Conscientious Autonomy: Displacing Decisions in Health Care

Kukla, Rebecca

doi:10.1353/hcr.2005.0025

Cited by 79 publications

(51 citation statements)

References 10 publications

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“…25 This study articulated that older people have possibilities to make decisions at least when they are in line with the routines or do not cause extra work for the nurses. According to Kukla,49 the norms and standards of health practice present themselves as already authoritative and in place so they are largely found rather than chosen. She points out that informed, free choice would not be autonomous if one has not capacity to assess one's own commitments, which requires that we have a fair amount of justifiable selftrust.…”

Section: Discussionmentioning

confidence: 99%

Older people’s experiences of their free will in nursing homes

2014

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Section: Discussionmentioning

confidence: 99%

Older people’s experiences of their free will in nursing homes

2014

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“…The consequences of individual decisions have often proved to be difficult for patients to comprehend, which some have taken to indicate that patients do not want to make autonomous choices 20. Perhaps it instead reflects the fact that particular decisions cannot be considered in isolation from the rest of the patient's treatment, and that healthcare must be understood as a continuous and partially routine form of praxis 21. Autonomous choices play a marginal part in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

2010

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The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion.

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“…The requirement of a trusting relationship ensures that the professional has a reasonably accurate understanding of the patient and that, in certain contexts, the patient authorises the physician to act from that understanding 25. The nature of this trust may differ based on the type of decision to be made and how it is made.…”

Section: Medical Maternalismmentioning

confidence: 99%

Medical maternalism: beyond paternalism and antipaternalism

Sullivan

2016

J Med Ethics

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This paper argues that the concept of paternalism is currently overextended to include a variety of actions that, while resembling paternalistic actions, are importantly different. I use the example of Japanese physicians' non-disclosures of cancer diagnoses directly to patients, arguing that the concept of maternalism better captures these actions. To act paternalistically is to substitute one's own judgement for that of another person and decide in place of that person for his/her best interest. By contrast, to act maternalistically is to decide for another person based on a reasonable understanding of that person's own preferences. The concept of maternalism allows for a more thorough assessment of the moral justification of these types of actions. I conclude that it is possible, at least in principle, to justify Japanese physicians' non-disclosures, and that this justification must be based on an understanding of these actions as maternalistic.

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Conscientious Autonomy: Displacing Decisions in Health Care

Cited by 79 publications

References 10 publications

Older people’s experiences of their free will in nursing homes

Older people’s experiences of their free will in nursing homes

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

Medical maternalism: beyond paternalism and antipaternalism

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