Relational Autonomy, Paternalism, and Maternalism

Sullivan, Laura Specker; Niker, Fay

doi:10.1007/s10677-018-9900-z

Cited by 29 publications

(19 citation statements)

References 30 publications

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“…Our finding that, regardless of how individualistic they identified as (on the communitarian-individualist scale), people perceive an influence from a PREAUTHORIZED agent as less undue than the identical influence from a NON-PREAUTHORIZED agent is all the more interesting in light of this persistent cultural glorification of the rugged individual making decisions “for himself, by himself” ( Callero, 2013 ; Brownlee, 2017 ). Our data suggest that people tend to see through this “myth of individualism” ( Code, 2016 ) when considering how they navigate their own lives; instead, they appear to ascribe to a more relational conception of autonomy, which understands autonomous decision-making as partly conditional on the cultivation of the types of relationships and interpersonal contexts that can support its realization ( Mackenzie and Stoljar, 2000 ; Specker Sullivan and Niker, 2018 ).…”

Section: Discussionmentioning

confidence: 94%

“…There is a burgeoning philosophical literature on these topics. For instance, some theorists have argued in favor of reconceptualizing personal autonomy along socio-relational lines ( Mackenzie and Stoljar, 2000 ; Oshana, 2006 ), and the implications of this reconceptualization for other concepts in moral and political theory are beginning to be considered ( Christman, 2014 ; Specker Sullivan and Niker, 2018 ). There is also increasing philosophical interest in exploring and integrating social dimensions into our accounts of moral responsibility ( Vargas, 2013 ; Hutchison et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Perceptions of Undue Influence Shed Light on the Folk Conception of Autonomy

2018

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Advances in psychology and neuroscience have elucidated the social aspects of human agency, leading to a broad shift in our thinking about fundamental concepts such as autonomy and responsibility. Here, we address a critical aspect of this inquiry by investigating how people consider the socio-relational nature of their own agency, particularly the influence of others on their perceived control over their decisions and actions. Specifically, in a series of studies using contrastive vignettes, we examine public attitudes about when external influences on everyday decisions are perceived as “undue” – that is, as undermining the control conditions for these decisions to be considered autonomous – vs. when they are perceived as appropriate and even supportive of autonomous decision-making. We found that the influence of preauthorized agents – individuals and institutions with whom we share a worldview – was judged to be less undue than non-preauthorized agents, even after controlling for the familiarity of the agent. These effects persisted irrespective of the extent to which respondents identified as communitarian or individualistic, and were consistent across two distinct scenarios. We also found that external influences that were rational were perceived as less undue than those that were arational. Our study opens new avenues of inquiry into the “folk conception” of autonomy, and we discuss the implications of our findings for the ethics of public policies designed to influence decisions and for information sharing in social networks.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Perceptions of Undue Influence Shed Light on the Folk Conception of Autonomy

2018

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“…Although lab/imaging facilities required for diagnosis are available in most rural health settings, individuals experience similar barriers related to accessing health care resources. 74 Studies conducted in rural settings report limited resources on education about dementia and dementia care, as well as services such as adapted transportation, respite, and day-care programs. 75,76 Receptiveness to receiving formal caregiving may be influenced by cultural or political beliefs, the distance between the home of the patient and their provider, or misunderstandings about dementia or delayed diagnosis that can isolate the individual with dementia.…”

Section: Mistrust With Providersmentioning

confidence: 99%

“…This culture of independence and self‐reliance within rural communities can result in the misconception that receiving support or seeking new knowledge is a sign of dependency. Paternalism or maternalism elicits both positive (protection from harm) and negative (unwarranted loss of autonomy) influences in rural settings based on the degree of illness and involvement by caregivers 74 . Beliefs and attitudes toward seeking help and receiving care from family/friends versus receiving care from formal providers influences whether dementia care is adequate.…”

Section: Modifiable Factors Contributing To Adrd Burden In Rural Areasmentioning

confidence: 99%

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Wiese,

Gibson,

Guest

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONIndividuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place‐based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.METHODSAn interdisciplinary, international group of ADRD researchers convened to address the overarching question of: “What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?” In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.RESULTSA range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.DISCUSSIONA location dynamics model and ADRD‐focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.HIGHLIGHTS Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD‐related challenges. A novel “location dynamics” model guides assessment of rural‐specific ADRD issues.

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“…Another approach to solve the conundrums of paternalism is medical maternalism, which is increasingly emerging in contemporary medical ethics (Specker Sullivan & Niker, 2018). It considers patients’ autonomy in a relational context and allows space for HCPs to support their patients in medical decision making through counseling.…”

Section: Introductionmentioning

confidence: 99%