Respect For Personal Autonomy Research Articles

Piper on Respect for Personal Autonomy and Prudential Value

Piper on Respect for Personal Autonomy and Prudential Value

On Respect for Personal Autonomy and the Value Instantiated in Autonomous Choice

On Respect for Personal Autonomy and the Value Instantiated in Autonomous Choice

A Code of Ethics for the fistula surgeon

Vesicovaginal fistulas from obstructed labor no longer exist in wealthy industrialized countries. In the impoverished countries of sub-Saharan Africa and south Asia obstetric fistulas continue to be a prevalent clinical problem. As many as 3.5 million women may suffer from this condition and few centers exist that can provide them with competent and compassionate surgical repair of their injuries. As this situation has become more widely known in the industrialized world, increasing numbers of surgeons have begun traveling to poor countries to perform fistula operations. To date, these efforts have been carried out largely by well-intentioned individuals, acting alone. An international community of fistula surgeons who share common goals and values is still in the process of being created. To help facilitate the development of a common ethos and to improve the quality of care afforded to women suffering from obstetric fistulas, we propose a Code of Ethics for fistula surgeons that embraces the fundamental principles of beneficence, non-maleficence, respect for personal autonomy, and a dedication to the pursuit of justice.

Non-Attendance for Health Care: When Rational Beliefs Collide

Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests ‘positive choices’ for such non-attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's ‘cognitivist theory of action’ is used to conceptualise non-attendance as both a rational and irrational choice, from different perspectives. Because the perspective of non-attendees has been marginalised, the paper also suggests a typology of instrumental and non-instrumental ‘strong reasons’ for rational non-attendance. This may help groups such as professionals to understand and accept that non-attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non-attendees is needed to show respect for non-attendees’ moral agency and to begin to repair relationships with these individuals, who may seek help from health professionals in the future.

Why Markets in Proto-Deceptive Goods Should Be Restricted

In recent years there has been much philosophical discussion over the question of whether the prohibitions on markets in such items as human body parts and gene sequences, and services such as human reproductive labor and sex, should be lifted. Yet despite the attention paid to this issue there are been surprisingly little discussion of the question of whether markets in certain items that are currently freely traded should be restricted or eliminated. In particular, there has been little discussion of the question of whether markets in items that could be readily used to deceive people should be restricted. I argue in this paper that one of the central moral values of the contemporary West - respect for personal autonomy - requires that such markets be restricted.

Seeking patients' consent in anaesthesiology: consent in clinical practice

SummaryThe article explores the historical, legal and philosophical background and justification of informed consent. Anaesthesiologists have a responsibility to obtain separate informed consent, both to prevent litigation and to satisfy the requirement of rationality and respect for personal autonomy. The three-tiered model—competence, information, and consent—is described. The inherent nature and current practice of anaesthesiology problematizes proper informed consent. This includes timing, time-constraints, managed care, same-day surgery and emergencies. Wider use of pre-op clinics is advocated. There is a move towards written consent. Properly documented consent relieves the burden of proof, yet is neither a legal requirement nor confirmation of a proper interview. Authors generally advocate written consent in obstetric analgesic practice. Pre-printed forms do not replace an interview. The interview should be tapered to the needs and requirements of the particular patient. The reason why information is provided should be explained. Appropriate illustrative material and aids are advised. The uninformed patient cannot give consent. The supply of information empowers the patient to engage in an interactive conversation with the anaesthesiologist, and broadens the base for further discussions and questions. At least a full explanation of the procedure and techniques (particularly of all invasive procedures), information about the chances of success, incidence of complications, risks involved, available alternatives, the relative risks and complications of alternatives, costs, and the role of the anaesthesiologist is required. Particular reference to the training of students is mandatory. Separate consent is required for all research purposes.

