Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Respect for Autonomy. Show all posts
Showing posts with label Respect for Autonomy. Show all posts

Friday, May 9, 2014

Are medical students ethically illiterate?

By Xavier Symons
BioEdge
Originally published June 1, 2013

Here is an excerpt:

Many experts believe that there needs to be more ethical education at a practical clinical level if students are to retain the information. “I would really encourage [faculties] to think about how to integrate ethical education also into the clinical realm,” said Dr Lauris Kaldjian, principal author and director of bioethics and humanities at the University of Iowa Carver College of Medicine.

The entire article is here.

Here is a link to the original study.

Tuesday, January 7, 2014

The Ethics of Chemical Castration (Part One)

By John Danaher
Philosophical Disquisitions: Institute for Ethics and Emerging Technologies
Originally posted December 15, 2013

Chemical castration has been legally recognised and utilised as a form of treatment for certain types of sex offender for many years. This is in the belief that it can significantly reduce recidivism rates amongst this class of offenders. Its usage varies around the world. Nine U.S. states currently allow for it, as well as several European countries. Typically, it is presented as an “option” to sex offenders who are currently serving prison sentences. The idea being that if they voluntarily submit to chemical castration they can serve a reduced sentence.

Obviously, this practice raises a number of empirical and ethical questions. Does chemical castration actually reduce recidivism? Is it ethically right to present a convicted sex offender with a choice between continued imprisonment or release with chemical castration? Is this not unduly coercive and autonomy-undermining?

The entire article is here.

Saturday, August 31, 2013

Where Does Morality Come From?

By John Corvino
Published on Mar 27, 2013

Is it possible to have a foundation for moral beliefs without appealing to Scripture? John Corvino argues that it is, making a plea for humility from all parties in the debate. At the same time, he challenges his fellow liberals to reject the claim that "morality is a private matter."



Thursday, July 11, 2013

Privacy and the Threat to the Self

By MICHAEL P. LYNCH
The New York Times - Opinionator
Originally published June 22, 2013

In the wake of continuing revelations of government spying programs and the recent Supreme Court ruling on DNA collection – both of which push the generally accepted boundaries against state intrusion on the person — the issue of privacy is foremost on the public mind. The frequent mantra, heard from both media commentators and government officials, is that we face a “trade-off” between safety and convenience on one hand and privacy on the other. We just need, we are told, to find the right balance.

This way of framing the issue makes sense if you understand privacy solely as a political or legal concept. And its political importance is certainly part of what makes privacy so important: what is private is what is yours alone to control, without interference from others or the state. But the concept of privacy also matters for another, deeper reason. It is intimately connected to what it is to be an autonomous person.

What makes your thoughts your thoughts? One answer is that you have what philosophers sometimes call “privileged access” to them. This means at least two things. First, you access them in a way I can’t. Even if I could walk a mile in your shoes, I can’t know what you feel in the same way you can: you see it from the inside so to speak. Second, you can, at least sometimes, control what I know about your thoughts. You can hide your true feelings from me, or let me have the key to your heart.

The entire story is here.

Saturday, June 15, 2013

UNC-Chapel Hill drops honor court case against student

By Phil Gast
CNN
Originally posted June 7, 2013

The University of North Carolina at Chapel Hill has dropped honor-court proceedings against a student who said the school retaliated against her for a sexual assault allegation.

In an e-mail to faculty and students on Thursday, Chancellor Holden Thorp said an outside review indicated no evidence of retaliation against Landen Gambill, who accused her ex-boyfriend of rape.

Gambill is one of several students who sparked a Department of Education investigation into how the university handles sex assault cases.

Thorp said a section of the honor code pertaining to "disruptive or intimidating behavior" would be suspended pending further review.

"This action is not a challenge to the important role of students in our Honor System, but is intended to protect the free speech rights of our students," the chancellor said in his e-mail. Thorp said the "important issue" will receive further discussion.

Gambill's attorney, Henry Clay Turner, had written a letter to Thorp, saying his client believed the university was retaliating against her because it let the student-run honor court charge her with intimidating her former boyfriend.

Gambill did not file a sexual assault report with police, and her former boyfriend -- who has not been identified publicly -- denied her accusation, according to his attorney.

The entire story is here.


Thursday, June 6, 2013

Gag Orders on Sexuality

By Allie Grasgreen
Inside Higher Ed
Originally posted on May 23, 2013

When Brittney Griner, Baylor University’s star basketball player and one of the most celebrated athletes in the history of the sport, came out publicly as gay last month, she was rather nonchalant about it. She didn’t write a Sports Illustrated cover story – à la professional basketball player Jason Collins, a few weeks later – she just sort of mentioned it in media interviews. Griner is “someone who’s always been open,” she said, with family, friends and teammates.

But, as Griner revealed a few weeks later, she wasn’t allowed to be open as much as she might have liked. That’s because Baylor head coach Kim Mulkey told her and her teammates not to talk publicly about their sexuality.

“It was a recruiting thing,” Griner told ESPN. “The coaches thought that if it seemed like they condoned it, people wouldn’t let their kids come play for Baylor.”

Griner's account followed on the heels of speculation that her coming out signaled a new age at Baylor – a private Christian university whose nondiscrimination policy does not cover sexual orientation and whose student handbook entry for “sexual misconduct” includes as examples of inappropriate actions "homosexual behavior" and participation in “advocacy groups which promote understanding of sexuality that are contrary to biblical teaching.”

Monday, March 4, 2013

Advocates Seek Mental Health Changes, Including Power to Detain

By BRANDI GRISSOM
The Texas Tribune/The New York Times
Published: February 23, 2013

Here are some excerpts:

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

(cut)

Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.

The entire story is here.

Saturday, August 18, 2012

In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide

by Katie Hafner
The New York Times
Originally published on August 11, 2012

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.

Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable. And they are making the choice not because they are in pain but because they want to have the same control over their deaths that they have had over their lives.

(cut)

Dr. Linda Ganzini, a professor of psychiatry at Oregon Health and Science University, published a study in 2009 of 56 Oregonians who were in the process of requesting physician-aided dying.
      
“Everybody thought this was going to be about pain,” Dr. Ganzini said. “It turns out pain is kind of irrelevant.”

By far the most common reasons, Dr. Ganzini’s study found, were the desire to be in control, to remain autonomous and to die at home. “It turns out that for this group of people, dying is less about physical symptoms than personal values,” she said.

Saturday, December 24, 2011

Patient Participation in Medical and Social Decisions in Alzheimer's Disease

By Johannes Hamann, MD; Katharina Bronner; Julia Margull; Rosmarie Mendel, PhD; Janine Diehl-Schmid, MD; Markus Bühner, PhD; Reinhold Klein, MD; Antonius Schneider, MD; Alexander Kurz, MD; Robert Perneczky, MD

From Journal of the American Geriatrics Society

The participation of patients in healthcare-related decisions is an ethical imperative that patient organizations and treatment guidelines promote. The mental health guidelines for most major psychiatric disorders, such as depression or schizophrenia, strongly recommend the inclusion of patients in all healthcare decisions,[1, 2] but Alzheimer's disease (AD) is an exception in this regard; although guidelines emphasize the disclosure of diagnosis and stress patient independence as a major aim, they consider impaired decisional capacity to be a limiting factor for patient participation at the same time.[3] Although AD is characterized by a cognitive decline that impairs the participation in medical decision-making,[4, 5] decisional capacity for important medical and social decisions might still be intact in patients in the early clinical stages of AD.[6] Important medical and social decisions that need to be made in these early stages are the introduction of an advance directive, a decision about driving, the initiation of antidementia treatment, and participation in clinical trials. Preventing patients from participating in these decisions not only reduces patient autonomy, but also risks ignoring the patients' will while they are still capable of making decisions, which might result in postponed decisions until decisional capacity has been lost.

The entire study can be found here.  In order to access the study, the reader needs to be registered with Medscape.  Registration is free.

Wednesday, August 3, 2011

Reviewing Autonomy

Implications of the Neurosciences and the Free Will Debate for the Principle of Respect for the Patient's Autonomy

Sabine Muller & Henrik Walter. Cambridge Quarterly of Healthcare Ethics. New York: Apr 2010. Vol. 19, Iss. 2; pg. 205, 13 pgs

Introduction

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.

Beauchamp and Childress analyze autonomous actions in terms of normal choosers who act (1) intentionally, (2) with understanding, and (3) without controlling influences (coercion, persuasion, and manipulation) that determine their actions. 1 In terms of the free will debate, the absence of external controlling influences, their third criterion, corresponds to the freedom of action: to do what one wants to do without being hindered to do so. Criteria one and two are related to volition: that a choice is intentional, that is, that it has a certain goal that is properly understood by the person choosing.

According to Beauchamp and Childress, the principle of autonomy implies that patients have the right to choose between different medical therapy options taking into account risks and benefits as well as their personal situation and individual values. To enable an autonomous decision the procedure of informed consent 2 has been developed. This procedure has become the gold standard in almost every part of medicine. Importantly, Beauchamp and Childress demand respect for a patient's autonomy under the premise that the patient is able to act in a sufficiently autonomous manner. 3 The crucial question in a special situation is whether this is the case.

Let us consider the example of the recent controversial discussion of Body Integrity Identity disorder: 4 If a patient asks a physician to amputate one of his legs although it neither hurts nor is deformed, paralyzed, or ugly (in the patient's view), and if the patient understands the consequences of the amputation and is not controlled by external influences, then one could deduce from the principle of respect for the patient's autonomy that the physician should amputate the leg. Although some commentators regard this as self-evident, we think that the case is not yet made, as it is important which internal processes have led to the wish of the patient.

We propose to add a fourth criterion for autonomous actions, namely, freedom of internal coercive influences. In the case of the patient who desires an amputation, it would have to be investigated whether his decision is based on internal coercion. Clear examples for that would be an acute episode of schizophrenia or a brain tumor. More controversial are neurotic beliefs, obsession and compulsion, severe personality disorders, or neurological dysfunctions not accessible with conventional diagnostic tools.

Although Beauchamp and Childress have not elaborated the principle of autonomy with regard to internal coercions, they clearly argue that the obligations to respect autonomy do not apply to persons who show a substantial lack of autonomy because they are immature, incapacitated, ignorant, coerced, or exploited, for example, infants, irrationally suicidal individuals, severely demented subjects, or drug-dependent patients. 5 But these kinds of patients are treated in medical ethics as exceptions and therefore as marginal cases. They are not considered to be important for the formulation of the principles.

The rest of the article can be found here.  Without access to PubMed.gov, it is not available for free.  A university library may also be helpful in reading the entire article.