Conscientious autonomy: what patients do vs. what is done to them.
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Within the western health-care context autonomy is a central value. Still, as it is used within this context it is far from clear what we are actually talking about. In this article the author outlines four different uses or aspects of autonomy: self-determination, freedom, desire-fulfilment and independence. One important conclusion will be that in order to be able to respect autonomy in a way that actually brings value to the patient's life we need to clearly assess what aspect of autonomy the patient values and for what reason it is valued by the patient.
This articles assesses the arguments that bioethicists have presented for the view that patients' autonomy has value over and beyond its instrumental value in promoting the patients' wellbeing. It argues that this view should be rejected and concludes that patients' autonomy should be taken to have only instrumental value in medicine.
This paper reviews the advent of unilateral do-not-resuscitate orders. Unilateral do-not-resuscitate policies presume that cardiopulmonary resuscitation is a medical therapy and that physicians have no obligation to undertake a medical therapy that does not offer achievable and appropriate goals. Four do-not-resuscitate policies from U.S. hospitals and some of the significant published proposals are reviewed. We conclude that anything other than a physiologic definition of futility is indefensible because of imposed value judgments, imprecise definitions of quantitative and qualitative futility, inexact data, lack of certitude of economic benefit, and the role of autonomy for the patient and physician.
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