The value of autonomy in medical ethics
Admittedly, this connection is not made by many advocates either of autonomy ( Beauchamp and Childress, p 57–), or of the contractual model: indeed, the. Understand the relationships among moral value judgments, moral rules or .. Biomedical Ethics Beauchamp and Childress “believe that principles provide the follows: respect for autonomy; nonmaleficence; beneficence; and justice. The four rules of professional–patient relationships set forth and explained by Beauchamp and Childress are: a. Autonomy, privacy, respect, and confidentiality.
Discussion In analyzing the above case, the physician had a prima facie duty to respect the autonomous choice of the patient, as well as a prima facie duty to avoid harm and to provide a medical benefit.
In this case, informed by community practice and the provisions of the law for the free exercise of one's religion, the physician gave greater priority to the respect for patient autonomy than to other duties. By contrast, in an emergency, if the patient in question happens to be a ten year old child, and the parents refuse permission for a life saving blood transfusion, in the State of Washington and other states as well, there is legal precedence for overriding the parent's wishes by appealing to the Juvenile Court Judge who is authorized by the state to protect the lives of its citizens, particularly minors, until they reach the age of majority and can make such choices independently.
Thus, in the case of the vulnerable minor child, the principle of avoiding the harm of death, and the principle of providing a medical benefit that can restore the child to health and life, would be given precedence over the autonomy of the child's parents as surrogate decision makers McCormick, See Parental Decision Making top 2. The Principle of Nonmaleficence The principle of nonmaleficence requires of us that we not intentionally create a harm or injury to the patient, either through acts of commission or omission.
The Ethics Centre - Thomas Beauchamp & James Childress on Medical Ethics
In common language, we consider it negligent if one imposes a careless or unreasonable risk of harm upon another. Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our commonly held moral convictions, but by the laws of society as well see Law and Medical Ethics. This principle affirms the need for medical competence.
It is clear that medical mistakes may occur; however, this principle articulates a fundamental commitment on the part of health care professionals to protect their patients from harm.
The value of autonomy in medical ethics
Case 2 In the course of caring for patients, there are situations in which some type of harm seems inevitable, and we are usually morally bound to choose the lesser of the two evils, although the lesser of evils may be determined by the circumstances. For example, most would be willing to experience some pain if the procedure in question would prolong life. However, in other cases, such as the case of a patient dying of painful intestinal carcinoma, the patient might choose to forego CPR in the event of a cardiac or respiratory arrest, or the patient might choose to forego life-sustaining technology such as dialysis or a respirator.
The reason for such a choice is based on the belief of the patient that prolonged living with a painful and debilitating condition is worse than death, a greater harm. It is also important to note in this case that this determination was made by the patient, who alone is the authority on the interpretation of the "greater" or "lesser" harm for the self.
Discussion There is another category of cases that is confusing since a single action may have two effects, one that is considered a good effect, the other a bad effect. How does our duty to the principle of nonmaleficence direct us in such cases? The formal name for the principle governing this category of cases is usually called the principle of double effect.
A typical example might be the question as to how to best treat a pregnant woman newly diagnosed with cancer of the uterus. The usual treatment, removal of the uterus is considered a life saving treatment.
However, this procedure would result in the death of the fetus. What action is morally allowable, or, what is our duty?Ethical Principles
It is argued in this case that the woman has the right to self-defense, and the action of the hysterectomy is aimed at defending and preserving her life. The foreseeable unintended consequence though undesired is the death of the fetus.
There are four conditions that usually apply to the principle of double effect: The nature of the act. The action itself must not be intrinsically wrong; it must be a good or at least morally neutral act. A beneficent person does more than the bare minimum. The applications of beneficence in healthcare are wide reaching. On a larger level, beneficence can determine how a national health system approaches a problem like organ donation.
In Australia, organ donation is voluntary. However, beneficence might suggest reversing this process. Our healthcare system would do more good if we had more organs to give. The principle of beneficence can often clash with the principle of autonomy. Beauchamp and Childress think autonomy can only be violated in the most extreme circumstances: However, given the administration of medical procedures without consent can result in legal charges of assault or battery in Australia, there is clearly still debate around how to best balance these two principles.
