost in MAiD

For most of Canada’s approximately 40-year debate on medically assisted death, euthanasia and assisted suicide were considered distinct issues. Yet in 2016 their ethical, psychological, and practical differences were effectively disregarded when the two acts were grouped together in the legislation under the umbrella term “Medical Assistance in Dying” (MAiD). The lack of distinction under the law of the two terms ignores important ethical considerations from the MAiD practitioners’ perspective. Although the principle of respect for autonomy must remain central to the assessments of MAiD eligibility, it cannot be the only consideration. This paper examines the ethical considerations and principles that underlie decisions to provide MAiD through an analysis of the progress, and results, of the 40-year debate on assisted suicide and euthanasia.

Principles of Biomedical Ethics

The text presents the principles of biomedical ethics (the principle of respect for autonomy, the principle of beneficence, the principle of non-harm, the principle of justice) and shows how principlism has influenced perceptions of what is right (good) in medical practice – both in everyday medicine, as well as in clinical research – and to what extent bioethics has provided answers to the moral dilemmas of medicine of the 20th and 21st centuries, a medicine supported by advances in science and research. It is shown that although the principlist approach is not perfect, it represents a successful attempt to bring together the great moral theories developed over time and to create, by balancing them in a new formula, a scheme that represents at the same time a guide moral and an analytical key to human behavior and actions in health care.

간호대학생의 생명의료윤리 원칙 인식에 대한 분석

Objectives This study was attempted to identify and systematically understand how nursing students perceive the principles of biomedical ethics.
 Methods Through an open questionnaire, first-year nursing students who took a biomedical ethics lecture for one semester were asked to choose the most important principle among the four principles of biomedical ethics and write the rationale for it. A total of 99 subjects were analyzed using the content analysis method.
 Results Among the four biomedical ethics principles, the importance distribution was shown in the order of prin-ciple of respect for autonomy(45.5%), principle of nonmaleficence(29.3%), principle of beneficence(20.2%), and principle of justice(5.0%), and 14 themes and 42 statements supporting the basis were revealed. There were a total of 15 statements on the principle of respect for autonomy, and 4 themes were included: inherent rights, right to choose, right to know, and right to be respected(45.5%). There were a total of 15 statements on the principle of nonmaleficence, including 4 themes: avoiding harm, minimizing suffering, basic duties, and licensing as a nurse(29.3%). There were a total of 9 statements on the principle of beneficence, and 4 themes were included: the role of medical personnel, use of professional knowledge, active help, and human well-being(20.2%). There were a total of 3 statements on the principle of justice, including 2 themes: establishment of standards and fair-ness(5.0%).
 Conclusions It was confirmed that the students showed an active attitude to solidify their moral values and to cul-tivate a sense of ethics. In the undergraduate curriculum, not teacher-centered lectures, but learner-centered bi-oethics education that reflects students' understanding and feedback should be provided.

Human dignity and researcher conduct in emergency care research with incapacitated adults

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, which features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken.

Some Ethical Concerns About End of Life: A Paradigm Shift From Ars Moriendi to Medicalized Death

Medicine has several goals, including preventing and curing diseases, relieving pain and suffering, and promoting and maintaining the mental and physical health of the person from birth to death. Thanks to medical and technological developments in the last century, medicine has started to provide the opportunity to live longer. However, whether a longer life leads to a better life is debatable. Before these developments, death was regarded as a natural and inevitable end and mostly handled with religious approaches, such as Ars moriendi. However, these medical and technological advances have caused a misleading perception that medicine has the power to achieve every desired outcome. Under the influence and pressure of this misleading situation, people began to demand aggressive treatments, like resuscitation, mechanical ventilation, artificial nutrition and hydration, and chemotherapy. Of course, these medical interventions can be lifesaving for some patients. However, in the case of incurable conditions, such as metastatic cancers, Alzheimer's disease, or advanced organ failure, aggressive treatment methods often fail to produce promising results; on the contrary, they place a variety of burdens on patients, families, and society, as significantly reducing patients' quality of life, causing unrealistic hopes, and exhausting limited health resources. In this context, the article aims to briefly examine the change in people's perception of death and the dying process and to evaluate its de facto and ethical impacts. This study shows that medical and technological breakthroughs have significantly changed people's comprehension, acceptance, and perception of death, which made death no longer a natural end, but a medical failure. In other words, a medical interventions-based death, called medicalized death, has replaced a religion-based death. As a result of this change, the social, spiritual, and emotional aspects of death and the dying process are ignored for the sake of excessive and ineffective medical interventions. This situation brings about a critical shift in where, how, and when to die, and produces various ethical problems regarding the principles of respect for autonomy, non-maleficence, and justice. The present article demonstrates that most people want to die at home and spend their last days with their families. However, due to medical interventions, many die in healthcare facilities while on medical treatments and machines. In this context, this study recommends home-based palliative care services encompassing social, emotional, and spiritual support instead of aggressive medical interventions at end-of-life. Home-based palliative care will enable individuals to spend the last days of their lives at home with their loved ones, receive emotional and spiritual support, and prevent themselves, their families, and society from unnecessary and futile medical expenses. In conclusion, in light of the principles of respect for autonomy, non-maleficence, and justice, in end-of-life issues, medicine should focus on improving patients' quality of life, providing patients with social, emotional, and spiritual support, and ensuring that patients have the opportunity to spend their last days of life with their family members, which can most suitable be achieved through home-based palliative care.

