autonomy
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Principle of Respect for Autonomy
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AutonomyAutonomy
Autonomy: Key concepts
Competence Informed consent
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Autonomy: Autonomy: DerivationDerivation Greek autos (“self”) nomos (“rule,” governance,” or “law”) originally referred to self-governance of
independent Hellenic city-states
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Autonomy: Essential Autonomy: Essential ConditionsConditions Liberty - independence from controlling influences
Agency - capacity for intentional action
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Autonomous ActionAutonomous ActionBy normal persons who act:IntentionallyWith understandingWithout controlling influences that determine their action
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Principle of Respect for Principle of Respect for AutonomyAutonomy
Being autonomous is not the same as being respected as an autonomous agent.
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Principle of Respect Principle of Respect for Autonomyfor Autonomy
To respect an autonomous agent requires recognition of other’s right to:
hold views, make choices & take actions based on beliefs and attitudes
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Principle of Respect Principle of Respect for Autonomyfor Autonomy
Involves respectful action, not merely respectful
attitude
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Kant’s ViewKant’s View
Respect for autonomy flows from recognition:that all people have unconditional worth &capacity to determine own destiny
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Immanuel Kant’s ViewImmanuel Kant’s View
To violate a person’s autonomy is to treat that person as a means - in accordance with others’ goals without regard to his or her goals.
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Immanuel Kant’s ViewImmanuel Kant’s View
Must assist persons in achieving their ends
Foster their capacities as agents
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John Stewart Mill’s ViewJohn Stewart Mill’s ViewCitizens should be permitted to develop according to their personal convictions, as long as they do not interfere with a like expression of freedom by others.
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Respect for Autonomy - Respect for Autonomy - Related ConceptsRelated ConceptsRights and obligations of:- privacy- confidentiality- truthfulness- consent
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Respect for Autonomy: Respect for Autonomy: ScopeScopeDisagreement in literature over
scope of rights related to autonomy
Prima facie standingCan be over-ridden by
competing moral considerations
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Autonomy & ConsentAutonomy & Consent
Basic paradigm of autonomy in health care:
express and informed consent
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CompetenceCompetenceCore meaning - the ability to perform a task
Criteria for competence:- should be relative to decision- rarely incompetent in all
spheres
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CompetencyCompetencyAsk - “Competency for what?”Sometimes the following are
inappropriate triggers for questioning competency:
- not doing what MD/nurse think should do
- preferences not mainstream
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Categories of PeopleCategories of Peoplecompetent was competent but now is not - wishes known - wishes not knownnever competentnewborn
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Categories of PeopleCategories of PeopleWas competent but now is not
permanent reversible
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Incompetent Incompetent CategoriesCategoriesFetuses, newborns, childrenBrain deadPersistent vegetative stateRetardedClearly mentally illDementia
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Competent Consent or Competent Consent or DecisionDecisionAdult person with ability to: - get information - comprehension - process information - capacity - make decision & communicate itAware of: medical situation &
prognosis; alternatives; & risks, benefits, & consequences of each
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Competent Consent or Competent Consent or DecisionDecisionAbsence of coercionDecision is stable over timeDecision is consistent with person’s values & goals
Decision not a result of delusions or hallucinations