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  1. A Non-Ideal Authenticity-Based Conceptualization of Personal Autonomy.Jesper Ahlin Marceta - 2019 - Medicine, Health Care and Philosophy 22 (3):387-395.
    Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp and Childress’s theory, (...)
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  • The Impossibility of Reliably Determining the Authenticity of Desires: Implications for Informed Consent.Jesper Ahlin - 2018 - Medicine, Health Care and Philosophy 21 (1):43-50.
    It is sometimes argued that autonomous decision-making requires that the decision-maker’s desires are authentic, i.e., “genuine,” “truly her own,” “not out of character,” or similar. In this article, it is argued that a method to reliably determine the authenticity (or inauthenticity) of a desire cannot be developed. A taxonomy of characteristics displayed by different theories of authenticity is introduced and applied to evaluate such theories categorically, in contrast to the prior approach of treating them individually. The conclusion is drawn that, (...)
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  • Do We Need a Threshold Conception of Competence?Govert den Hartogh - 2016 - Medicine, Health Care and Philosophy 19 (1):71-83.
    On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her. In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect (...)
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  • Anorexia and the MacCAT-T Test for Mental Competence: Validity, Value, and Emotion.Louis C. Charland - 2007 - Philosophy, Psychiatry, & Psychology 13 (4):283-287.
    How does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least some accepted pretheoretical desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. (...)
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  • Autonomy and Metacognition : A Healthcare Perspective.Henrik Levinsson - 2008 - Dissertation, Lund University
    Part I of the dissertation examines the cognitive aspects of autonomy. The central question concerns what kind of cognitive capacity autonomy is. It will be argued that the concept of autonomy is best understood in terms of a metacognitive capacity of the individual. It is argued that metacognition has two components: procedural reflexivity and metarepresentation. Metarepresentation in turn can be divided into inferential reflexivity and other-attributiveness. These two components are essential for autonomy. Particular emphasis is put on procedural reflexivity. Further, (...)
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  • Autism, Neurodiversity, and Equality Beyond the "Normal".Andrew Fenton & Tim Krahn - 2007 - Journal of Ethics in Mental Health 2 (2):2.
    “Neurodiversity” is associated with the struggle for the civil rights of all those diagnosed with neurological or neurodevelopmental disorders. Two basic approaches in the struggle for what might be described as “neuro-equality” are taken up in the literature: There is a challenge to current nosology that pathologizes all of the phenotypes associated with neurological or neurodevelopmental disorders ); there is a challenge to those extant social institutions that either expressly or inadvertently model a social hierarchy where the interests or needs (...)
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  • Depression, Possibilities, and Competence: A Phenomenological Perspective. [REVIEW]Gerben Meynen - 2011 - Theoretical Medicine and Bioethics 32 (3):181-193.
    Competent decision-making is required for informed consent. In this paper, I aim, from a phenomenological perspective, to identify the specific facets of competent decision-making that may form a challenge to depressed patients. On a phenomenological account, mood and emotions are crucial to the way in which human beings encounter the world. More precisely, mood is intimately related to the options and future possibilities we perceive in the world around us. I examine how possibilities should be understood in this context, and (...)
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  • Getting From the Ethical to the Empirical and Back Again: The Danger of Getting It Wrong, and the Possibilities for Getting It Right: 2008 Bioethics Special Edition: Editorial 2. [REVIEW]Anna Smajdor, Jonathan Ives, Emma Baldock & Adele Langlois - 2008 - Health Care Analysis 16 (1):7-16.
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  • Hidden Substance: Mental Disorder as a Challenge to Normatively Neutral Accounts of Autonomy.Fabian Freyenhagen & Tom O'Shea - 2013 - International Journal of Law in Context 9 (1):53-70.
    Mental capacity and autonomy are often understood to be normatively neutral - the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and functional tests requiring consistency, expression of (...)
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  • Assessing Decision-Making Capacity After Severe Brain Injury.Peterson Andrew - unknown
    Severe brain injury is a leading cause of death and disability. Following severe brain injury diagnosis is difficult and errors frequently occur. Recent findings in clinical neuroscience may offer a solution. Neuroimaging has been used to detect preserved cognitive function and awareness in some patients clinically diagnosed as being in a vegetative state. Remarkably, neuroimaging has also been used to communicate with some vegetative patients through a series of yes/no questions. Some have speculated that, one day, this method may allow (...)