Paternalism and autonomy: psychotherapists’ choices in dilemmas and their justifications as ethical aspects of the therapeutic relationship

Aim: The aim of the study was to analyse solutions to ethical dilemmas based on the criterion of “paternalism-autonomism” in the context of psychotherapists’ professional experience and therapeutic modality. Another aim was to review the sources of choices of ethical decisions from the perspective of the “intuitiveness – ethical reflection” dichotomy, and to assess the percentage of ethical, ambiguous, and non-ethical justifications of solutions preferred in those ethical dilemmas. Method: It was a cross-sectional qualitative study. An original questionnaire describing three exemplary clinical and ethical dilemmas combined with a multiplechoice questionnaire containing recommended solutions to the presented dilemmas was employed in the study. The responses were correlated with the modality of psychotherapy (cognitive-behavioural, psychoanalytic-psychodynamic, psychodynamic-systemic, systemic, integrated) and the professional experience of therapists. The statistical analysis included questionnaires obtained from 191 respondents. Results: Statistical data indicate the general advantage of autonomous decisions in the entire group of therapists, regardless of their professional experience. A significant advantage of autonomic solutions over paternalistic solutions was demonstrated in all analysed therapeutic approaches with the exception of the cognitive-behavioural approach. Moreover, a statistically significant majority of psychotherapists reported the use of ethical reflection when choosing the solutions to the discussed dilemmas. A comparison of the total number of selected justifications revealed a significant advantage of ethical justifications over ambiguous and non-ethical ones, regardless of the professional experience of therapists and in all modalities except the psychoanalytic-psychodynamic and psychodynamic-systemic types. Conclusions: The principle of respect for autonomy plays an important role in the professional ethics of psychotherapists, and the preference for ethical considerations and justifications when choosing solutions to practical ethical dilemmas indicates a potential benefit of incorporating ethics into the professional training of therapists.

Undermining autonomy and consent: the transformative experience of disease

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for...

Using legal doctrine and feminist theory to move beyond shared decision making for the practice of consent

The necessity of consent is widely justified on the basis of the principle of respect for autonomy. Also, it is widely believed that shared decision making (SDM) is the practical device to seek patients’ consent for medical treatment. In this essay, I argue that SDM, while necessary, is insufficient for consent; because, in the paradigm of evidence-based medicine, SDM is contingent upon other practices to identify appropriate treatments that form the subjects of SDM. Indeed, case law emphasises normative decision-making practices that precede SDM. Furthermore, case law supplies a nuanced understanding of SDM, which includes not only exchange of information but also attention to human vulnerability that persists despite formal retention of decision-making capacity. In addition, the law marks out a space in which people with capacity are absolutely entitled to self-determination. Thus, a four-step framework of decision making can be induced from legal doctrine. This legal framework corresponds to a construct of respect for autonomy that draws upon feminist theory. Feminist scholars have objected to the focus on individuals in traditional theories of autonomy; instead, they insist that people have to be considered in the context of their social influences and relationships. Feminists separate out four ideas of autonomy, and these ideas can be used to construct a four-layered model of respect for autonomy, in which each layer corresponds sequentially to a step in the legal framework of decision making. This model of respect for autonomy provides both conceptual clarity and theoretically robust justification for doctors’ various obligations in decision-making practices for consent.

Compréhension/acceptation de la radiothérapie : un dilemme éthique résolu par une éthique de la considération et de la sollicitude

PurposeEthical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology. Materials and methodsA quantitative analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy. ResultsThe main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient. ConclusionThe main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.

Bioethics and the Contours of Autonomy

AbstractThe principle of respect for autonomy often dominates the bioethical discourse. Yet despite its prominence, the exact contours are not always well defined. Widespread disagreement about the nature of autonomy has led some to conclude that autonomy is hopelessly vague and therefore ought to be abandoned in contemporary bioethics. Despite calls to move beyond it, autonomy remains at the center of bioethical reflection. The challenge, then, if autonomy is to function as a bedrock of contemporary bioethics, is to define more clearly the shape of autonomy, to mark more precisely its conceptual boundaries, and to delineate more carefully how best autonomy is put into practice in medical ethics. In this article, I raise questions about the ways autonomy is used in theory, as well as the ways that it is operationalized in practice.

Artificial intelligence-assisted psychosis risk screening in adolescents: Practices and challenges.

