Presentation on theme: "N What is ethics? n What is autonomy? n Models of the health- professional-patient relationship."— Presentation transcript:
n What is ethics? n What is autonomy? n Models of the health- professional-patient relationship
What ought to be done in a given situation, all things considered? --Benjamin and Curtis
What ought to be done... n Action oriented n Implies personal ownership and responsibility n Implies choice n Implies reasonable control
…in a given situation... n All ethics is “situation ethics” n Concrete facts matter n What makes one situation like another situation in ethically relevant ways?
…all things considered? n There is no “ethical point of view” distinct from other (“practical”) points of view n Good ethical reasoning is not a new viewpoint but an integration (and critical analysis) of all existing viewpoints n Can we ever in practice “consider all things” finally and irrevocably? (Provisional nature of ethical conclusion)
What ought to be done in a given situation, all things considered? Is this the only “ethical” question?
Snapshot vs. videotape n What does it mean to do the right thing now? n What does it mean to live a morally good life?
Snapshot vs. videotape n What does it mean to do the right thing now? n Rules, principles, case study n What does it mean to live a morally good life? n Virtue
(Respect for) Autonomy n Not interfering in another’s wishes and choices n Treat others as ends-in-themselves and not as means only (Kant) n = Self-determination n Assumes “adult” capacities
Paternalism n Refusing to acquiesce in another person’s wishes or choices for that person’s own benefit. --Childress
Paternalism and Principles n Paternalism = principle of benefit/harm takes priority over principle of autonomy n Other, non-benefit-based reasons to reject autonomy not paternalism n Is it “really” paternalism if principle of autonomy does not apply due to lack of capacity?
Why paternalism and not parentalism? n Is concept gender-specific? n Does it derive from a gender-specific role? n “Father Knows Best” (TV show, 1950’s)
Paternalism and the history of U.S. medical ethics n Hippocratic ethic: no challenge to physician paternalism n 1960’s: traditional authority questioned n Veatch: Contractual vs. priestly model of physician-patient relationship, 1972 n Veatch, “generalization of expertise,” 1973
Paternalism and the history of U.S. medical ethics n Much of U.S. medical ethics since the 1960’s amounts to the refutation of physician paternalism
Autonomy: Problems to flag n Is autonomy culturally specific? n Is autonomy gender biased? n Does autonomy favor some life stages over others? n Does autonomy focus on individual in isolation rather than as member of family and community?
Models of P-patient relationship n Veatch, 1972: Priestly vs. Contractual models n Miller, 1981: 4 senses of autonomy n Emanuels, 1992: Paternalistic vs. Informative models-- and more
Miller, 4 senses of autonomy n Free action n Authenticity n Effective deliberation n Moral reflection --Miller, Hastings Cen Rep 1981