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  • Euthanasia and Assisted Suicide for People with an Intellectual Disability and/or Autism Spectrum Disorder: An Examination of Nine Relevant Euthanasia Cases in the Netherlands.Irene Tuffrey-Wijne, Leopold Curfs, Ilora Finlay & Sheila Hollins - 2018 - BMC Medical Ethics 19 (1):17.
    Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees. The purpose of this (...)
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  • Anorexia Nervosa: The Diagnosis: A Postmodern Ethics Contribution to the Bioethics Debate on Involuntary Treatment for Anorexia Nervosa.Sacha Kendall - 2014 - Journal of Bioethical Inquiry 11 (1):31-40.
    This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter “AN: the diagnosis”) several ethical issues are revealed. Firstly, “AN: the diagnosis” influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, “AN: the diagnosis” impacts on how treatment and treatment efficacy are defined (...)
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  • Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry.A. M. Ruissen, T. A. Abma, A. J. L. M. Van Balkom, G. Meynen & G. A. M. Widdershoven - 2016 - Health Care Analysis 24 (1):71-85.
    Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...)
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  • Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines.Andrew M. Siegel, Anna S. Barnwell & Dominic A. Sisti - 2014 - HEC Forum 26 (2):159-168.
    Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...)
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  • Ist die Beihilfe zum Suizid auf der Grundlage des Wunsches, anderen nicht zur Last zu fallen, ethisch gerechtfertigt?Is physician-assisted suicide justifiable when the patient is worried about being a burden to others?Julian Bleek - 2012 - Ethik in der Medizin 24 (3):193-205.
    ZusammenfassungEin Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...)
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  • Einwilligungsfähigkeit: inhärente Fähigkeit oder ethisches Urteil?Decision-making capacity: inherent ability or ethical judgment?Helena Hermann, Manuel Trachsel & Nikola Biller-Andorno - 2016 - Ethik in der Medizin 28 (2):107-120.
    ZusammenfassungDie Bestimmung der Einwilligungsfähigkeit von Patienten beinhaltet weitreichende ethische und rechtliche Implikationen. Ausreichende Klärung des Begriffs ist daher unerlässlich. Solche Bemühungen gelten vorwiegend der Definition von Kriterien hinsichtlich relevanter mentaler Fähigkeiten. Grundlegendere Aspekte werden kaum explizit besprochen, so die Frage, ob Einwilligungsfähigkeit eher eine inhärente Fähigkeit oder ein ethisches Urteil bezeichnet. Zentral bei dieser Unterscheidung ist der Stellenwert ethischer Überlegungen die Zulässigkeit fürsorglicher Bevormundung betreffend. Geht man von einer inhärenten Fähigkeit aus, schließen solche Überlegungen an die Beurteilung von Einwilligungsfähigkeit an. (...)
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  • Evaluating Medico-Legal Decisional Competency Criteria.Demian Whiting - 2015 - Health Care Analysis 23 (2):181-196.
    In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria—where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the “Decisional Competency in Medico-Legal Contexts” section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an interpretation that (...)
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  • A Civic Republican Analysis of Mental Capacity Law.Tom O'Shea - 2018 - Legal Studies 1 (38):147-163.
    This article draws upon the civic republican tradition to offer new conceptual resources for the normative assessment of mental capacity law. The republican conception of liberty as non-domination is used to identify ways in which such laws generate arbitrary power that can underpin relationships of servility and insecurity. It also shows how non-domination provides a basis for critiquing legal tests of decision-making that rely upon ‘diagnostic’ rather than ‘functional’ criteria. In response, two main civic republican strategies are recommended for securing (...)
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  • Unreasonable Reasons: Normative Judgements in the Assessment of Mental Capacity.Natalie F. Banner - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1038-1044.
  • Personal Autonomy and Mental Capacity.Fabian Freyenhagen - 2009 - Psychiatry 8 (12):465-7.
    The Mental Capacity Act 2005 has put the assessment of mental capacity for decision-making at the forefront of psychiatric practice. This capacity is commonly linked within philosophy to autonomy, that is, to the idea, or ideal, of self-government. However, philosophers disagree deeply about what constitutes autonomy. This contribution brings out how the competing conceptions of autonomy would play out in psychiatric practice, taking anorexia nervosa as a test case. © 2009 Elsevier Ltd. All rights reserved.
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  • Ist die Beihilfe zum Suizid auf der Grundlage des Wunsches, anderen nicht zur Last zu fallen, ethisch gerechtfertigt?Dr Julian Bleek - 2012 - Ethik in der Medizin 24 (3):193-205.
    Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...)
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