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PubMed2004

The relation between autonomy-based rights and profoundly mentally disabled persons.

A chapter from his forthcoming book "Deciding for the Profoundly Mentally Disabled," Professor Norman Cantor argues persuasively for the right of incompetent persons to have a surrogate make critical medical decisions on their behalf, particularly in the context of refusing life-sustaining treatment. While abusive surrogate decision-making is always a concern, Professor Cantor recommends both substantive and procedural protections in order to preserve intrinsic human dignity for the profoundly disabled.

Decision Making↗
PubMed1994

A new perspective on threatened autonomy in elderly persons: the disempowering process.

This study explored factors other than medical condition and treatments which contributed to the discharge experiences of 12 rural and 9 urban patients. Interpretive research methodology included document review, observation and in-depth interviews of all key participants. The purposefully selected sample consisted of a total of 21 patients, 22 informal caregivers, and 117 professionals involved in the hospital and/or home setting. Findings document a new perspective on how patients and professionals together contribute to the patient's threatened autonomy. Lack of clarity about goals, aspirations, and purpose in life and a generally negative frame of mind in the elderly combine with professional practice approaches to create a disempowering process. Faced with the biomedical orientation and paternalism of professionals, patients with a positive mindset and sense of direction and purpose in life did not experience threat to their autonomy. The researchers conclude that empowerment strategies must encompass a patient-centred approach, which includes an understanding of the patient's mindset, goals, aspirations, and sense of purpose within a larger life context. This consideration is essential to enable elderly patients to maintain autonomy despite continued health care requirements.

Aged↗
PubMed2006

The semblance of autonomy: treatment of persons with disabilities under the Uniform Health-Care Decisions Act.

This Article illuminates the dangers of the Uniform Health-Care Decisions Act, which provides a set of model rules designed to clarify and expedite end-of-life health-care decisionmaking for incapacitated patients. The uniform commissioners and many scholars who have commented on the Act have touted the legislation as a model for defending patient autonomy. As this Article will reveal, the impression of autonomy is an illusion. In fact, the Act privileges the perspectives of the able-bodied over those of persons with disabilities, endangers the autonomy of incapacitated patients, and empowers proxy decisionmakers who have incentives to terminate treatment. These risks have become all the more significant with the rise of managed-care programs that create pressures to minimize care. After highlighting the serious risks to vulnerable patients under the Uniform Health-Care Decisions Act, the Article offers alternative rules and stronger safeguards to better protect patient autonomy and defend against wrongful health-care decisions. This Article urges states seeking improved end-of-life health-care procedures to codify these or similar protections in order to avoid the lethal shortcomings of the Uniform Health-Care Decisions Act.

Decision Making↗
PubMed1994

A freedom to choose. The ethics of informed consent.

1. It is difficult to know how much information should be given to patients to help them give an informed consent. 2. Informed consent provides an avenue for the expression of the ethical themes of autonomy, respect for persons and truth. 3. Informed consent acknowledges patients' intrinsic right to decide what happens to their bodies.

Aged↗
PubMed1994

[Factors associated with a 1-year development in the functional autonomy of elderly persons living at home].

The purpose of the study was to examine the incidence and reversibility of disability among elderly people over one year follow-up and to determine the predictors of functional changes. The population used in this analysis consisted in 1850 subjects aged 65 and over included in the PAQUID cohort and visited again at one year follow-up. Disability was measured by Katz's scale (Activities of Daily Living or ADLs), Lawton's scale (Instrumental Activities of Daily Living or IADLs) and a mobility scale. The one year incidence of the dependency was 5.6% for ADLs, 10.8% for IADLs, and 3.3% for mobility. Being dependent at baseline was associated with an increased risk of one year mortality comprised between 3.3 and 5.3 according to the measurement scale. Recovery back to independence was frequent however, especially for ADLs (44.7%) and mobility (28.9%). Predictors of disability were: age in all scales, vision impairment and Mini Mental State Examination score for IADL and mobility scales, depressive symptomatology for ADLs, female sex and breathlessness for IADLs. Absence of cognitive impairment at baseline was associated with recovery to independence in all scales.

Activities of Daily Living↗
PubMed1993

The relationship between Beck's concepts of sociotropy and autonomy and the NEO-Personality Inventory.

Beck (1983) proposed that two personality dimensions, sociotropy and autonomy, represent vulnerability factors for depression. This study assesses the relations between sociotropy/autonomy (Sociotropy/Autonomy scale) and five personality dimensions, i.e. neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness (NEO-Personality Inventory). Sociotropy was related positively to neuroticism and negatively to openness to experience. Autonomy was positively associated with conscientiousness.

Adult↗
PubMed2004

Respect: or, how respect for persons became respect for autonomy.

