Tag: autonomy

Blog Posts (27)

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 […]
May 30, 2014

Your Doctor Has a DNR Order, But Not for the Reasons You’d Think

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012) How many doctors would choose to have a “Do-Not Resuscitate” (DNR) order over a full code option? 88.3%, at least according to a new study. For those counting at home, that’s greater than percentage of Americans who currently disapprove of the job that Congress is doing. This means that nearly 9 […]
May 30, 2014

Your Doctor Has a DNR Order, But Not for the Reasons You’d Think

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012) How many doctors would choose to have a “Do-Not Resuscitate” (DNR) order over a full code option? 88.3%, at least according to a new study. For those counting at home, that’s greater than percentage of Americans who currently disapprove of the job that Congress is doing. This means that nearly 9 […]
May 22, 2014

Alzheimer’s Disease: The Forgotten Epidemic

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership We hosted a conference on Alzheimer’s disease at the College last week, inviting a distinguished group of physicians, researchers, caregivers, advocates and policymakers to discuss the ethical and legal challenges of diagnosing and treating those with the disease. These issues are particularly important to […]

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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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