Tag: autonomy

Blog Posts (30)

November 26, 2014

Striking the Balance Between Population Guidelines and Patient Primacy

by Susan Mathews, Bioethics Program Alumna (2014) Breast cancer is the second leading cause of cancer death among North American women. Although routine mammography decreases the risk of death by about 15 percent, research on the effectiveness of wide-scale screening programs shows that 2,500 people would need to be screened to prevent one cancer death among women […]
November 16, 2014

The New Abortion Issue: The Moral Status of Women

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Let me emphatically state at the outset of this short blog: I have always thought the elective termination of pregnancy (ETOL) was a serious moral issue. As I have taught students over the years on this topic, to fully appreciate the moral conflict around abortion (or any other moral conflict) one must be willing to put oneself in the middle of two important value positions. In other words, one must be willing to hold and take seriously in one’s mind simultaneously two opposing thoughts or value positions in order to weigh them fairly. </span><span style="line-height: 19.0400009155273px;"> </span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Though I don’t think that a fetus is a person with a personal or social identity, it is biologically human—and that alone is a relevant piece of moral information. The fetus has a unique genetic code and has the potential to grow to full term into a new baby and eventually grow into a child, adolescent, and adult human being. Because a fetus has the potential to become a full-fledged member of the human community, all things equal, we should not destroy it. But rarely in human life are all things equal.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
October 3, 2014

The Scylla and Charybdis of Medical Ethics: Not Enough Medicine, Not Enough Ethics

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 22.3999996185303px;">I was at a conference last week in medical ethics, and I was surprised by, or perhaps appalled at, the attitude displayed by many of the philosophers regarding the importance of medical knowledge in medical ethical decision making. Several of them proudly announced a total ignorance of the medical issue they were speaking on, and also showed no interest in what I would call “real world” implications of their conclusions.</span><span style="line-height: 22.3999996185303px;">  </span><span style="line-height: 22.3999996185303px;">Although I have a PhD in philosophy, I am not a philosopher in the sense that I am capable of, or interested in, spinning arguments from “thin air” with no grounding in medical facts, and no implications for real medical practice.</span><span style="line-height: 22.3999996185303px;">  </span><span style="line-height: 22.3999996185303px;">Medical ethics must begin in real life issues and problems, and end with equally real and meaningful conclusions that can be applied, and sometimes even empirically tested.</span><span style="line-height: 22.3999996185303px;"> </span></p> <p class="MsoNormal" style="line-height: 22.3999996185303px;"><span style="line-height: 22.3999996185303px;">This is not to say that philosophers cannot make good, or even great, medical/clinical ethicists. But they need to begin with a healthy respect for the way in which the “facts on the ground” inform the ethical decision-making.  A brief example illustrates my point.  In Hilde Lindemann Nelson’s famous </span><a style="line-height: 22.3999996185303px;" href="http://link.springer.com/article/10.1023/A:1008844116526?LI=true">article</a><span style="line-height: 22.3999996185303px;"> explaining narrative ethics, she discusses the case of Carlos and Consuela. Carlos is an HIV positive gang member wounded in gang violence, who is recovering from his injuries in a hospital.  He is now ready for discharge, but needs dressing changes at home.  He wants his sister Consuela to do the dressing changes, but he insists that she not be told about his HIV status.  While Dr. Lindemann Nelson uses this case to make several excellent points about the limitations of principle based ethics, one aspect of the question, crucial to any ethical reasoning on the case, is obviously the transmissibility of HIV infection through dressing changes.  This “fact” is an essential aspect that underpins any ethical judgment regarding the case.  The conflict between patient confidentiality and duty of nonmaleficence (toward Consuela) pivots in part on the fact that HIV is not readily contagious, and simple universal precautions should make the risk to Consuela essentially nil.</span></p> <p class="MsoNormal" style="line-height: 22.3999996185303px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a></strong></p>
September 22, 2014

Epistemological Uncertainty & Autonomy

In the September 17, 2014 issue of JAMA Scott Stonington, MD, PhD wrote a remarkable piece entitled “Whose Autonomy?” This short piece should be required reading for everyone in medicine. Stonington discusses the idea of family roles and puts this in light of his anthropological work in northern Thailand. He uses his fieldwork experience to introduce the idea that, when ill, people may not express... // Read More »
September 8, 2014

Limning the Limits

Shortly after I submitted my last post “Limning Autonomy in Surgery” I was contacted by the blog editor letting me know that I had made a typo in my title and that he would go ahead and correct it for me. The problem is that I really do mean to use the word “limn.” When I was at Wheaton College a couple of my professors... // Read More »
August 25, 2014

