Autonomy, Liberty, and Medical Decision-Making

Coggon, John; Miola, José

doi:10.1017/s0008197311000845

Cited by 87 publications

(87 citation statements)

References 35 publications

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“…They justify this position by referring to a plurality of values and the lack of an overarching moral consensus. However, this position is often guided by libertarian motives and extreme emphasis on individual freedom [45]. In this case, they might argue that, if individual can agree with the intrusion of their life sphere, there is no ethical issue any more.…”

Section: Discussionmentioning

confidence: 99%

Smart homes, private homes? An empirical study of technology researchers’ perceptions of ethical issues in developing smart-home health technologies

et al. 2017

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BackgroundSmart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology’s potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought to contribute to dialogue between ethics and the engineering community.MethodsEither face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants’ consent, interviews were audio-recorded, transcribed and analysed using a thematic approach.ResultsTwo overarching themes emerged: in ‘Privacy’, researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In ‘Choice’, researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design.ConclusionsThe tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may reduce acceptability of smart-home technologies to future end-users. While attention to choice suggests links with privacy, this may misidentify the sources of privacy and risk unjustly burdening end-users with problems that they cannot resolve. Separating considerations of choice and privacy may result in more satisfactory treatment of both. Finally, through our engagement with researchers as participants this study demonstrates the relevance of (bio)ethics as a critical partner to smart-home engineering.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-017-0183-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Smart homes, private homes? An empirical study of technology researchers’ perceptions of ethical issues in developing smart-home health technologies

et al. 2017

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“…Stated another way, autonomy is not equivalent to liberty [22,24,47]. As two legal scholars note, "As a legal principle, autonomy's recognition and the potential for its scrutiny allow judgments of whether an apparent expression of will should be followed" [48]. One might envision a reasonable distinction in pediatrics between reason autonomy and act autonomy, the former being the right of parents to make informed decisions, to be acted upon insofar as their preferences do not abrogate the clinician's fiduciary duties to the child.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Manifestations of Iatrogenesis in Pediatrics

Teti¹,

Ennis-Durstine

Silber³

2017

AMA Journal of Ethics

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There is general agreement in the literature of what ought to occur following iatrogenic harm. Senior members of the team should disclose what occurred and how the problem will be remedied. Those involved should express heartfelt regrets and apologize sincerely. But in the pediatric setting, parents, as surrogates, can sometimes place clinicians on the horns of a dilemma: respect parental autonomy, which may involve continuing nonadvised therapy, or uphold the patient's best interests, which may indicate another course of care. In other cases, clinicians themselves may initiate or continue care without real benefit. The young patients who may be harmed as a result often cannot understand an explanation, an apology, or, when warranted, receive reparation; what duties are owed them? In this paper, we first discuss iatrogenesis writ large and then propose the formulation of this concept in this latter context, where harm occurs as a result of counterpoise between two or more ethical obligations, which we term counterpoise iatrogenesis. We then articulate its etiology and manifestation through two true cases. We conclude with a re-examination of the meaning and function of autonomy in pediatrics and the designation of secondary victims. IntroductionIatrogenesis, as we use the term here, refers to any patient harm resulting from treatment by a member of the medical team [1, 2] and is not limited to medical error [1,3]. Following iatrogenic harm, the clinicians involved, preferably senior members of the team, should inform the patient or family of what happened, how the problem will be remedied, and-particularly when lasting harm has occurred-what can be done for the patient [1,3]. Physicians should express regret and offer a sincere apology, which patients who have been harmed deserve [4,5].

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“…Rather than re-tread the vast and varied legal and ethical debates surrounding the concept of autonomy (for which, see e.g., Beauchamp and Childress 2008;Coggon and Miola 2011;Donnelly 2010;Dworkin 1988;MacKenzie and Stoljar 2000;Maclean 2009;McLean 2010;O'Neill 2002), my concern here is much more circumspect. Here, I critique the applicability of two contrasting approaches to autonomy, 'individual autonomy', and 'relational autonomy,' to the lives and experiences of people with dementia.…”

Section: R Harding 426mentioning

confidence: 99%

“…Since 2005, these challenges have been addressed in English law through the MCA, which takes as its starting point the presumption that people have the ability to make their own decisions and exercise autonomy (Coggon and Miola 2011). The MCA framework was developed to codify and consolidate a succession of health care case law (Donnelly 2009) and to provide an expanded approach to determining capacity in English law.…”

Section: R Harding 426mentioning

confidence: 99%

Legal constructions of dementia: discourses of autonomy at the margins of capacity

Harding

2012

Journal of Social Welfare and Family Law

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Autonomy, Liberty, and Medical Decision-Making

Cited by 87 publications

References 35 publications

Smart homes, private homes? An empirical study of technology researchers’ perceptions of ethical issues in developing smart-home health technologies

Smart homes, private homes? An empirical study of technology researchers’ perceptions of ethical issues in developing smart-home health technologies

Etiology and Manifestations of Iatrogenesis in Pediatrics

Legal constructions of dementia: discourses of autonomy at the margins of capacity

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