Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients’ decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism (...) for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating. (shrink)

Lev Vygotsky has acquired the status of one of the grand masters in psychology. Following the English translation and publication of his Collected Works there has been a new wave of interest in Vygotsky, accompanied by a burgeoning of secondary literature. Ronald Miller argues that Vygotsky is increasingly being 'read' and understood through secondary sources and that scholars have claimed Vygotsky as the foundational figure for their own theories, eliminating his most distinctive contributions and distorting his theories. Miller peels away (...) the accumulated layers of commentary to provide a clearer understanding of how Vygotsky built and developed his arguments. In an in-depth analysis of the last three chapters of Vygotsky's book Thinking and Speech, Miller provides a critical interpretation of the core theoretical concepts that constitute Vygotsky's cultural-historical theory, including the development of concepts, mediation, the zone of proximal development, conscious awareness, inner speech, word meaning and consciousness. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)