Autonomy in medical ethics after O'Neill.

Abstract:

:Following 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.

journal_name

J Med Ethics

authors

Stirrat GM,Gill R

doi

10.1136/jme.2004.008292

keywords:

subject

Has Abstract

pub_date

2005-03-01 00:00:00

pages

127-30

issue

3

eissn

0306-6800

issn

1473-4257

pii

31/3/127

journal_volume

31

pub_type

杂志文章
  • When caesarean section operations imposed by a court are justified.

    abstract::Court-ordered caesarean sections against the explicit wishes of the pregnant woman have been criticised as violations of the woman's fundamental right to autonomy and to the inviolability of the person--particularly, so it is argued, because the fetus in utero is not yet a person. This paper examines the logic of this...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.14.4.206

    authors: Kluge EH

    更新日期:1988-12-01 00:00:00

  • Personality disorder and competence to refuse treatment.

    abstract::The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality d...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2007.023341

    authors: Winburn E,Mullen R

    更新日期:2008-10-01 00:00:00

  • All hail the new flesh: some thoughts on scarification, children and adults.

    abstract::Body art as expressed through non-therapeutic bodily modification is extremely popular, with techniques ranging from the commonplace such as ear piercing to the more esoteric forms such as tongue splitting. Scarification is one such body art practice that is becoming popular as an alternative to tattooing and ear pier...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2008.027615

    authors: Oultram S

    更新日期:2009-10-01 00:00:00

  • Therapeutic privilege: between the ethics of lying and the practice of truth.

    abstract::The 'right to the truth' involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a 'right to the truth' entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.033340

    authors: Richard C,Lajeunesse Y,Lussier MT

    更新日期:2010-06-01 00:00:00

  • Will international human rights subsume medical ethics? Intersections in the UNESCO Universal Bioethics Declaration.

    abstract::The International Bioethics Committee (IBC) of the United Nations Educational, Scientific and Cultural Organisation (UNESCO) is currently drafting a Universal Bioethics Declaration ("the declaration"). The content and even the name of the declaration has yet to be finalized, but it is expected to range widely over hum...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2004.006502

    authors: Faunce TA

    更新日期:2005-03-01 00:00:00

  • Autonomy in the face of a devastating diagnosis.

    abstract::Literary accounts of traumatic events can be more informative and insightful than personal testimonials. In particular, reference to works of literature can give us a more vivid sense of what it is like to receive a devastating diagnosis. In turn this can lead us to question some common assumptions about the nature of...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.24.2.123

    authors: Spriggs M

    更新日期:1998-04-01 00:00:00

  • HIV, confidentiality and 'a delicate balance': a reply to Leone Ridsdale.

    abstract::The passing on of information to GPs by genito-urinary doctors is to be encouraged but is not always possible and ultimately the patient's wishes and confidentiality must be respected if sexually transmitted diseases and HIV infection are to be controlled. Infected health-care workers should seek counselling and medic...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.17.4.196

    authors: Adler MW

    更新日期:1991-12-01 00:00:00

  • Sexual rights puzzle: re-solved?

    abstract::My sexual rights puzzle according to which positive sexual rights are not compatible with negative sexual rights has been recently criticised in the Journal of Medical Ethics by Steven J Firth, who has put forward three objections to the puzzle. In this brief response, I analyse and reject each of these three objectio...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/medethics-2019-105642

    authors: Di Nucci E

    更新日期:2020-05-01 00:00:00

  • The great slippery-slope argument.

    abstract::Whenever some form of beneficent killing--for example, voluntary euthanasia--is advocated, the proposal is greeted with a flood of slippery-slope arguments warning of the dangers of a Nazi-style slide into genocide. This paper is an attempt systematically to evaluate arguments of this kind. Although there are slippery...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.19.3.169

    authors: Burgess JA

    更新日期:1993-09-01 00:00:00

  • Need for ethics support in healthcare institutions: views of Dutch board members and ethics support staff.

    abstract:OBJECTIVE:The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. METHODS:This study had a mixed methods design integrating quantitative and qualita...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章,多中心研究

    doi:10.1136/jme.2010.040626

    authors: Dauwerse L,Abma T,Molewijk B,Widdershoven G

    更新日期:2011-08-01 00:00:00

  • Camouflage is no defence--a response to Kottow.

    abstract::The author responds to Professor Kottow's criticisms, explaining numerous errors and misconceptions. ...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.25.4.344

    authors: Seedhouse D

    更新日期:1999-08-01 00:00:00

  • The role of the principle of double effect in ethics education at US medical schools and its potential impact on pain management at the end of life.

    abstract:BACKGROUND:Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern f...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100105

    authors: Macauley R

    更新日期:2012-03-01 00:00:00

  • The costs and benefits of a cigarette ban.

    abstract::The death toll from tobacco is staggering: it might contribute to one billion premature deaths over the course of the 21st century. In 'The case for banning cigarettes', Kalle Grill and Kristin Voigt argue that the well-being and equality benefits of a complete ban on cigarettes more than justify the restrictions on a...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2017-104172

    authors: Doucet M

    更新日期:2017-06-01 00:00:00

  • Covert video surveillance: the Staffordshire Protocol--a response to Dr Shinebourne.

    abstract::This paper is a response to Dr Shinebourne's response to my recent paper assessing the relative merits of the Staffordshire Protocol on covert video surveillance. Dr Shinebourne does not take the opportunity to rebut the criticisms made of the text of the protocol. It is further suggested that judicial oversight of th...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.22.6.349

    authors: Thomas T

    更新日期:1996-12-01 00:00:00

  • Woman wants dead fiancé's baby: who owns a dead man's sperm.

