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PubMed1978

On children and proxy consent.

The meaning of valid proxy consent for children has recently been the subject of an important debate between Richard McCormick and Paul Ramsey on the ethics of experimenting with children. Ramsey is willing to agree with McCormick that parental consent for a child to undergo some medical procedure is valid only if parents consider what the child would consent to if he could. But beyond this, Ramsey has a fundamentally different conception of the child from McCormick, and therefore gives a very different interpretation to this standard for valid proxy consent. In Ramsey's view, McCormick's basic mistake is to think of the child as a small adult, thereby overlooking the child's peculiar vulnerabilities and needs. In particular, McCormick fails to attend to the child's needs for "preservation in life and healthful growth". In this paper, the author pursues Ramsey's suggestion that a correct analysis of valid proxy consent for children would replace the "language of consent" with the "language of need". He does this by sketching a theory of parenthood that rests on two central notions: that of primary goods, as found in the writing of John Rawls, and that of autonomy.

Child↗
PubMed1980

The right to refuse psychiatric treatment: some legal and ethical considerations.

The paper addresses some of the ethical and legal issues involving the rights of psychiatric patients to refuse treatment. Particular attention is focused on two recently decided cases--Rogers v. Okins, and Rennie v. Klein--that deal with the rights of involuntarily committed patients to refuse psychotropic medications. Both cases approach this issue in different ways, but inevitably point to some very complicated philosophical concepts such as the meaning of self-determination, autonomy and identity of personhood, especially as these concepts are applied to mentally ill patients.

Commitment of Persons with Psychiatric Disorders↗
PubMed1995

Futility and the common cold. How requests for antibiotics can illuminate care at the end of life.

The dominant approach to futility in medicine assumes that the probability and utility of medical interventions may be separated to provide a quantitative (probabilistic) definition of futility. This assumption is not only misleading but also responsible for much of the confusion that futility has engendered in medical discussions. The divorce of utility from probability is the opposite of how clinicians reason: an improbable intervention looks different if it is cheap, easy, and without morbidity than if it is technology intensive, expensive, and likely to involve great pain and suffering. Futility is how physicians describe the sense of being compelled to proceed with resource intensive care for marginal benefits. Outside the intensive care unit, physicians weigh and sometimes reject patient requests without the need to invoke futility. By examining the ways that physicians can legitimately evaluate patient requests, we can show that appeals to futility are both unnecessary and counterproductive. In cases where such appeals are unavoidable, the outpatient model suggests a process to adjudicate the competing claims of patient autonomy and physician responsibility.

Beneficence↗
PubMed1990

Old and thin.

Viewing an elderly patient's refusal of food from the perspective of the jain tradition of sallekhana (voluntary starvation) permits the author to reconcile her need to "do something" with her belief in the principle of patient autonomy.

Aged↗
PubMed1998

Procreative torts: enhancing the common-law protection for reproductive autonomy.

Roe v. Wade's twenty-fifth anniversary is likely to herald widespread scholarly commentary on the decision's continued vitality and the future of abortion in the United States. However, if such commentary focuses solely upon the constitutional dimensions and political aspects of a woman's right to privacy, an important dimension of this right will be overlooked. Few commentators have considered the extent to which tort law safeguards a woman's interest in reproductive autonomy. In this article, Professor Northern argues that the interest in reproductive autonomy has not yet received the full protection to which it is entitled and that tort law is poised to evolve distinct causes of action for the interference with procreative autonomy interests. Professor Northern begins with an overview of the medical and psychological literature on abortion-related risks. She goes on to discuss current trends in abortion malpractice litigation. The author then reviews the three basic types of malpractice causes of action--battery, negligence, and lack of informed consent--and explores their application to abortion malpractice claims. The focus of the article then shifts to the development of specialized procreative torts, and Professor Northern contends that courts should go beyond previous decisions to redress any substantial interference with procreative autonomy. Finally, the author asserts that legislative alternatives to the common-law development of procreative torts, such as right-to-know statutes, are less protective of women's interests. Professor Northern concludes that tort law could and should be used to more fully protect women's interests in procreative autonomy.

Abortion, Induced↗
PubMed1992

Ethical issues in the care of cancer patients.

Nearly all the topics considered by medical ethics generally present themselves to those caring for cancer patients. Although most attention may be given to questions of resource allocation and limiting treatment, other issues are of equal importance. Providing respect and compassion for patients may be even more important. The day-to-day treatment of the patient that recognizes the practical autonomy of the patient and legitimizes the patient's involvement in deciding about his or her own care may do more to preserve the integrity of the patient as a person than anything else that happens to someone who accepts the cancer diagnosis. The physician who can accept the patient's judgment and participation and who can help the patient find positive meaning in what can be a personally and socially devastating disease experience has enacted a highly laudatory ethical standard of patient care.

Beneficence↗
PubMed2003

Separated after birth.

Bioethics has developed against a backdrop of increased concern for human and civil rights, including the rights of patients to decide about their own treatment. The recent case of Laleh and Ladan Bijani, the twenty-nine-year old Iranian conjoined twins who died in a Singapore hospital on Jul 8, after more than fifty hours of surgery aimed at separating them, highlights the tensions between respect for patient autonomy and professional medical judgment.

Adult↗
PubMed2006

[Coercion and active interference in psychiatry].

It is becoming increasingly clear that the autonomy and legal position of psychiatric patients are impediments to their adequate care. There is a strong emphasis on the voluntary cooperation of the patient involved. The patient as a person appears to be more important than his or her health status. There will always be tension between the right to self-determination and the dangers to the patient's health. There is a need for a law addressing the necessity to treat. In addition, a chain of care should be developed encompassing the whole spectrum of care institutions and centred around the individual's needs for food, shelter, care, financial support and medical attention.

Coercion↗
PubMed1990

Counterpoint: is patient control of treatment always appropriate?

Health care providers often find tension and even conflict between what they consider is important for the patient to do and what the patient wants or decides to do. The current trend among patients is to assume more autonomy and freedom in the process of their care. Yet situations that commonly arise between the provider and the patient prompt the patient to refuse to accept or acquiesce to the provider's wishes or choices that are perceived by the provider to be in the patient's best interest. Under what circumstances should the provider practice beneficence in the form of paternalism at the expense of the patient's autonomy? This article explores justifiable paternalism and beneficence.

Authoritarianism↗
PubMed1990

Futility and the ethics of resuscitation.

Recent recommendations that physicians be allowed to withhold cardiopulmonary resuscitation, without patient consent, from patients for whom it would be futile have drawn objections that such unilateral judgments would undermine respect for patient autonomy. These objections assume that since futility determinations involve value judgments, patient input is always required. However, certain sorts of value judgments must be made unilaterally by physicians as part of reasonable medical practice. Moreover, the mixed messages inherent in requesting patient consent to withhold futile therapy serve to undermine rather than to enhance autonomous choice. Real patient interests can better be saved by a broad public dialogue around judgments of medical reasonableness and medical futility, rather than concern for the form but not the substance of patient autonomy.

Adult↗
PubMedDate not supplied

Ethical questions inherent in compliance.

Promoting patient compliance is considered to be good clinical practice. However, compliance conveys a sense of being submissive or obedient to another; therefore, promoting compliance becomes a paternalistic action. The author uses a clinical situation to demonstrate some of the ethical questions related to compliance (i.e., who decides, who knows best, and how noncompliant patients are treated) and discusses these questions using the ethical precepts of doing no harm and respecting autonomy.

Aged↗