This article provides an intellectual archeology of how the term "respect" has functioned in the field of bioethics. I argue that over time the function of the term has shifted, with a significant turning point occurring in 1979. Prior to 1979, the term "respect" connoted primarily the notion of "respect for persons" which functioned as an umbrella which conferred protection to autonomous persons and those with compromised autonomy. But in 1979, with the First Edition of Principles of Biomedical Ethics by Beauchamp and Childress, and the report of the Ethical Advisory Board (EAB) of the (then) Department of Health, Education, and Welfare entitled Research on In Vitro Fertilization, usage shifts from "respect for persons" to "respect for autonomy." Two results: 1) those with compromised autonomy are no longer protected by the canons of "respect" but rather the less overriding canons of beneficence; and 2) the term "respect" functions increasingly as a rhetorical device in public bioethics discourse.

Bioethical Issues↗
PubMed2001

Persuasion as respect for persons: an alternative view of autonomy and of the limits of discourse.

The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of autonomy as derived from the right persons have to respect, as agents who can argue, persuade and be persuaded in matters of utmost personal significance such as decisions about medical care. Hence, autonomy should and could be respected only after such an attempt has been made. Understanding suffering to a significant degree is a prerequisite to sincere efforts of persuasion. It is claimed that a modified and pragmatic form of discourse is the necessary framework for understanding suffering and for compassionately interacting with the frail.

Empathy↗
PubMedDate not supplied

[A relationship between autonomy and mental disorders].

The aim of this article is to present three new cognitive approaches to autonomy and it's importance for pathology. According to Ryan and Deci's self-determination theory autonomy is manifested through intrinsically motivated behaviour. As the individual develops it's autonomous activity is expanded gradually by the integration of regulatory processes. Being autonomous, one can modulate and manage one's emotions and impulses, is aware of emotional states and hence is capable of behaving adequately. Pathology develops when the problems with the integration of external regulatory processes occur. According to Toru Sato, there are two parts of the self--autonomy and relatedness. The first one focuses on control over one's environment and one's bodily functioning. For the other one "being associated" with one or more persons is a goal in itself. For correct functioning the person's autonomy and relatedness needs should be satisfied. Both self-systems are involved in the process, which should result in their integration. Sato claims that too much stress put on one of the systems weakens the other one. The person satisfies only one need and it is crucial for it's mental condition. Pathological mechanisms are culturally conditioned. Beck describes two personality dimensions--autonomy and sociotropy. Autonomy refers to the personal interest in independence, individuality and attaining personal goals. The autonomous individual takes it's sense of well-being from personal achievements and control over her/his own activity and environment. The author claims that both highly autonomous and highly sociotropic individuals are vulnerable to depression.

Humans↗
PubMed1997

A United Methodist approach to end-of-life decisions: intentional ambiguity or ambiguous intentions.

The position of the United Methodist Church on end-of-life decisions is best described as intentional ambiguity or ambiguous intentions or both. The paper analyzes the official position of the denomination and then considers the actions of a U.M.C. bishop who served as a foreman for a trial of Dr. Jack Kevorkian. In an effort to find some common ground within an increasingly divided denomination, the work concludes with a consideration of the work of John Wesley and his approach to human death.

Advance Directives↗
PubMed1992

Rationale for an integrated approach to genetic epidemiology.

CONCLUSION: Genetic knowledge is now in the public domain and its interpretation by the media and the citizens brings the issues into the public forum of discussion for the necessary ethical, legal and socio-cultural evaluation of its application. Science is being perceived by some as dangerous and as requiring international regulation. Others feel that genetic knowledge will be the breakthrough that will permit medical progress and individual autonomy with regards to personal health and lifestyle choices. The mapping of the human genome has already yielded valuable information on an increasing number of diseases and their variants. Prevailing popular and journalistic archetypes ("imaginaires") used in the media are perceived by the producers as slowing down the possible application of genetic knowledge. The answers to these dilemmas are not readily apparent nor are they prescribed by classical philosophy of medicine. Since genetic knowledge eventually resides with the individual who carries the genes of disease and/or susceptibility, a logical approach to integration of this knowledge at a societal level would seem to reside with individual education and decision-making. The politics of the ensuing social debate could transform the current social contract since an individual's interests need to be balanced against those of his or her immediate family in the sharing of information. The ethical foundations of such a contract requires the genetic education of "Everyone" as a matter of urgent priority. Genetic education should not serve ideological power struggles between the medical establishment and the ethical-legal alliance. Instead, it should ensure the transfer of knowledge to physicians, to patients, to users, to planners, to social science and humanities researchers and to politicians, so that they may make "informed" and free decisions....

Base Sequence↗