Distribute health resources fairly Healthcare often operates with limited resources. Justice is the principle that helps us determine who gets priority in these cases. However, rather than providing their own theory, Beauchamp and Childress pointed out the various different philosophical theories of justice in circulation. They observe how resources are distributed will depend on which theory of justice a society subscribes to. Referring to these reasons does not seem to be helpful for the proponents of the argument for autonomy.
Furthermore, adopting the values that the proponents of the argument for autonomy present to explain our alleged reluctance towards letting others choose for us does not commit us to accepting that there is reason to allow persons to make their own choices when they consider others more capable of getting good results for them, since each of these values can be pursued when persons are better at making choices than others, or equally good with them.
A continued to seek a partner, but could not find a suitable one. A couple of times she thought she had found her perfect match, and she even married twice, but her marriages ended in divorces. She became even more frustrated with her work, which currently is nothing but a drag for her. Due to marital and work problems, she has become depressive and considers that only alcohol can console her, etc.
However, what has happened to A follows from her own autonomous choices. A then complains to B that she has ruined her life and that she is miserable. In other words, although A is, and has been, autonomous, her autonomy as such has no value for her. Although A does value her autonomy, this objection could proceed, she values the wellbeing that getting a satisfying job and a good marriage assumedly could have brought even more.
However, the argument for autonomy claims that we put so much value on making our own choices in important matters of our lives that we are not willing to give it up even if we were convinced that others could make better choices for us than we can.
If this were true, A should not be more interested in her wellbeing than she is in her autonomy.
However, I would argue that bad choices are the worse for us the more they are of our own making. If, for example, a person commits what she considers to be a terrible crime autonomously, why should she consider it to be positively valuable for her that it was she who committed the crime? If committing the crime requires some special skills that the person has to a rare degree, she can be proud of having these skills, but it would be intuitively implausible to maintain that her using these skills in a way that she considers to be bad could have intrinsic positive value for her.
But what would be an acceptable balance between autonomy and wellbeing for proponents of the argument for autonomy? But referring to that kind of balance between autonomy and wellbeing would not support the argument for autonomy, since even A was not, nor is, hideously tortured and there is no serious threat of her going mad.
Let us assume that B has found a partner that she likes very much and that she is pursuing a career that brings her great satisfaction. B is then offered the possibility to delegate her decisions of whom to marry and what line of job to pursue to experts, and she is aware that studies show a higher level of satisfaction among marriages and jobs chosen by experts than among those chosen by the individuals themselves. Should B, as a reasonable and autonomous person, be reluctant towards delegating her decisions to experts?
I think that B could be willing to let experts make her marriage and career choices. And even if she were not, this could not show that B values her autonomy irrespective of its effects on her wellbeing. She is after all a highly competent person, and probably knows herself better than the experts.
When B considers these things, she may think that, since she is faring sufficiently well already, in her case it does not pay to resort to any outside help. Her reluctance towards letting others to make her choices would thus ultimately be based on her valuing her wellbeing, not on her seeing her autonomy as valuable irrespective of its role in promoting her wellbeing.
But what reason does one have to accept this? I am unwilling to let others make my important life choices for me. But when I consider the possibility of letting others choose for me and find myself being reluctant towards doing that, I do not think about autonomy, agency, self-creation, expressing myself, etc. In addition to those discussed above, the argument for autonomy confronts still other problems. Below I turn to those difficulties. Delegating our choices to others and autonomy Proponents of the argument for autonomy thus aim to demonstrate that autonomy has intrinsic value for us by drawing attention to the alleged fact that we are not willing to delegate our important choices to other people even if we believe that they can make better choices than we can.
A problem with this line of thinking is that letting others to make our important choices for us need not be incompatible with our being autonomous. If the person delegating her choices to others is autonomous to begin with and nobody manipulates or tricks her into renouncing her choices, coerces her, etc.
Indeed, if others are more capable of getting the kind of results that the person wants, the person who lets others make her choices for her can thereby become even more autonomous than she were to begin with. This is because, as a consequence of letting others make her important choices for her, her life goes more in the way that she wants than it would have gone if she had made her choices by herself.
