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PubMed1981

Mental health as rational autonomy.

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real.

Brain Diseases↗
PubMed1999

Autonomy, rationality and the wish to die.

Although suicide has traditionally carried a negative sanction in Western societies, this is now being challenged, and while there remains substantial public concern surrounding youth and elder suicide, there is a paradoxical push to relax the prohibition under certain circumstances. Central to the arguments behind this are the principles of respect for autonomy and the importance of rationality. It is argued here that the concepts of rationality and autonomy, while valuable, are not strong enough to substantiate a categorical "right to suicide" and that the concepts of "understandability" and "respect" are more useful and able to provide the foundation for responding to a person expressing a wish to die. Roman suicide, sometimes held as an example of "rational suicide", illustrates the effects of culture, tradition and values on the attitudes to, and the practice of, suicide.

Age Factors↗
PubMed1998

Issues for nurses regarding elder autonomy.

This article reviews issues related to elder autonomy that challenge nurses in their daily practice. Maintaining and promoting quality patient care is paramount to the profession of nursing. Included in that promotion is the need for nurses to remain sensitive to the older individual's desire to act autonomously and make life choices. A brief review of limitations to elder autonomy is included, as well as examples of research studying autonomous action on the part of the elderly. The completing ethical principle of beneficence is briefly discussed and the issue of competency is considered. Autonomy remains a concern for all health-care providers, in particular, the role of the nurse is to support the decision making of the older adult and provide needed information to allow the elderly person to make decisions based on what is right for him or her.

Aged↗
PubMed2002

Children's rights: a decade of dispute.

AIM: This paper attempts to raise issues surrounding children's rights against a backdrop of ethical principles and their subsequent interpretation and application in practice. METHOD: Key words have been used to search a selection of electronic databases and a range of 'grey' literature has been reviewed. BACKGROUND: Over a decade ago the United Nations (1989) Convention on the Rights of the Child was ratified, with the exception of two member states (UNICEF 2000). The Human Rights Act (Department of Health 1998) became law in October 2000 in the United Kingdom (UK). Despite a decade of recommendations, guidelines and legislation, children's rights, particularly consent to health care, remain complex and inconsistent. As we move into a new era of human rights involving all members of society, it is timely for nurses in the UK to reflect on the challenges created in attempting to interpret the philosophy of such legislation because such complexity surrounds the interpretation of human rights for many other vulnerable clients within health care. FINDINGS: The interpretation of children's rights continues to be influenced by the evolution of the meanings of childhood. Adults view children's rights from multiple perspectives of best interest, which are determined by their beliefs about children's ability to understand and consent to health care and treatment. An ability and right to consent appears not to be balanced by the right to withhold consent. Inconsistency and ambiguity persist in the law and its interpretation. Adults need to develop a more pragmatic approach to children's rights. This requires better understanding of children and their experiences of health care. CONCLUSION: Until adults develop a more pragmatic ideology in relation to children's rights then a true respect for children's autonomy will not be achieved. Consent will therefore remain an adult and legal prerogative.

Child↗
PubMed2005

Parent and adolescent versions of the diabetes-specific parental support for adolescents' autonomy scale: development and initial testing.

OBJECTIVE: To develop and initially test the psychometric properties of parent and adolescent versions of the Diabetes-Specific Parental Support for Adolescents' Autonomy Scale. METHODS: Data-based scale items were developed, analyzed for content validity, and then piloted with 43 adolescents with type 1 diabetes and their parents. Psychometric properties of the scales were then determined with 100 adolescents with type 1 diabetes and their parents. RESULTS: Content validity indices of .80 or greater were obtained for 26 items. Item analysis in the pilot and large-sample groups resulted in 22 items being deleted. Principal Components Analysis of the remaining four items indicated one factor in both parent and adolescent versions, accounting for 50-62% of variance and with Cronbach alpha coefficients of .67-.80. CONCLUSIONS: This newly developed parsimonious scale, initially tested to be reliable, and valid, will facilitate research on parental support for adolescents' development of diabetes management autonomy.

Adolescent↗
PubMed1999

A care perspective on coercion and autonomy.

In the Netherlands there is a growing debate over the possibility of introducing 'compassionate interference' as a form of good psychiatric care. Instead of respecting the autonomy of the patient by adopting an attitude of non-interference, professional carers should take a more active and committed role. There was a great deal of hostile reaction to this suggestion, the most commonly voiced criticism being that it smacked of 'modern paternalism.' Still, the current conception of care leaves us with a paradox. On the one hand patients are regarded as individuals who have a strong interest in (and a right to) freedom and non-interference; on the other hand many of them have a desperate need for flourishing, viable relationships. In fact, part of their problem is that they cannot relate very well with other people. This creates a dichotomy, because respecting patients' autonomy often means that they cannot be given the help they so desperately need. In this respect current care practices do not answer the caring needs of these patients. The criticism on care practices is to be considered as important. It invites us to reexamine and reevaluate the current conception of caring relationships and its main values. In line with this reexamination an alternative perspective on care is introduced in this paper, a perspective in which 'compassionate interference' is not so much a threat to autonomy, but a means of attaining autonomy. For this we need a different definition of autonomy than that commonly used in current care practice.

Altruism↗
PubMed2006

Moral considerations in body donation for scientific research: a unique look at the University of Tennessee's anthropological research facility.

This paper discusses keys to the moral procurement, treatment and disposition of remains used for scientific research, specifically those donated to the University of Tennessee's Anthropological Research Facility (ARF). The ARF is an outdoor laboratory dedicated to better understanding the fate of human remains in forensic contexts, and focuses its research on decomposition, time since death estimates, body location and recovery techniques, and skeletal analysis. Historically, many donations were unclaimed bodies received from medical examiners (although it will be shown that this trend is changing), and it has been argued that the use of the unclaimed bodies for medical or scientific purposes is a violation of autonomy since no consent was given by the individual. It is argued here, however, that the domain of autonomous choice extends to one's own corpse only insofar as expressed wishes are made known prior to one's death, and that in the absence of expressed intent toward final disposition, it is acceptable for institutions to receive donations from medical examiners or family members. This paper also discusses other philosophical issues related to donation, consent and autonomy, and the forensic benefits of research conducted at the Anthropological Research Facility.

Cadaver↗