Many health care decisions depend not only upon medical facts, but also on value judgments—patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of (...) medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients—failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals. (shrink)

Most recent accounts of personal autonomy acknowledge that the social environment a person lives in, and the personal relationships she entertains, have some impact on her autonomy. Two kinds of conceptualizing social conditions are traditionally distinguished in this regard: Causally relational accounts hold that certain relationships and social environments play a causal role for the development and on-going exercise of autonomy. Constitutively relational accounts, by contrast, claim that autonomy is at least partly constituted by a person’s social environment or standing. (...) The central aim of this paper is to raise the question how causally and constitutively relational approaches relate to the fact that we exercise our autonomy over time. I argue that once the temporal scope of autonomy is opened up, we need not only to think differently about the social dimension of autonomy. We also need to reconsider the very distinction between causally and constitutively relational accounts, because it is itself a synchronic (and not a diachronic) distinction. (shrink)

The idea that the self is in need of rethinking, as the title to this collection of essays suggests, presupposes that the self has already been “thought.” And indeed it has—both explicitly, by philosophers, and implicitly, in the practices of everyday life. For philosophers, this thinking about the self has taken place largely in abstract terms; persons have been treated as metaphysical-cum-moral subjects, disembodied minds that could plausibly be split from or melded with other such minds, or as rational agents, (...) capable of choosing a plan in terms of which to live their lives. In everyday life, in contrast, we “think” one another as selves by making assumptions about how the people we encounter fit into the social landscape and about how we ourselves have a place in the world. As the essays in this collection demonstrate, feminists have challenged both ways of thinking of selfhood in various, sometimes contradictory, ways. (shrink)