This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...) (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

A philosophical essay under this title faces severe rhetorical challenges. New accounts of the good life regularly and rapidly turn out to be variations of old ones, subject to a predictable range of decisive objections. Attempts to meet those objections with improved accounts regularly and rapidly lead to a familiar impasse — that while a life of contemplation, or epicurean contentment, or stoic indifference, or religious ecstasy, or creative rebellion, or self-actualization, or many another thing might count as a good (...) life, none of them can plausibly be identified with the good life, or the best life. Given the long history of that impasse, it seems futile to offer yet another candidate for the genus “good life” as if that candidate might be new, or philosophically defensible. And given the weariness, irony, and self-deprecation expected of a philosopher in such an impasse, it is difficult for any substantive proposal on this topic to avoid seeming pretentious. (shrink)

The cluster of concerns usually identified asmatters of privacy can be adequately accountedfor by unpacking our natural rights to life,liberty, and property. Privacy as derived fromfundamental natural rights to life, liberty,and property encompasses the advantages of thecontrol and restricted access theories withouttheir attendant difficulties.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995.