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PubMed2001

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?

Adult↗
PubMed2000

The cultural adaptability of health sciences faculty.

PURPOSE: Health care educators have a major responsibility to prepare future health care practitioners to provide services for culturally diverse clients. As a starting point, prior to making any curricular changes, the cultural adaptability of the faculty needs to be measured; therefore, this study was conducted to determine the cultural adaptability of the faculty within a College of Health Sciences of an urban regional university in Southeastern Virginia. METHODS: The sample consisted of 40 health sciences faculty representing dental hygiene, medical laboratory sciences, nursing and physical therapy. The principal investigator personally administered the Cross-Cultural Adaptability Inventory (CCAI), a 50-item instrument that contains questions to measure the construct cultural adaptability and its four dimensions: emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy. The CCAI is not targeted to one particular culture, but rather is designed to be culture general. RESULTS: Overall, all four faculty groups exhibited higher average CCAI scores than the CCAI norm group which consisted of individuals with cross-cultural experience and training. Analysis of variance revealed no statistically significant difference, at the 0.05 level, in the overall CCAI scores among the health sciences faculty. Analysis of CCAI scores among the health sciences faculty, using analysis of variance revealed no statistically significant difference, at the 0.05 level, in emotional resilience, perceptual acuity, and personal autonomy. In the dimension flexibility/openness, a significant difference was exhibited between the physical therapy and medical laboratory sciences faculty. CONCLUSIONS: These qualities should provide a strong foundation for the development of additional competence in cross-cultural health care and for preparing practitioners who can provide culturally sensitive health care. Further exploration to determine whether a cross culturally adaptable faculty can impart this attribute to students might be to administer the CCAI to entering and exiting students.

Analysis of Variance↗
PubMed1980

Resident and staff perceptions of latitude of choice in elderly institutionalized men.

Ninety-nine elderly institutionalized males, selected equally from three decades, completed measures of: their personal, perceived latitude of choice (LOC) in activities of daily living; self-concept; and life satisfaction. One hundred staff, of both sexes, estimated how the typical or "average" V.A. domiciliary resident would respond to the LOC measure. Mean resident LOC scores were found to be significantly related to life satisfaction but not to self-concept. This supports the thesis that latitude of choice, or personal autonomy, is related to well-being and that the LOC measure may be a useful tool in the development and evaluation of interventions aimed at improving resident well-being. Significant relationships between resident age and the importance of daily activities, self-concept and life satisfaction were also observed although there were no age differences in the resident data for the LOC, importance or choice measures. In comparing staff attributed and resident perceived latitude of choice, significant differences were found. Examination of response patterns to the specifically listed activities of daily living also revealed significant staff-resident differences. Therefore, any attempt to intervene in the environment to increase the personal autonomy or control of residents, and hence their well-being, must deal with such staff-resident differences and with staff misperceptions of what is and is not important to residents. Interventions should be targeted at specific activities viewed by a majority of residents as restricted and insofar as practical, interventions should be individually tailored.

Activities of Daily Living↗
PubMedDate not supplied

Patient autonomy in care: a theoretical framework for nursing.

Patient autonomy has increasingly become an issue in a health care system that often promotes dependence in decision making. The complex technology of health care creates situations in which difficult decisions need to be made by patients and their families. Nurses are important participants in that decision-making process. Models available for developing a theoretical approach to patient autonomy traditionally have been limited to ethics literature. A more recent approach to personal autonomy is Meyer's philosophical feminist perspective. Any philosophical approach to patient autonomy must be congruent with other critical nursing concepts. In addition, a model of patient autonomy for nursing must be useful for persons who operate at various functional levels. The model, Patient-Autonomy in Care, based on the Meyer's model, was developed to incorporate the special vulnerability and functional needs of patients in the health care system.

Decision Making↗
PubMed1998

Exploitation, autonomy, and the case for organ sales.

A recent argument in favor of a free market in human organs claims that such a market enhances personal autonomy. I argue here that such a market would, on the contrary, actually compromise the autonomy of those most likely to sell their organs, namely, the least well off members of society. A Marxian-inspired notion of exploitation is deployed to show how, and in what sense, this is the case.

Capitalism↗
PubMed2001

Understanding autonomy relationally: toward a reconfiguration of bioethical principles.

Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patient's self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality.

Bioethics↗
PubMed2002

Autonomy and freedom of choice in prenatal genetic diagnosis.

An increase in autonomy and freedom is often considered one of the main arguments in favour of a broad use of genetic testing. Starting from Gerald Dworkin's reflections on autonomy and choice this article examines some of the implications which accompany the increase in choices offered by prenatal genetic diagnosis. Although personal autonomy and individual choice are important aspects in the legitimation of prenatal genetic diagnosis, it seems clear that an increase in choice offered by prenatal genetic diagnosis also leads to various implications that may negatively influence the freedom of the persons involved.

Decision Making↗
PubMed2004

Challenging the bioethical application of the autonomy principle within multicultural societies.

This article critically re-examines the application of the principle of patient autonomy within bioethics. In complex societies such as those found in North America and Europe health care professionals are increasingly confronted by patients from diverse ethnic, cultural, and religious backgrounds. This affects the relationship between clinicians and patients to the extent that patients' deliberations upon the proposed courses of treatment can, in various ways and to varying extents, be influenced by their ethnic, cultural, and religious commitments. The principle of patient autonomy is the main normative constraint imposed upon medical treatment. Bioethicists typically appeal to the principle of patient autonomy as a means for generally attempting to resolve conflict between patients and clinicians. In recent years a number of bioethicists have responded to the condition of multiculturalism by arguing that the autonomy principle provides the basis for a common moral discourse capable of regulating the relationship between clinicians and patients in those situations where patients' beliefs and commitments do or may contradict the ethos of biomedicine. This article challenges that claim. I argue that the precise manner in which the autonomy principle is philosophically formulated within such accounts prohibits bioethicists' deployment of autonomy as a core ideal for a common moral discourse within multicultural societies. The formulation of autonomy underlying such accounts cannot be extended to simply assimilate individuals' most fundamental religious and cultural commitments and affiliations per se. I challenge the assumption that respecting prospective patients' fundamental religious and cultural commitments is necessarily always compatible with respecting their autonomy. I argue that the character of some peoples' relationship with their cultural or religious community acts to significantly constrain the possibilities for acting autonomously. The implication is clear. The autonomy principle may be presently invalidly applied in certain circumstances because the conditions for the exercise of autonomy have not been fully or even adequately satisfied. This is a controversial claim. The precise terms of my argument, while addressing the specific application of the autonomy principle within bioethics, will resonate beyond this sphere and raises questions for attempts to establish a common moral discourse upon the ideal of personal autonomy within multicultural societies generally.

Bioethics↗
PubMed2000

Autonomy, justice, and disability.

In this Article, Professor Carlos A. Ball explores the philosophical foundations for the types of rights and benefits that our society currently provides to individuals with disabilities. The concept of autonomy places on society a moral obligation to assist individuals with disabilities when their basic human functional capabilities are impaired. The exercise of this obligation entails assisting individuals with crossing a minimum threshold of functional capabilities below which it is not possible to lead autonomous lives. In making this argument, Professor Ball responds to libertarian critics who contend that notions of freedom or liberty proscribe an activist role for government in this arena. He explains how even a libertarian state redistributes wealth in order to provide for some incapacities. Professor Ball also disputes the idea that the meeting of the needs of the disabled is enough to provide moral justification for the rights and benefits provided to individuals with disabilities. The problem with the concept of needs, Professor Ball argues, is that it fails to account sufficiently for the human good of personal autonomy.

Persons with Disabilities↗
PubMed1982

The justification of medical paternalism.

This paper examines the moral justification of medical paternalism. It is shown that while there are sufficient grounds to justify the practice of medical paternalism in some instances, there are many instances of the practice which cannot be justified. The application of the utilization principle of paternalism is considered in detail. It is argued that the physician can justifiably apply the principle in a particular case only after he has determined both that there are no alternate non-paternalistic courses of action which will have the same results and that he is in the same privileged position with respect to any relevant non-medical considerations as he is in with respect to medical considerations. The moral constraints on paternalistic action flowing from the concept of personal autonomy are also examined. It is concluded that medical paternalism is justified only when utilitarian considerations apply and when they do not violate personal rights. This occurs only when the subject of paternalism is not fully competent, when he has explicitly or by implication given consent, or when it can be reasonably concluded, from the knowledge of his emotional and cognitive make up, that he would approve of such treatment. For the most part, only the physician with a more intimate knowledge of his patient than is possible in most modern medical practice is in the position to undertake medical paternalism with moral propriety.

