David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Theoretical Medicine and Bioethics 4 (3) (1983)
Medical decisions concerning noncompetent patients that are most morally problematical are those that involve life and death choices. In making these choices for others, I urge that decision-makers carefully attend to the degree and history of a person's noncompetence, and distinguish four relevant categories of competence: partial, potential, lost and never possessed. Attending to these will help enable us to sort out when and how autonomous choice is possible and desirable and when and how to rely upon a judgment of a patient's best interests instead. This conflict is explored with particular reference to the Quinlan, Fox and Saikewicz cases. I argue that respect for autonomy, wherever possible, has presumptive priority, and that it is more often possible than frequently supposed. On the other hand, the notion of autonomous choice itself is perverted when forced upon inappropriate cases, such as those presented by the never competent. Here it is not merely legitimate, but inescapable to use a best interest criterion that ignores autonomy in making treatment decisions. Specific cases in which these normally distinct guidelines for decision-making concur, conflict and need resolution are discussed. In the end it is often more important to determine who will choose than by what substantive criteria he or she will be guided. In considering this issue, I try to show that the substantive criteria have implications for who the proper decision-makers are in many problematical cases.
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
Eugene V. Boisaubin (2004). Observations of Physician, Patient and Family Perceptions of Informed Consent in Houston, Texas. Journal of Medicine and Philosophy 29 (2):225 – 236.
Gretchen B. Chapman & Frank A. Sonnenberg (eds.) (2000). Decision Making in Health Care: Theory, Psychology, and Applications. Cambridge University Press.
Susan R. Martyn (2009). Substituted Judgment, Best Interests, and the Need for Best Respect. Cambridge Quarterly of Healthcare Ethics 3 (02):195-.
Jos V. M. Welie & Sander P. K. Welie (2001). Patient Decision Making Competence: Outlines of a Conceptual Analysis. [REVIEW] Medicine, Health Care and Philosophy 4 (2):127-138.
Joseph S. Pliskin & Clyde H. Beck (1980). A Mathematical Approach for Establishing Treatment Priorities Among Patients. Theoretical Medicine and Bioethics 1 (1):29-38.
John Mark Freeman (1987). Tough Decisions: A Casebook in Medical Ethics. Oxford University Press.
M. Carmela Epright (2010). Coercing Future Freedom: Consent and Capacities for Autonomous Choice. Journal of Law, Medicine and Ethics 38 (4):799-806.
Margaret P. Battin (1985). Non-Patient Decision-Making in Medicine: The Eclipse of Altruism. Journal of Medicine and Philosophy 10 (1):19-44.
Jillian Craigie (2011). Competence, Practical Rationality and What a Patient Values. Bioethics 25 (6):326-333.
Arthur R. Derse (1999). Making Decisions About Life-Sustaining Medical Treatment in Patients with Dementia. Theoretical Medicine and Bioethics 20 (1):55-67.
Added to index2009-01-28
Total downloads22 ( #84,909 of 1,140,267 )
Recent downloads (6 months)1 ( #142,694 of 1,140,267 )
How can I increase my downloads?