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Added by: Rochelle DuFord
Summary: 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.Etieyibo, Edwin. The Case of Competancy and Informed Consent2013, Journal of Clinical Research and Bioethics, 4 (2): 1-4.-
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Added by: Rochelle DuFord
Abstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.Comment: This text presents an introduction to the relationship between competance, informed consent, and autonomy in medical contexts through the use of a case study. As such, it would be a good text for an introductory course in health care ethics or biomedical ethics within a unit on autonomy or culturally-specific applications of medical ethical principles.
Bortolotti, Lisa, Daniela Cutas. Reproductive and Parental Autonomy: An Argument for Compulsory Education2009, Reproductive Biomedicine Online, 19 (Ethics Supplement): 5-14.-
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Added by: Rochelle DuFord
Abstract: In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not believe that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.Comment: This text provides a clear overview of debates about reproductive autonomy and compulsory education. It also contains responses to well known criticisms of compulsory parental education. It would be best used in a course dealing with issues of parenthood and procreation, reproduction, or autonomy in a medical context.
Jackson, Jennifer. Truth, trust and medicine2001, 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.
Jaworska, Agnieszka. Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value1999, Philosophy and Public Affairs 28(2): 105–138.-
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Added by: Simon Fokt
Introduction: Dworkin puts forth two main arguments to justify adhering to the wishes the patient expressed before becoming demented. As he sees it, this course of action both promotes the patient’s well-being and is required in order to respect the patient’s autonomy. In each argument, while I consider most of the ideas well-founded, I challenge the crucial premise. In the argument focused on the patient’s well-being, I dispute the claim that demented patients are no longer capable of generating what Dworkin calls “critical interests.” In the argument concerning autonomy, I question the premise that demented patients no longer possess the “capacity for autonomy.”7 In each case, I will trace how the problematic premise arises within Dworkin’s argument and then develop an alternative account of the relevant capacity.Comment: Jaworska asks: 'Should we, in our efforts to best respect a patient with dementia, give priority to the preferences and attitudes this person held before becoming demented, or should we follow the person’s present preferences?' (p. 108). The article offers a useful critical overview of the views expressed by Rebecca Dresser and Ronald Dworkin. It is best used as a primary reading in ethics classes focusing directly on medical ethics or autonomy, or as further reading in general ethics teaching on autonomy.
Tsai, George. Rational Persuasion as Paternalism2014, Philosophy and Public Affairs 42(1): 78-112.-
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Added by: Carl Fox
Content: Tsai argues that offering another agent reasons can sometimes count as paternalism when it is motivated by distrust of the other's agency, conveys this lack of confidence, and intervenes in the target's sphere of agency.Comment: Best suited as further or specialised reading on paternalism and agency.
Seavilleklein, Victoria. Challenging the Rhetoric of Choice in Prenatal Screening2009, Bioethics 23(1): 68-77.-
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Added by: Simon Fokt
Abstract: 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 Autonomy2009, Journal of medicine and philosophy 33: 594-608.-
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Added by: Simon Fokt
Abstract: 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."
Oshana, Marina. Personal Autonomy and Society1998, Journal of Social Philosophy 29(1): 81–102.-
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Added by: Simon Fokt
Content: 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.
Barclay, Linda. Genetic Engineering and Autonomous Agency2003, Journal of applied philosophy 20(3): 223–236.-
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Added by: Simon Fokt
Abstract: In this paper I argue that the genetic manipulation of sexual orientation at the embryo stage could have a detrimental effect on the subsequent person's later capacity for autonomous agency. By focussing on an example of sexist oppression I show that the norms and expectations expressed with this type of genetic manipulation can threaten the development of autonomous agency and the kind of social environment that makes its exercise likely.Comment: Useful mainly in the context of (the limitations of) reproductive rights and as a further reading on the ethics of genetic engineering and human enhancement.
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Oshana, Mariana. Autonomy and the Partial-Birth Abortion Act
2011, Journal of Social Philosophy, 42 (1): 46-60.
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.