Patient autonomy, assessment of competence and surrogate decision-making: A call for reasonableness in deciding for others
Bioethics 24 (2):87-95 (2010)
In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of 'structural arbitrariness' in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others.
|Keywords||reasonableness surrogate decision‐making respectful treatment competence assessment autonomy non‐competent consent|
|Categories||categorize this paper)|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
The Medical Decision-Making Process and the Family: The Case of Breast Cancer Patients and Their Husbands.Roy Gilbar & Ora Gilbar - 2009 - Bioethics 23 (3):183-192.
Deciding for Others: The Ethics of Surrogate Decisionmaking.Allen E. Buchanan - 1989 - Cambridge University Press.
Autonomy and Dependence: Chronic Physical Illness and Decision-Making Capacity.Wim J. M. Dekkers - 2001 - Medicine, Health Care and Philosophy 4 (2):185-192.
Turning Failures Into Successes: A Methodological Shortcoming in Empirical Research on Surrogate Accuracy.Mats Johansson & Linus Broström - 2008 - Theoretical Medicine and Bioethics 29 (1):17-26.
The Not Unreasonable Standard for Assessment of Surrogates and Surrogate Decisions.Rosamond Rhodes & Ian Holzman - 2004 - Theoretical Medicine and Bioethics 25 (4):367-386.
The Substituted Judgment Standard. Studies on the Ethics of Surrogate Decision Making.Linus Broström - unknown
Shared Decision-Making and Patient Autonomy.Lars Sandman & Christian Munthe - 2009 - Theoretical Medicine and Bioethics 30 (4):289-310.
Dementia and Dignity: Towards a New Method of Surrogate Decision Making.Elysa R. Koppelman - 2002 - Journal of Medicine and Philosophy 27 (1):65 – 85.
Patient Decision Making Competence: Outlines of a Conceptual Analysis. [REVIEW]Jos V. M. Welie & Sander P. K. Welie - 2001 - Medicine, Health Care and Philosophy 4 (2):127-138.
Added to index2009-01-28
Total downloads100 ( #50,704 of 2,169,401 )
Recent downloads (6 months)3 ( #126,618 of 2,169,401 )
How can I increase my downloads?