At the Intersection of Intimacy and Care: Redefining “Family” through the Lens of a Public Ethic of Care

The institution of the family has changed, but U.S. public institutions and policies generally have not kept pace. In response, a number of feminist theorists have argued that we should recognize and support more diverse family forms. They argue that equality, respect for personal autonomy, recognition of diversity, and facilitating relationships of care demand such a move. Building on their work, I explicitly situate the necessity of redefining “family” within a public ethic of care and offer a comprehensive working definition of family that focuses on recognizing relationships that combine intimacy and care. In so doing, I address how to handle biological ties without excluding or marginalizing other bases upon which people form families.The author would like to thank the following individuals for sharing their expertise and comments on earlier versions of this manuscript: Eileen Botting, Fred Dallmayr, Daniel Engster, Neve Gordon, Jyl Josephson, Michael Kirsch, Victor Levy, Hugh Wilson, Christina Wolbrecht, Catherine Zuckert, the editors of Politics & Gender, and the anonymous reviewers. An earlier draft of this piece was presented in Chicago at the 2002 National Conference of the Midwest Political Science Association.

Is In-Vitro Fertilization for Older Women Ethical? a personal perspective

Fertility treatments raise a range of social and ethical issues regarding self-identity for family, sexual intimacy, and the interests and welfare of potential children. Eggs and sperm are combined to produce fertilized eggs. These eggs are then implanted as embryos and grow into viable fetuses, which are carried by the original mother or a surrogate mother. This artificial form of conception can challenge religious values and family structures. In-vitro fertilization (IVF) can be considered either as a medical miracle or playing with divinity. What obligation do medical professionals have to infertile women and to what extent? The bioethical dilemma of IVF use encompasses different moral issues for all involved in the process. Ethical issues address respect for personal autonomy, access and care, and the duty of the health care provider to be compassionate to persons whose actions and moral values may be different from their own. Health care providers need to impart empathy, understanding and sensitivity towards this unique type of patient population. The conflict for those treating patients who are trying to conceive by IVF includes respect for personal autonomy, nonmaleficence, justice, utility and the ethics of care. As a registered nurse in a postpartum hospital unit, I have seen antepartum and postpartum women involved with this new technology. I have worked with mothers and their partners as they experience different levels of anxiety and hope for the future. There is an underlying psychosocial connection with patients who undergo IVF treatments. The purpose of this article is to explore the ethical use of IVF on older women. Is this type of biotechnolgy being applied for the right reasons and for the best patient population?

Ethical issues in molecular pathology: paradigms in flux.

Recent advances in molecular pathology and molecular genetics have created new concerns about the use of human biologic materials in research. Since researchers now have the ability to extract and amplify DNA from minuscule archived samples, virtually any human tissue sample can potentially become the template for a test that provides information that may relate to the inherited genes of an individual. Researchers using human biologic materials should follow the 3 basic principles that have been defined for all ethical human subjects research: respect for persons, beneficence, and justice. Institutional Review Boards are responsible for providing review of the risks and benefits of research proposals to safeguard the rights and welfare of human subjects. Currently, there is considerable debate concerning the role of informed consent procedures and the Institutional Review Board oversight process in situations when researchers use human biologic materials that have been anonymized or coded. In 1999, the National Bioethics Advisory Commission is expected to make recommendations to President Clinton and the National Science and Technology Council that are expected to clarify the balance between respect for personal autonomy and the societal need to pursue biomedical research to improve the health and welfare of all individuals.

Ethical Issues in Molecular Pathology Paradigms in Flux

Recent advances in molecular pathology and molecular genetics have created new concerns about the use of human biologic materials in research. Since researchers now have the ability to extract and amplify DNA from minuscule archived samples, virtually any human tissue sample can potentially become the template for a test that provides information that may relate to the inherited genes of an individual. Researchers using human biologic materials should follow the 3 basic principles that have been defined for all ethical human subjects research: respect for persons, beneficence, and justice. Institutional Review Boards are responsible for providing review of the risks and benefits of research proposals to safeguard the rights and welfare of human subjects. Currently, there is considerable debate concerning the role of informed consent procedures and the Institutional Review Board oversight process in situations when researchers use human biologic materials that have been anonymized or coded. In 1999, the National Bioethics Advisory Commission is expected to make recommendations to President Clinton and the National Science and Technology Council that are expected to clarify the balance between respect for personal autonomy and the societal need to pursue biomedical research to improve the health and welfare of all individuals.

Autonomy's dominion: Dworkin on abortion and euthanasia.

