David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jonathan Jenkins Ichikawa
Jack Alan Reynolds
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Journal of Medical Ethics 31 (3):127-130 (2005)
Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors
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Adalberto de Hoyos, Rodrigo Nava-Diosdado, Jorge Mendez, Sergio Ricco, Ana Serrano, Carmen Flores Cisneros, Carlos Macías-Ojeda, Héctor Cisneros, David Bialostozky, Nelly Altamirano-Bustamante & Myriam Altamirano-Bustamante (2013). Cardiovascular Medicine at Face Value: A Qualitative Pilot Study on Clinical Axiology. Philosophy, Ethics, and Humanities in Medicine 8 (1):3.
Nina Hallowell (2008). Encounters with Medical Professionals: A Crisis of Trust or Matter of Respect? [REVIEW] Medicine, Health Care and Philosophy 11 (4):427-437.
Richard Huxtable (2008). Whatever You Want? Beyond the Patient in Medical Law. Health Care Analysis 16 (3):288-301.
A. Ravelingien, J. Braeckman, L. Crevits, D. De Ridder & E. Mortier (2009). 'Cosmetic Neurology' and the Moral Complicity Argument. Neuroethics 2 (3):151-162.
E. K. Salter (2014). Resisting the Siren Call of Individualism in Pediatric Decision-Making and the Role of Relational Interests. Journal of Medicine and Philosophy 39 (1):26-40.
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