Respect For Self-determination Research Articles

Caregiving Systems at the End of Life: How Informal Caregivers and Formal Providers Collaborate

End-of-life care is moving out of hospitals and families are replacing professionals in the delivery of care as death approaches. Guided by concepts from the social care model (Cantor & Brennan, 2000), this qualitative study aimed to explore and describe the interrelationship between informal and formal care in a terminal illness. In-depth interviews with 64 families were audiotaped, transcribed, and coded. Genograms and ecomaps were created to visually represent caregivers’ sources of support and used to analyze caregiving networks. Results indicate that quasi-formal and informal social support become an important link between informal and formal caregiving. As a relative is dying, families value kindness and compassion, clear and straightforward communication, information, anticipatory guidance, and respect for self-determination from formal caregivers.

Justifications of physicians’ choice of actionAttitudes among the general public, GPs, and oncologists in Sweden

ObjectiveTo compare choice of actions and justifying reasons among the general public, GPs and oncologists.DesignA postal questionnaire using four vignettes: a healthy patient reluctant to quit smoking and one demanding an X-ray, a pulmonary cancer patient reluctant to quit smoking and one demanding immunotherapy.SubjectsA random sample of the general public (n=1000), GPs (n=200), and oncologists (n=200).Main outcome measuresThe respondents’ choice of how the physician should act (general public)/would act (physicians), and, with reference to their choice of action, their justifying reasons.ResultsA majority answered that the physician should/would bring up the question about smoking cessation with the reluctant patient, justified by promotion of medical benefit and protection from harm. With reference to the reluctant cancer patient every second oncologist and every third GP would not mention smoking cessation, justified by respect for self-determination and enhancement of the relationship. Facing the patient demanding a new X-ray the general public was more in favour while the physicians rejected it. One-third of the general public answered that the seriously ill patient's demand for immunotherapy should be granted and referred to respect for self-determination and enhanced relationship. A majority of the physicians rejected such a demand, justified by promotion of a fair distribution of resources.ConclusionThe fear of infringing the patient's right to self-determination and harming the relationship is exaggerated by physicians. They are mostly expected to bring up smoking cessation with a reluctant patient. How to manage demanding patients is more controversial.

Why Japan Will Not Give up Whaling

Despite enduring so much foreign criticism for its pro-whaling stance, why does Japan continue to push for a resumption of commercial whaling? By exploring this question we can become more cognisant of the wider influences on Japanese state behaviour from societal groups in domestic politics and accepted cultural traditions. We can then understand why foreign pressure has difficulty in resonating within Japan. This paper analyses Japanese diplomacy at the two recent Meetings of the Convention on International Trade in Endangered Species (1997 and 2000) and the International Whaling Commission (2000 and 2001), and also the apparent paradoxes of Japan's having a popular whale-watching industry and the Japanese public's increasing engagement in whale rescues. From these negotiations, it is clear that Japan's pro-whaling stance underscores the principles that it holds as important, such as respect for self-determination, respect for the legally binding rules of international treaties, and respect for science-based management as the basis for regulating the international use of resources when cultural values and preferences differ so greatly. It also shows that the current misinformation, polarisation, posturing, dogmatism and hostility dominating the whaling debate is not helpful to anyone. Furthermore, the implicit love for living whales which is associated with a whale-watching industry and rescuing stranded whales is not necessarily incompatible with wishing to harvest whales. These apparent inconsistencies can coexist because they link to Buddhist notions of respect for whales.

Introduction: European bioethics on a rocky road.

There are quite a number of rocky roads on which the 'old continent' has embarked. There is, first, a harmonization of cultures and attitudes in the creation of a common European market of values and valuables, a harmonization undertaken in order to survive in an increasingly competitive global market. Second, there is a reactivation of specific European traditions in discourse, peaceable hermeneutics, solidarity, subsidiarity, tolerance in both conflict reduction and solution, and respect for self-determination and self-responsibility. Third, there is an integration of theory and practice, of visions and reality, of national identity or pride and common European rights, and of obligations and cultural heritages. Last but not least, there is a question about the definition of 'European' in a world which, at least in part, has been developed by successful European missionary work in the distribution of Age-of-Reason principles such as personal autonomy and social and ideational tolerance, the promotion of science-based technologies, and the creation of global markets for goods and services.

The Role of Values and Experience in Determining Social Workers' Attitudes Toward Euthanasia and Assisted Suicide

ABSTRACT This article reports results of a study examining the impact of personal and professional values and experience on 122 hospital social workers' attitudes toward euthanasia and assisted suicide. Respect for self-determination was rated as the most important consideration in end-of-life issues. Predictors of social workers' agreement that euthanasia should be legal were: self-determination, religious beliefs, educational level (BSW/MSW), and for assisted suicide were: religious beliefs, belief in the potential for abuse, educational level and participation in ethics training. The findings underscore the need for social workers' awareness of how an interplay of personal and professional factors in potentially explosive ethical issues may influence practice in health care settings.

Intervention and Collective Self-Determination

Intervention often violates both respect for state sovereignty and the right to self-determination. McMahan focuses on the latter ethical dimension rather than the former political and legal one, although his claims have important implications for issues of state sovereignty. He challenges the common assumption that respect for self-determination requires an almost exceptionless doctrine of nonintervention by first defining the notions of “intervention” and “self-determination,” and then analyzing Walzer's doctrine of nonintervention. The recognition that there are different ideals of self-determination results in a less rigid and more permissive doctrine of nonintervention.

The Principles of Medical Ethics and Their Application to Mexican- American Elderly Patients

Within the vigor of the American medical ethical dialogue, awareness that the principles of respect for autonomy, beneficence, and justice may reflect some cultural bias that, in effect, may not be applicable to Americans of all ethnicities is growing. This bias raises the question about what happens when these three ethical principles are applied in clinical situations involving elderly Mexican-American patients. Four case studies based on actual patient encounters are presented to show the manner in which ethical principles may apply for Mexican-American patients and to generate discussion by presenting evidence that indicates that the fundamental ethical principle that Mexican-American elders expect will be applied by their physicians is beneficence, and not respect for self-determination.