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PubMed2005

Shared decision making and determining decision-making capacity.

Shared decision making respects patient autonomy and allows patients to select how much they wish to become involved in various health care decisions. Advance care planning allows a person to document preferences that can become operative at a later time when the person has lost decision-making capacity. Structured methods exist for assessing the presence or absence of decision-making capacity, but some subjectivity cannot be eliminated from these assessments. An ethical challenge in the care of older patients who have diminished capacity is to show respect for their previously expressed wishes and for their present, experienced quality of life.

Activities of Daily Living↗
PubMed2005

Health and autonomy.

Individual autonomy is a prominent value in Western medicine and medical ethics, and there it is often accepted that the only way to pay proper respect to autonomy is to let the patients themselves determine what is good for them. Adopting this approach has, however, given rise to some unwanted results, thus motivating a quest for an objective conception of health. Unfortunately, the purportedly objective conceptions of health have failed in objectivity, and if a conception of health is not acceptable for all agents, the threat of offending the patients' autonomy arises. This article sketches an objective conception of health that is able to respect individual autonomy.

Age Factors↗
PubMed2003

Autonomy, sanity and moral theory.

The concept of autonomy plays at least two roles on moral theory. First, it provides a source of constraints upon action: because I am autonomous you may not interfere with me, even for my own good. Second, it provides a foundation for moral theory: human autonomy has been thought by some to produce moral principles of a more general kind. This paper seeks to understand what autonomy is, and whether the autonomy of which we are capable is able to serve these roles. We would naturally hope for a concept of autonomy that is value-neutral rather than value-laden. That is to say, we would want the judgement that I am autonomous to depend wholly on, say, structural features of my psychology, and in no way to require us to make ethical judgements, or other value judgements. Being value-neutral is perhaps desirable in a concept of autonomy serving the first role, and plausibly indispensible in one playing the second. I shall argue, however, that value-neutral conceptions of autonomy are impoverished and out of line with our intentions; set out and defend an explicitly value-laden conception of autonomy; and explore the implications of such a view for the ability of autonomy to play the roles mentioned above.

Adult↗
PubMed2005

The tension between self governance and absolute inner worth in Kant's moral philosophy.

The concepts of autonomy as the self governance of individuals and dignity as the inner worth of human beings play an important role in contemporary bioethics. Since both notions are crucial to Immanuel Kant's moral theory, it would be tempting to think that Kantian ethics could ease the friction between the two concepts. It is argued in this paper, however, that this line of thought cannot be supported by Kant's original ideas. While he did make a conscious effort to bring autonomy and dignity together, his emphasis on the absolute inner worth of our collective humanity made it impossible for him to embrace fully the personal self determination of individuals, as it is usually understood in today's liberal thinking.

Ethical Theory↗
PubMed1998

Natural deaths while driving: would screening for risk be ethically justified?

OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons.

Adult↗