All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he (...) argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

This paper undertakes a critical examination of recent philosophical discussions of the concept of individual autonomy. The paper is divided into two parts. Part I focusses on the work of joel feinberg, Gerald dworkin, Harry frankfurt and others, As well as their critics, In the development of the concept of autonomy itself (or its analogues). The suggestion defended is that autonomy is an important complement to freedom when the latter is construed only as the absence of restraints. Also considered is (...) the relation between autonomy and reason or rationality. In part ii, I examine various recent attempts to utilize the property of autonomy in moral and political theory. (shrink)

IN THE winter and spring of 1031,1 was invited to give a series of ten lectures at Harvard University. The subject chosen was the Philosophy of Art; the lectures are the origin of the present volume. The Lectureship was founded in memory of William James and I esteem it a great honor to have this book associated even indirectly with his distinguished name. It is a pleasure, also, te recall, in connection with the lectures, the unvarying kindness and hospitality of (...) my colleagues in the department of philosophy at Harvard. I am somewhat embarrassed in an effort to acknowledge indebtedness to other writers on the subject. Some aspects of it may be inferred from authors mentioned or quoted in the text. I have read on the subject for many years, however, more or less widely in English literature, somewhat less in French and still less in German, and I have absorbed much from sources which I cannot now directly recall. Moreover, my obligations to a number of writers are much greater than might be gathered from allusions to them in the volume itself. My indebtedness to those who have helped me directly can be more easily stated. Dr. Joseph Ratner gave me a number of valuable references. Dr. Meyer Schapiro was good enough to read the twelfth and thirteenth chapters and to make suggestions which I have freely adopted. Irwin Edman read a large part of the book in manuscript and I owe much to his suggestions and criticism. Sidney Hook read many of the chapters, and their present form is largely the result of discussions with him; this statement is especially true of the chapters on criticism and the last chapter. My greatest indebtedness is to Dr. A. C. Barnes. The chaptershave been gone over one by one with him, and yet what I owe to his comments and suggestions on this account is but a small measure of my debt. I have had the benefit of con versations with him through a period of years, many of which occurred in the presence of the unrivaled collection of pictures he has assembled. The influence of these conversations, together with that of his books, has been a chief factor in shapingmy own thinking about the philosophy of esthetics. Whatever is sound in this volume is due more than I can say to the great educational work carried on in the Barnes Foundation. That work is of a pioneer quality comparable to the best that has been done in any field during the present generation, that of science not ex cepted. I should be glad to think of this volume as one phase of the widespread influence the Foundation is exercising. I am indebted to the Barnes Foundation for permission to reproduce a number of illustrations and to Barbara and Willard Morgan for the photographs from which the reproductions were made. J. D. (shrink)

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

This book approaches ethical and legal issues in medicine from the patient's viewpoint and argues that many patients do not want the full burden of decision making that contemporary bioethics has thrust upon them.

Based on John Dewey's lectures on esthetics, delivered as the first William James Lecturer at Harvard in 1932, Art as Experience has grown to be considered internationally as the most distinguished work ever written by an American on the formal structure and characteristic effects of all the arts: architecture, sculpture, painting, music, and literature.

Donald VanDeVeer probes the moral complexities of the question: under what conditions is it permissible to intervene invasively in the lives of competent persons--for example, by deception, force, or coercive threat--for their own good? In a work with broad significance for law, public policy, professional-client relations, and private interactions, he presents a theory of an autonomy-respecting" paternalism. Originally published in 1986. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist (...) of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, not (...) a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements. (shrink)