Online research in philosophy

To aid neuroscientists in determining the ethical limits of their work and its applications, neuroethical problems need to be identified, catalogued, and analyzed from the standpoint of an ethical framework. Many hospitals have already established either autonomy or welfare-centered theories as their adopted ethical framework. Unfortunately, the choice of an ethical framework resists resolution: each of these two moral theories claims priority at the exclusion of the other, but for patients with neurological pathologies, concerns about the patient’s welfare are treated as meaningless without consideration of the patient’s expressed wishes, and vice versa. Ethicists have long fought over whether suffering or autonomy should be our primary concern, but in neuroethics a resolution of this question is essential to determine the treatment of patients in medical and legal limbo. I propose a solution to this problem in the form of ethical dualism. My paper deviates from this text in many ways, but especially in the inclusion of autonomy and happiness as part of ethical theories, rather than guiding principles. This is a conservative measure in that it retains both sides of the debate: both happiness and autonomy have intrinsic value. However, this move is often met with resistance because of its more complex nature—it is more difficult to make a decision when there are two parallel sets of values that must be considered than when there is just one such set. The monist theories, though, do not provide enough explanatory power: namely, I will present two recently publicized cases where it is clear that neither ethical value on its own (neither welfare nor autonomy) can fully account for how a vegetative patient should be treated. From the neuroethical cases of Terri Schiavo and Lauren Richardson, I will argue that a dualist framework is superior to its monist predecessors, and I will describe the main features of such an account.

In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.

In English medical law, it is something of an axiom that adult competent patients have an absolute right to refuse all and any medical treatment, including potentially life-saving and life-sustaining treatment. This legal proposition, which is embedded in the doctrine of consent, has for the last few decades been regarded as the expression of the philosophical principle of personal autonomy and ethical right of self-determination. The Western ethical and legal traditions places heavy emphasis on notions of personal sovereignty reflected in the strong rhetorical entrenchment of patient autonomy in judicial determinations of treatment refusal cases. In a spate of legal cases in the 1980s and 1990s judicial rhetoric ..

Background Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance directives policy and practice. Methods We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. Results Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). Conclusion This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy.

Defenders of patient autonomy have successfully supported the legal adoption of advance directives. More recently, some defenders of patient autonomy have also supported the legalization of voluntary active euthanasia. This paper explores the wisdom of combining both practices. If euthanasia were to become legal, should it be permitted by advance directives? The paper juxtaposes the most significant doubts about advance directives, with the most significant doubts about euthanasia. It argues that the doubts together raise more concern about the combined practices than about either euthanasia or advance directives separately. Not all cases of voluntary euthanasia by advance directive are equally problematic, however. Advance directives can help in the defense of euthanasia for patients who make the request in advance and reaffirm it under circumstances of severe suffering. Keywords: advance directives, durable power of attorney, euthanasia, living will, patient interests CiteULike Connotea Del.icio.us What's this?

Advance directives (ADs), which are also sometimes referred to as ‘living wills’, are statements made by a person that indicate what treatment she should not be given in the event that she is not competent to consent or refuse at the future moment in question. As such, ADs provide a way for patients to make decisions in advance about what treatments they do not want to receive, without doctors having to find proxy decision-makers or having recourse to the doctrine of necessity. While patients can request particular treatments in an AD, only refusals are binding. This paper will examine whether ADs safeguard the autonomy and best interests of the incompetent patient, and whether legislating for the use of ADs is justified, using the specific context of the legal situation in the United Kingdom to illustrate the debate. The issue of whether the law should permit ADs is itself dependent on the issue of whether ADs are ethically justified; thus we must answer a normative question in order to answer the legislative one. It emerges that ADs suffer from two major problems, one related to autonomy and one to consent. First, ADs’ emphasis on precedent autonomy effectively sentences some people who want to live to death. Second, many ADs might not meet the standard criteria for informed refusal of treatment, because they fail on the crucial criterion of sufficient information. Ultimately, it transpires that ADs are typically only appropriate for patients who temporarily lose physical or mental capacity.

Patients' wishes regarding health care and dying must be taken into consideration by their physicians. Competent patients need to record directives about their care in advance of a crisis situation. The primary care physician, seeing the patient at the time of a routine office visit, is in a favorable position to explore and record attitudes. A patient's value system should be part of a medical history before hospital admission. Details in a Value History Questionnaire facilitate guiding an incompetent patient through a terminal illness in accordance with wishes previously expressed.An instrument in the form of a questionnaire was designed to record the attitudes of 200 patients regarding health care and dying. Respondents ranged in age from 17 to 84 years, and all were members of one family practice. They reacted positively to the opportunity to record their values, opinions, and wishes about their health care and process of dying. They clearly indicated that, in the absence of prior directives, they would want their families consulted about crucial decisions.

I discuss conditions for the validity of proxy consent to treatment on behalf of an incompetent person. I distinguish those incompetents who, when previously competent, expressed an opinion on the treatment in question from those who were never competent or who, though previously competent, never expressed an opinion on the proposed treatment. In the former case valid proxy consent usually requires respecting the stated wishes of the patient. The latter case is more difficult. I consider a widely-held principle which appeals to the counterfactual wishes of the incompetent person. I argue that it is unacceptable and propose in its place a principle having to do with the best interests of the patient. Keywords: proxy consent, informed consent, competence, hypothetical wishes, substituted judgment, counterfactual wishes CiteULike Connotea Del.icio.us What's this?

Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients.

This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making.