Controversies over abortion and euthanasia are, among other things, controversies about the scope of personal autonomy. Liberals on these issues argue that respect for personal autonomy requires that individuals be free to make such choices. Conservatives on abortion and euthanasia, on the other hand, think that autonomy is rightfully limited when an individual seeks to take human life. In either case the issue is whether personal autonomy in the disputed decision is a fundamental value and, if so, whether social or moral concerns about taking human life are sufficient justifications for limiting autonomy. Ronald Dworkin, the noted legal philosopher, has written an elegant and impressive book-Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom-that emphasizes respect for autonomy as the solution to the life-and-death dilemmas of abortion and euthanasia. While many other thinkers have reached this conclusion, few have confronted as forthrightly as Life's Dominion does the religious or spiritual nature of these dilemmas. Dworkin views controversies over abortion and euthanasia as reflections of personal views about the intrinsic sanctity of human life, and not about the rights or interests of fetuses or comatose patients per se. Because such views are so clearly religious or spiritual in content, they should

Rights and privileges: Marx and the Jewish question

social criticism practiced by Bauer, and so falls prey to similar sorts of practical conundrums. Condemning sectararian tradition as a form of dogmatic servitude, Marx the rationalist rejects the substantive basis for true communal solidarity-identification with shared concrete values. Human emancipation is construed by him in a way that is at cross-purposes with his original intentions; the emancipation of the individual from the particular values, interests, and roles which define his distinct personality would not be the restoration of social humanity, but the utter debasement of it to the level of abstract egoism. Con demning political emancipation as a form of egoistic servitude, Marx the romantic excoriates the formal-legal basis for true individuality tolerance and respect for personal autonomy. In doing so, he neglects the wisdom of his mature critique of political theory: "The communists ... do not put to people the moral demand: love one another, do not be egoists, etc.: on the contrary, they are very well aware that egoism, just as much as self-sacrifice, is in definite circumstances a necessary form of the self-assertion of individuals."52 But sectarian self-assertion formally guaranteed by a modern state is precisely what eluded European Jewry and made them vulnerable to anti-Semitism, Zionism notwithstanding. The irony of all this in light of the tragic resolution of the Jewish question in the twentieth century is summed up well by Hannah Arendt. The birth and growth of modern antisemitism has been accompanied by and inter connected with Jewish assimilation, the secularization and withering away of the old religious and spiritual values. ... But one should also bear in mind that lack of political ability and judgment have been caused by the very nature of Jewish history, the history of a people without a government, without a country, and without a language. ... The simultaneous decline of the European nation-state and growth of antisemitic move ments, the coincidental downfall of nationally organized Europe and the extermination of Jews have to be taken as a serious indication of the source of antisemitism. ... If in the final stage of disintegration antisemitic slogans proved the most effective means of inspiring and organizing great masses of people for imperialist expansion and destruc tion of the old forms of government, then the previous history of the relationship between Jews and state must contain elementary clues to the growing hostility between certain groups of society and the Jews."53 This content downloaded from 207.46.13.156 on Sat, 10 Sep 2016 06:08:27 UTC All use subject to http://about.jstor.org/terms

Some Ethical Problems in Special Education

AbstractThis paper examines, from a philosophical perspective, some of the main ethical problems pertaining to the special education field. It is argued that while special education practice has been strongly grounded in psychological theory, it has not always been adequately justified by reference to general moral principles. Rationales for intervention are mostly couched in descriptive or explanatory terms while the over-riding prescriptive or evaluative dimensions are often presupposed without explicit justification. Particular issues such as diagnostic assessment, educational placement and behavioural management can be seen to entail complex ethical problems concerning the consideration of individual rights and interests, equality of educational opportunity, and respect for personal autonomy. Examples of the moral dilemmas inherent in particular special educational practices are examined. Finally, it is claimed that special educators must be able to defend not only the empirical bases of their educational theories, but also the value judgments implicit in them.

Moral duties of parents and nontherapeutic clinical research procedures involving children.

Shared views regarding the moral respect which is owed to children in family life are used as a guide in determining the moral permissibility of nontherapeutic clinical research procedures involving children. The comparison suggests that it is not appropriate to seek assent from the preadolescent child. The analogy with interventions used in family life is similarly employed to specify the permissible limit of risk to which children may be exposed in nontherapeutic research procedures. The analysis indicates that recent writers misconceive how certain moral principles, such as respect for personal autonomy, require us to act toward children. The results are also used to assess proposed federal regulations on research with children.