    abstract::The Brisbane Supreme Court has denied an Australian woman's request to harvest and freeze her dead fiancé's sperm for future impregnation. After she was denied access to the sperm, the woman learnt that her fiancé may have been a sperm donor and she began checking to find out if his sperm was still available. Given wh...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2003.004432

    authors: Spriggs M

    更新日期:2004-08-01 00:00:00

  • Community care--same problems, different epithet?

    abstract::A negative image of community care prevails. This method of care is perceived to be a relatively novel phenomenon and has received mixed media coverage. The negative image of community care has led to the growing belief that this care method has failed. This failure has largely been ascribed to the lack of powers avai...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.24.5.336

    authors: Glover N

    更新日期:1998-10-01 00:00:00

  • Stem cells, embryos, and the environment: a context for both science and ethics.

    abstract::Debate on the potential and uses of human stem cells tends to be conducted by two constituencies-ethicists and scientists. On many occasions there is little communication between the two, with the result that ethical debate is not informed as well as it might be by scientific insights. The aim of this paper is to high...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2003.002386

    authors: Towns CR,Jones DG

    更新日期:2004-08-01 00:00:00

  • How physician executives and clinicians perceive ethical issues in Saudi Arabian hospitals.

    abstract:OBJECTIVES:To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN:Self-completion questionnaire administered from February to July 1997. SETTING:Different health regions i...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.25.1.51

    authors: Saeed KS

    更新日期:1999-02-01 00:00:00

  • Participation in biomedical research is an imperfect moral duty: a response to John Harris.

    abstract::In his paper "Scientific research is a moral duty", John Harris argues that individuals have a moral duty to participate in biomedical research by volunteering as research subjects. He supports his claim with reference to what he calls the principle of beneficence as embodied in the "rule of rescue" (the moral obligat...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.2006.017384

    authors: Shapshay S,Pimple KD

    更新日期:2007-07-01 00:00:00

  • Disclosures of funding sources and conflicts of interest in published HIV/AIDS research conducted in developing countries.

    abstract:OBJECTIVES:Disclosures of funding sources and conflicts of interests (COI) in published peer-reviewed journal articles have recently begun to receive some attention, but many critical questions remain, for example, how often such reporting occurs concerning research conducted in the developing world and what factors ma...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2010.035394

    authors: Klitzman R,Chin LJ,Rifai-Bishjawish H,Kleinert K,Leu CS

    更新日期:2010-08-01 00:00:00

  • Medical murder in Belgium and the Netherlands.

    abstract::This article is a response to Raphael Cohen-Almagor's paper entitled 'First do no harm: intentionally shortening lives of patients without their explicit request in Belgium'. His paper deals with very important matters of life and death, however its concept usage is in part misleading. For instance, the fact that medi...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/medethics-2015-103128

    authors: Materstvedt LJ,Magelssen M

    更新日期:2016-09-01 00:00:00

  • End of life decisions: attitudes of Finnish physicians.

    abstract:OBJECTIVES:This study investigated Finnish physicians' experiences of decisions concerning living wills and do not resuscitate (DNR) orders and also their views on the role of patients and family members in these decisions. DESIGN:A questionnaire was sent to 800 physicians representing the following specialties: gener...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2002.001081

    authors: Hildén HM,Louhiala P,Palo J

    更新日期:2004-08-01 00:00:00

  • Patients' ethical obligation for their health.

    abstract::In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.10.3.138

    authors: Sider RC,Clements CD

    更新日期:1984-09-01 00:00:00

  • Why patients should keep their own records.

    abstract::Too many people now have access to confidential medical information. Patients are becoming justifiably wary and the doctor-patient relationship is deteriorating. We can avert the developing crisis by allowing patients to keep their own medical records at home. This will ensure that confidentiality is respected and tha...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.10.1.27

    authors: Coleman V

    更新日期:1984-03-01 00:00:00

  • "I can put the medicine in his soup, Doctor!".

    abstract::The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the ment...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2003.007336

    authors: Wong JG,Poon Y,Hui EC

    更新日期:2005-05-01 00:00:00

  • Publication ethics and the research assessment exercise: reflections on the troubled question of authorship.

    abstract::The research assessment exercise (RAE) forms the basis for determining the funding of higher education institutions in the UK. Monies are distributed according to a range of performance criteria, the most important of which is "research outputs". Problems to do with publication misconduct, and in particular, issues of...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.26.6.422

    authors: Sheikh A

    更新日期:2000-12-01 00:00:00

  • Limits of confidentiality.

    abstract::A patient is described, a woman of 60, who at that age was diagnosed as having Huntington's chorea, a genetic disease which is transmitted as an autosomal dominant. She had one daughter, who was married and lived abroad. The patient's mother and maternal aunt, it emerged during the consultations, had had the disease, ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:

    authors:

    更新日期:1976-03-01 00:00:00

  • When four principles are too many: bloodgate, integrity and an action-guiding model of ethical decision making in clinical practice.

    abstract::Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100136

    authors: Muirhead W

    更新日期:2012-04-01 00:00:00

  • Gamete derivation from stem cells: revisiting the concept of genetic parenthood.

    abstract::Genetic parenthood is usually portrayed as a value-neutral concept that can be confirmed or rejected based on objective, scientific tests. However, on inspection, it is exposed as a very complex idea that we might need to consider as something that comes in different shapes and forms and that is open to interpretation...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101830

    authors: Mertes H

    更新日期:2014-11-01 00:00:00

  • Assessing risk/benefit for trials using preclinical evidence: a proposal.

    abstract::Moral evaluation of risk/benefit in early phase studies requires assessing the clinical promise of a candidate intervention using preclinical evidence. Yet, there is little to guide ethics committees, investigators, sponsors or other stakeholders morally charged with making these assessments ('evaluators'). In what fo...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-102882

    authors: Kimmelman J,Henderson V

    更新日期:2016-01-01 00:00:00