- Multiple Choice
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At least for those accepting the procedural conception of autonomy, letting others make choices for one can thus be one autonomous decision among others.
A proponent of the argument for autonomy might object that we should see autonomy as a property of decisions and choices and that if a person lets others make her choices for her, she cannot be autonomous anymore. Let us, for the sake of argument, assume that autonomy is not primarily a property of persons, but a characteristic of the decisions and choices that persons make.
However, when, for example, a patient autonomously decides to undergo a complicated surgery, we can reasonably consider her as autonomous with respect to that surgery even though she does not autonomously choose each action performed during the operation. Similarly, an autonomous person remains autonomous after letting others choose a job and a partner for her. If it is objected that the patient who gives her autonomous consent to undergo the surgery assesses each of the actions that will be performed during the operation beforehand and gives her advanced consent to them, it can be responded that this is possible in the case of the person who delegates her career and marriage choices to others too.
A critic might still insist that, even if her life would go more in the way that she wants it to go after she renounces her choices to others, the person who lets others choose for her is heteronomous with respect to making the particular choices that others then make on her behalf.
As the person does not make these choices herself, this possible objection could proceed, she is not in control of them anymore. There are two points I would like to make concerning this possible criticism.
But at least when the person is able to withdraw her consent to letting others choose for her, it is intuitively plausible to accept that, in the sense relevant here, she has control over the choices that others make on her behalf. And in medicine, with the exception of patients like those who are under the influence of heavy anaesthetic, a patient who has given her informed consent to undergo a treatment is usually able to withdraw this consent if that is what she wants to do.
Second, contrary to what this criticism presupposes, we should not accept that a person can be in the relevant sense in control of choices, decisions, and actions only if she performs them by herself. Accepting that a person can be autonomous with respect to choices, decisions, and actions only if she controls them in the sense that she performs them by herself has the counterintuitive implication that patients can remain autonomous only if they treat themselves without any resort to outside help.
Its explanation of our alleged unwillingness to let others make our choices for us results in a still further problem for the argument for autonomy.
On the basis of my own case, I would argue that a person who considers the possibility of letting others choose for him and finds himself being reluctant towards doing that need not think about autonomy, self-creation, expressing herself, giving his life unique meaning, etc.
Although making such a requirement would not result in presenting substantive ends for autonomous persons so that one would then maintain, for example, that wanting to be a subservient housewife or requesting for euthanasia can never be autonomous, it would however rule out some substantive views on other than purely procedural grounds.
To maintain that an autonomous person wants to express herself, that an autonomous person wants to have a distinctive and unique life, etc.
And, for obvious reasons, saying that this kind of person is heteronomous cannot be based on purely procedural points of departure. Thus, the view maintaining that an autonomous person does not want to let others choose for her because she wants to express herself, because she wants to have an unique life, etc. If a conception of autonomy rules out these procedures to begin with, it cannot be a purely procedural conception of autonomy. To recapitulate, the argument for autonomy consists of maintaining that we would not be willing to let others make our important choices for us even if we believed that they could make better choices than we can.
This is taken to demonstrate that we put intrinsic value on our autonomy. Above I argued for several points against the argument for autonomy. First, contrary to what the argument for autonomy presupposes, it plausible that autonomous and reasonable persons are willing to let others choose for them if they believe that others can make better choices than they themselves can.
Second, many of the reasons that proponents of the argument for autonomy present for our alleged reluctance towards letting others choose for us do not presuppose autonomy. Third, accepting the reasons for our alleged unwillingness to let others choose for us that the proponents of the argument for us that the proponents of the argument for autonomy refer to does not commit one to accepting that persons should be allowed to make their own choices when other could choose better than them, because these reasons can be pursued when others are equally good, or worse, at making choices.
Fourth, even if a person would not be willing to let others choose for her, this would not demonstrate that she puts intrinsic value on her autonomy, as this unwillingness has other, and more plausible, explanations. Sixth, the reasons that proponents of the argument for autonomy present for our alleged reluctance towards letting others choose for us are incompatible with the procedural conception of autonomy that they accept.