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PubMed2003

Admission and continued-stay criteria for assisted living facilities.

As residents in assisted living facilities (ALFs) try to "age in place" but decline in health, the facilities, families, and residents must find a balance between protecting the health and safety of residents in ALFs and maintaining their desire to live independently. The assisted living industry incorporates resident autonomy into its goals, but with regard to resident health and safety, recent reports have found that ALF staff are struggling to provide adequate care for residents with increasingly complex needs. Moreover, state regulations are not consistent in obligating ALFs to prioritize adequate health care and protection for residents over resident autonomy, or vice versa. A set of admission and continued stay criteria for individuals residing in assisted living that could serve as a guideline for state regulations in addressing the balance between safety and autonomy in ALFs is recommended.

Aged↗
PubMed2003

The fetus as a patient: an essential concept for the ethics of perinatal medicine.

This article celebrates the professional life and contributions of Dr. Peter Auld, a founder of perinatal medicine. To this end we describe the essential concept of the fetus as a patient, based on two core ethical principles, beneficence and respect for autonomy. We explore the implications of this concept for perinatal medicine.

Beneficence↗
PubMed2005

Treating competent patients by force: the limits and lessons of Israel's Patient's Rights Act.

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient's decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence of this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients' informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm.

Aged↗
PubMed2006

Formal and effective autonomy in healthcare.

This essay lays the groundwork for a novel conception of autonomy that may be called "effective autonomy"-a conception designed to be genuinely action guiding in bioethics. As empirical psychology research on the heuristics and biases approach shows, decision making commonly fails to correspond to people's desires because of the biases arising from bounded cognition. People who are classified as autonomous on contemporary philosophical accounts may fail to be effectively autonomous because their decisions are uncoupled from their autonomous desires. Accordingly, continuing attempts to value patient autonomy must go beyond existing philosophical conceptions of autonomy to consider the background conditions of human decision making.

Decision Making↗
PubMed1997

"Goodbye Dolly?" The ethics of human cloning.

The ethical implications of human clones have been much alluded to, but have seldom been examined with any rigour. This paper examines the possible uses and abuses of human cloning and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major public and official responses to cloning by authorities such as President Clinton, the World Health Organisation, the European parliament, UNESCO, and others and reveals their inadequacies as foundations for a coherent public policy on human cloning. The paper ends by defending a conception of reproductive rights of "procreative autonomy" which shows human cloning to be not inconsistent with human rights and dignity.

Animals↗
PubMed1999

Family consent, communication, and advance directives for cancer disclosure: a Japanese case and discussion.

The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good.

Advance Directives↗
PubMed1989

The history of confidentiality in medicine: the physician-patient relationship.

The author of this article reviews the history of the confidentiality of medical information relating to patients from its roots in the Hippocratic Oath to the current codes of medical ethics. There has been an important shift in the basis for the demand for confidentiality, from a physician-based commitment to a professional ideal that will improve the physician-patient relationship and thus the physician's therapeutic effectiveness, and replace it with a patientbased right arising from individual autonomy instead of a Hippocratic paternalistic privilege.

Canada↗
PubMed2000

Death with dignity or life with health care rationing.

The observations made of Oregon's Death with Dignity Act are reassuring to the extent that they accurately state that patients who seek relief under the Act view it as a mechanism to further their autonomy. But, given the nature of social data gathering, including the potential for response bias and self-validation, and the degree to which the concept of "autonomy" is open to a broad or narrow interpretation, one has to be careful not to accept this finding at face value. It is also reassuring to read that contrary to what some people have supposed, the presence of an option to hasten death has not had a chilling effect on the prescription of pain medication. At the same time, however, the authors believe that it is important to ensure that these expressions of autonomy-based reasoning are indeed valid and authentic.

Coercion↗
PubMed1981

Truth: treatment of choice, scarce resource, or patient's right?

Two approaches are described for addressing ethical problems of truth telling. In neither approach is truth telling an ethical absolute, but rather a means of attaining the goal that is assumed for medicine. The first approach, based upon the aim of benefiting the patient, is the view that information is to be disclosed or withheld according to the anticipated effect upon the patient's well-being. The second approach, based upon the aim of facilitating patient autonomy in health matters, is the view that informed decision making requires access to all information the patient considers relevant. While the choice between the two views belongs to the individual practitioner, the author proposes that the autonomy position affords the greatest benefit to both patient and physician.

Clinical Competence↗