Jackson, Jennifer. Truth, trust and medicine
2001, London: Routledge.
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Publisher’s Note:
Publisher: Truth, Trust and Medicine investigates the notion of trust and honesty in medicine, and questions whether honesty and openness are of equal importance in maintaining the trust necessary in doctor-patient relationships. Jackson begins with the premise that those in the medical profession have a basic duty to be worthy of the trust their patients place in them. Yet questions of the ethics of withholding information and consent and covert surveillance in care units persist. This book boldly addresses these questions which disturb our very modern notions of a patient's autonomy, self-determination and informed consent.Comment: This text is best used as a further reading in medical, professional and applied ethics courses. It is very detailed and thorough in its approach, but some chapters can be used as more introductory standalone texts. In particular, chapters 3 and 4 offer a good discussion on 'Why truthfulness matters' and 'What truthfulness requires', and chapters 2 and 9 look critically at lying or withholding information for the benefit of the patient.
Kukla, Quill R.. A Nonideal Theory of Sexual Consent
2021, Ethics, 131(2): 270-292.
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Added by: Emma Holmes, David MacDonald, Yichi Zhang, and Samuel Dando-MooreAbstract:
Our autonomy can be compromised by limitations in our capacities, or by the power relationships within which we are embedded. If we insist that real consent requires full autonomy, then virtually no sex will turn out to be consensual. I argue that under conditions of compromised autonomy, consent must be socially and interpersonally scaffolded. To understand consent as an ethically crucial but nonideal concept, we need to think about how it is related to other requirements for ethical sex, such as the ability to exit a situation, trust, safety, broader social support, epistemic standing in the community, and more.Comment (from this Blueprint): Kukla uses this paper to describe a view of consent which is relational. This means that rather than asking questions about what each person individually consented to or not, the question is how the people having sex communicated. If they communicate sufficiently well then the sex is consensual, and if they do not it is not. We can use this to challenge a view of consent which has been implicit in most of the readings so far. This paper is used to discuss blameworthiness and responsibility for wrongful sex, and to ask questions about what the real world obligations of agents are, given their lack of complete information
O'Neill, Onora. Some limits of informed consent
2003, Journal of Medical Ethics 29 (1):4-7
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Added by: Simon FoktAbstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.Comment: A great introductory text offering a short overview of the problems related to consent. The point regarding the intransitivity of consent is likely to inspire interesting discussions. As the paper is quite short, it can easily be used in conjunction with other texts.
O'Neill, Onora. Autonomy and Trust in Bioethics
2002, Cambridge University Press.
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Added by: Chris Howard, Contributed by: Simon FoktPublisher's Note: Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.Comment: Parts of this book are an excellent supplement to units on autonomy and informed consent in an intermediate-advanced level medical ethics course. In particular, chapters 1, 2, and 4 would be excellent additions to a unit on autonomy, and chapter 7 would be a similarly excellent addition to a unit on informed consent.
O'Neill, Onora. Constructions of Reason: Explorations of Kant’s Practical Philosophy
1989, Cambridge University Press.
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Added by: Clotilde TorregrossaPublisher's Note: Two centuries after they were published, Kant's ethical writings are as much admired and imitated as they have ever been, yet serious and long-standing accusations of internal incoherence remain unresolved. Onora O'Neill traces the alleged incoherences to attempts to assimilate Kant's ethical writings to modern conceptions of rationality, action and rights. When the temptation to assimilate is resisted, a strikingly different and more cohesive account of reason and morality emerges. Kant offers a "constructivist" vindication of reason and a moral vision in which obligations are prior to rights and in which justice and virtue are linked. O'Neill begins by reconsidering Kant's conceptions of philosophical method, reason, freedom, autonomy and action. She then moves on to the more familiar terrain of interpretation of the Categorical Imperative, while in the last section she emphasizes differences between Kant's ethics and recent "Kantian" ethics, including the work of John Rawls and other contemporary liberal political philosophers
Oshana, Mariana. Autonomy and the Partial-Birth Abortion Act
2011, Journal of Social Philosophy, 42 (1): 46-60.
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Added by: Rochelle DuFordSummary: In this paper, Oshana argues that the U.S. Supreme Court's decision to affirm the Partial-Birth Abortion Act was mistaken. She claims that the Partial-Birth Abortion Act cannot withstand the test of strict scrutiny, that the Act fails to respect the privacy rights of individuals, and that there are compelling reasons (based in autonomy) to allow partial-birth abortion up until the point of fetal viability. As such, she claims, the Act violates the integrity of law.Comment: This text would be excellent to use in a course focused on abortion, any course that covers the suite of U.S. Supreme Court cases involving the right to privacy, or a course that wishes to discuss and apply the doctrine of strict scrutiny. While it requires a significant amount of background knowledge (concerning the legislative history on abortion in the United States), it provides an excellent example of applying both the principle of autonomy and the principle of strict scrutiny.
Oshana, Marina. Personal Autonomy and Society
1998, Journal of Social Philosophy 29(1): 81–102.
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Added by: Simon FoktContent: Oshana argues against 'internalist' theories of autonomy that focus exclusively on psychological conditions internal to the agent - what goes on inside her head - and suggests instead that certain social relations must obtain between the agent and those around her for genuine autonomy to be possible.Comment: Oshana argues that personal autonomy is a socio-relational phenomenon partially constructed by external, social relations. She also offers an interesting and detailed critique of internalist accounts, which makes the text very useful in teaching on autonomy and free will in general. The text is best used as a further reading in undergraduate and a more central required reading in postgraduate teaching. It offers a good synopsis of Gerald Dworkin's influential conception of autonomy.
Seavilleklein, Victoria. Challenging the Rhetoric of Choice in Prenatal Screening
2009, Bioethics 23(1): 68-77.
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Added by: Simon FoktAbstract: Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.Comment: The text introduces the notion of relational autonomy and argues that an increase in pre-natal screening can in fact act so as to restrict the autonomy of pregnant women. It is best used in teaching applied ethics modules on procreation and autonomy, and as a further reading offering a critique of approaches which do not take into account contextual features of particular situations in their moral assessment.
Walker, Rebecca L.. Medical Ethics Needs a New View of Autonomy
2009, Journal of medicine and philosophy 33: 594-608.
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Added by: Simon FoktAbstract: The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order.Comment: Walker argues against the Black Box view advocated by Beauchamp and Childress. The text is most useful when discussing principlism in biomedical ethics and more general issues related to autonomy and consent. The text works well when read alongside's Onora O'Neill's "Some limits of informed consent."
Warwick, Sarah Jane. A vote for no confidence
1989, Journal of Medical Ethics 15 (4):183-185.
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Added by: Clotilde Torregrossa, Contributed by: Simon FoktAbstract: This paper considers the justifications for adhering to a principle of confidentiality within medical practice. These are found to derive chiefly from respect for individual autonomy, the doctor/patient contract, and social utility. It is suggested that these will benefit more certainly if secrecy is rejected and the principle of confidentiality is removed from the area of health care
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