Attitude↗
PubMed2005

Bodily integrity and male and female circumcision.

This paper explores the ambiguous notion of bodily integrity, focusing on male and female circumcision. In the empirical part of the study we describe and analyse the various meanings that are given to the notion of bodily integrity by people in their daily lives. In the philosophical part we distinguish (1) between a person-oriented and a body-oriented approach and (2) between four levels of interpretation, i.e. bodily integrity conceived of as a biological wholeness, an experiential wholeness, an intact wholeness, and as an inviolable wholeness. We argue that bodily integrity is a prima facie principle in its own right, closely connected with, but still fundamentally different from, the principle of personal autonomy, that is, autonomy over the body.

Circumcision, Female↗
PubMed2004

Equipoise, design bias, and randomized controlled trials: the elusive ethics of new drug development.

The concept of 'equipoise', or the 'uncertainty principle', has been represented as a central ethical principle, and holds that a subject may be enrolled in a randomized controlled trial (RCT) only if there is true uncertainty about which of the trial arms is most likely to benefit the patient. We sought to estimate the frequency with which equipoise conditions were met in industry-sponsored RCTs in rheumatology, to explore the reasons for any deviations from equipoise, to examine the concept of 'design bias', and to consider alternative ethical formulations that might improve subject safety and autonomy. We studied abstracts accepted for the 2001 American College of Rheumatology meetings that reported RCTs, acknowledged industry sponsorship, and had clinical end-points (n = 45), and examined the proportion of studies that favored the registration or marketing of the sponsor's drug. In every trial (45/45) results were favorable to the sponsor, indicating that results could have been predicted in advance solely by knowledge of sponsorship (P < 0.0001). Equipoise clearly was being systematically violated. Publication bias appeared to be an incomplete explanation for this dramatic result; this bias occurs after a study is completed. Rather, we hypothesize that 'design bias', in which extensive preliminary data are used to design studies with a high likelihood of being positive, is the major cause of the asymmetric results. Design 'bias' occurs before the trial is begun and is inconsistent with the equipoise principle. However, design bias increases scientific efficiency, decreases drug development costs, and limits the number of subjects required, probably reducing aggregate risks to participants. Conceptual and ethical issues were found with the equipoise principle, which encourages performance of negative studies; ignores patient values, patient autonomy, and social benefits; is applied at a conceptually inappropriate decision point (after randomization rather than before); and is in conflict with the Belmont, Nuremberg, and other sets of ethical principles, as well as with US Food and Drug Administration procedures. We propose a principle of 'positive expected outcomes', which informs the assessment that a trial is ethical, together with a restatement of the priority of personal autonomy.

Bias↗
PubMed1990

HIV testing: the legal balance between individual and societal rights.

Testing for the presence of human immunodeficiency virus (HIV) antibodies creates a legal conflict between the individual's right to autonomy and privacy versus society's right to control the public health. A body of laws exists to address these conflicting rights. These laws, however, must evolve so as to strike a better balance between what society has a right to know and the individual's right to personal autonomy and privacy. Appropriate statutes should recognize that a legitimate need may arise for a physician to disclose otherwise confidential testing data to the spouse and other intimate sexual partners of an HIV-infected patient.

AIDS Serodiagnosis↗
PubMed2004

Correlates of quality of life in older adult veterans.

The purpose of this correlational study was to test theoretical propositions describing positive relationships between health promotion, sense of coherence, personal autonomy, and quality of life in older adult veterans and to explore their overall contribution to the prediction of quality of life. The sample consisted of 135 veterans aged 65 to 85 years who completed the Health-Promoting Lifestyle Profile, the Sense of Coherence-13 Scale, the Perceived Enactment of Autonomy Scale, and the Quality of Life Profile: Seniors Version, Short Scale. Health-promoting lifestyle, sense of coherence, and autonomy were positively correlated to quality of life. When the independent variables were subjected to a regression analysis, health-promoting lifestyle and autonomy explained 38% of the variance in quality of life.

Aged↗
PubMed2001

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.

Attitude to Health↗