Artificial intelligence-based technologies are gradually being applied to psych-iatric research and practice. This paper reviews the primary literature concerning artificial intelligence-assisted psychosis risk screening in adolescents. In terms of the practice of psychosis risk screening, the application of two artificial intelligence-assisted screening methods, chatbot and large-scale social media data analysis, is summarized in detail. Regarding the challenges of psychiatric risk screening, ethical issues constitute the first challenge of psychiatric risk screening through artificial intelligence, which must comply with the four biomedical ethical principles of respect for autonomy, nonmaleficence, beneficence and impartiality such that the development of artificial intelligence can meet the moral and ethical requirements of human beings. By reviewing the pertinent literature concerning current artificial intelligence-assisted adolescent psychosis risk screens, we propose that assuming they meet ethical requirements, there are three directions worth considering in the future development of artificial intelligence-assisted psychosis risk screening in adolescents as follows: nonperceptual real-time artificial intelligence-assisted screening, further reducing the cost of artificial intelligence-assisted screening, and improving the ease of use of artificial intelligence-assisted screening techniques and tools.

Guidelines for the ethical review of mental health research protocols from a culturally-sensitive perspective

In most of Africa, mental illness is considered a silent epidemic due to structural and systemic barriers such as inadequate health care infrastructure, insufficient number of mental health specialists, stigma and discrimination related to mental illness, and lack of access to all levels of care. The continued suffering and disability due to mental illness calls for newer treatments and continued research into the field of mental health treatment and therapy. Research ethics committees are cognizant of the importance of this aspect yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications. There is an urgent need to have guidelines that give guidance to research ethics involving mental health participants. Guidelines were developed for the ethical review of mental health research protocols with the aim of increasing health equity and access in Africa and other low-income countries. We systematically analyzed 13 programme, research, and policy evaluation tools in light of mental health and cultural attributes. A 54-item assessment tool was created to guide the process of mental health research protocol evaluation taking into account ethical, gender, and sociocultural factors in Africa. The emerging themes i.e. research governance, background and justification, methodology and ethical impact of the research forming the basis of the assessment tool are interlinked with the bioethical principles of respect for autonomy, beneficence, non-maleficence and justice. When they are applied to the evaluation of a study they will not only underscore these principles, they enhance their application and increase access to equitable health in Africa and other low-resource settings regardless of the varied contexts.

Ethics of care challenge to advance directives for dementia patients

Advance directives for withholding life-saving treatment are controversial for dementia patients whose previously expressed wishes conflict with their currently expressed desires. To illustrate this ethical dilemma, McMahan conceives a hypothetical...

Genome Editing and Relational Autonomy

ABSTRACTDeveloped in the past two decades, the clustered regularly interspaced short palindromic repeats‐associated protein 9 (CRISPR‐Cas9) technique offers greater accessibility and efficiency in editing genes. Its immediate success has transformed medical research and treatment in productive ways, but has also left questions about ethical consequences in its wake. These are questions familiar to bioethical inquiry. How do we balance short‐term and long‐term benefits and risks? How do we promote just and equitable access to new medical interventions? How do we protect respect for individual autonomy? These questions require a balance between protecting individuals' liberties and the good of the communities in which they live. In this essay, I am interested in how the principle of respect for autonomy can be interpreted in light of CRISPR‐Cas9. I argue that a relational autonomy framework forges a middle ground between the need to respect individual freedom to pursue genetic treatments and the need to acknowledge the networks of dependence that define our moral worlds. I identify three thematic areas that relational autonomy brings into greater focus: the importance of trust, the acknowledgment of vulnerability/dependence, and the promotion of justice. Autonomy understood relationally allows us to see individual freedom as tethered to communal well‐being.

An Australian interpretive description of Contact Precautions through a bioethical lens; recommendations for ethically improved practice

BackgroundContact Precautions (CP) were developed to control multi-resistant organisms (MROs) in hospitals. However, MROs persist and harms are associated with CP. Research objectives were to understand the bioethical impact of CP on patients and health-professionals, and make recommendations for ethically-improved management of MRO-colonized patients. MethodsInterpretive description methodology scaffolded upon bioethical principles framed this qualitative study. Findings were explored alongside contemporary published reports to make recommendations for practice and research. ResultsNine patients and 24 health professionals participated. Four themes were found: Powerlessness moving to acceptance; You feel a bit of a pariah; Others need protection, but I need looking after too; Doing Contact Precautions is not easy. DiscussionCP conflict with the principle of respect for autonomy due to non-adherence to informed consent, and sub-optimal communication. Patients experience health care inequality, and discriminatory practices breaching the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, pluralistic cost–benefit assessment situates CP as low-value practice. ConclusionsCP challenge organizational culture, professional well-being, and person-centered ethical care. Ethical costs of CP outweigh benefits, obliging policy-makers to reconsider CP in managing MRO-colonized patients.

On the relation between decision quality and autonomy in times of patient-centered care: a case study.

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered care and the ethical principle of respect for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh's theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh's theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call "structural paternalism." These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate.