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Principle of Respect for Autonomy
AutonomyAutonomy
Autonomy: Key concepts
Competence Informed consent
Autonomy: Autonomy: DerivationDerivation Greek autos (“self”) nomos (“rule,” governance,” or “law”) originally referred to self-governance of
independent Hellenic city-states
Autonomy: Essential Autonomy: Essential ConditionsConditions Liberty - independence from controlling influences
Agency - capacity for intentional action
Autonomous ActionAutonomous ActionBy normal persons who act:IntentionallyWith understandingWithout controlling influences that determine their action
Principle of Respect for Principle of Respect for AutonomyAutonomy
Being autonomous is not the same as being respected as an autonomous agent.
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
Principle of Respect Principle of Respect for Autonomyfor Autonomy
Involves respectful action, not merely respectful
attitude
Kant’s ViewKant’s View
Respect for autonomy flows from recognition:that all people have unconditional worth &capacity to determine own destiny
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.
Immanuel Kant’s ViewImmanuel Kant’s View
Must assist persons in achieving their ends
Foster their capacities as agents
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.
Respect for Autonomy - Respect for Autonomy - Related ConceptsRelated ConceptsRights and obligations of:- privacy- confidentiality- truthfulness- consent
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
Autonomy & ConsentAutonomy & Consent
Basic paradigm of autonomy in health care:
express and informed consent
CompetenceCompetenceCore meaning - the ability to perform a task
Criteria for competence:- should be relative to decision- rarely incompetent in all
spheres
CompetencyCompetencyAsk - “Competency for what?”Sometimes the following are
inappropriate triggers for questioning competency:
- not doing what MD/nurse think should do
- preferences not mainstream
Categories of PeopleCategories of Peoplecompetent was competent but now is not - wishes known - wishes not knownnever competentnewborn
Categories of PeopleCategories of PeopleWas competent but now is not
permanent reversible
Incompetent Incompetent CategoriesCategoriesFetuses, newborns, childrenBrain deadPersistent vegetative stateRetardedClearly mentally illDementia
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
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