Limning Autonomy in Surgery

Several years ago while still a surgery resident I was stuck with a needle while operating on a patient with hepatitis C and HIV. The infectious disease team at that institution started me immediately on the latest anti-retroviral cocktail to decrease my chances of becoming infected with HIV. I took the cocktail for about a week and then, unable to tolerate the horrible gastrointestinal side-effects,... // Read More »
August 20, 2014

The Early Bird Get the Ethics?

by Karen Solomon, Bioethics Program Student Does early to bed and early to rise, make a man healthy, wealthy and more ethical? Earlier research suggested a “morning morality effect”: that people are more ethical early in the morning, becoming less so as they “wear out as a day wears on.” Not so fast, researchers now […]
June 23, 2014

Refusal of Cesarean Section

<p>I was recently surprised to read in the <a href="http://www.nytimes.com/2014/05/17/nyregion/mother-accuses-doctors-of-forcing-a-c-section-and-files-suit.html?module=Search&amp;mabReward=relbias%3Ar&amp;_r=0">New York Times</a> that a woman had undergone a cesarean section despite her refusal to consent to the procedure. The details of the case are not entirely clear from the article, so I do not want what follows to be understood as a specific comment on this case. However, the source of my surprise was my assumption that the ethics of refusal of consent were not in dispute.  The American College of Obstetrics and Gynecology has taken a clear position on this: it is not permissible to perform surgery on a patient with decisional capacity without her consent. ACOG’s committee opinion, “<a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ethics/Maternal_Decision_Making_Ethics_and_the_Law">Maternal Decision Making, Ethics, and the Law</a>,” strongly discourages even attempting to seek a court order for treatment when a pregnant woman refuses cesarean section, and concludes with the following statement:</p> <p style="padding-left: 30px;">Pregnant women's autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and understood within the context of each woman's broad social network, cultural beliefs, and values. In <span style="white-space: pre;"> </span>the absence of extraordinary circumstances, circumstances that, in fact, the Committee on Ethics cannot currently imagine, judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman's autonomy. </p> <p>This committee opinion gives six strong and compelling arguments for these conclusions, and I will not repeat them here, but I encourage readers to review them.  What I would like to now focus on is the thinking that may lead some physicians to believe it is ethically permissible to override a patient’s autonomous choice.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 1, 2014

Justina Pelletier’s Less-Than-Sweet 16

by Theresa Spranger, Bioethics Program Alumna (MSBioethics 2012) Justina Pelletier turned 16 over Memorial Day weekend.  She was only 14 when the Massachusetts Department of Children and Families (MA DCF) took custody of her.  She has been hospitalized or institutionalized ever since.  Many of you will be aware that this is a story I have […]
June 1, 2014

Justina Pelletier’s Less-Than-Sweet 16

by Theresa Spranger, Bioethics Program Alumna (MSBioethics 2012) Justina Pelletier turned 16 over Memorial Day weekend.  She was only 14 when the Massachusetts Department of Children and Families (MA DCF) took custody of her.  She has been hospitalized or institutionalized ever since.  Many of you will be aware that this is a story I have […]

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Published Articles (16)

AJOB Neuroscience: Volume 4 Issue 4 - Sep 2013

Autonomy in Neuroethics: Political and Not Metaphysical Veljko Dubljević

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

The Encompassing Ethics of Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

Stuck in the Middle: The Many Moral Challenges With Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 9 - Sep 2010

Deidentification and Its Discontents: Response to the Open Peer Commentaries

American Journal of Bioethics: Volume 10 Issue 10 - Oct 2010

Invited Commentary: ?Rethinking Research Ethics,? Again: Casuistry, Phronesis, and the Continuing Challenges of Human Research

American Journal of Bioethics: Volume 10 Issue 7 - Jul 2010

Review of The Ethics of Consent, eds. Franklin G. Miller and Alan Wertheimer

American Journal of Bioethics: Volume 10 Issue 3 - Mar 2010

The Secret of Caring for Mr. Golubchuk

American Journal of Bioethics: Volume 10 Issue 3 - Mar 2010

The Case of Samuel Golubchuk and the Right to Live

American Journal of Bioethics: Volume 9 Issue 12 - Dec 2009

Response to Open Peer Commentaries on ?A Duty to Deceive: Placebos in Clinical Practice?

American Journal of Bioethics: Volume 9 Issue 12 - Dec 2009

A Duty to Deceive: Placebos in Clinical Practice

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