Patient Autonomy, Assessment of Competence and Surrogate Decision-Making: A Call for Reasonableness in Deciding for Others
Bioethics 2010 February; 24(2): 87-95
In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of 'structural arbitrariness' in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others.
Find in a Library
Full Text from Publisher
Showing items related by title, author, creator and subject.
Deciding for Others: The Ethics of Surrogate Decision- Making (Review of DECIDING for OTHERS: THE ETHICS of SURROGATE DECISION-MAKING by A.E. Buchannan and D.W. Brock) Arnold, Robert M. and Forrow, Lachlan (1990-03)
Incompetent Patients and Surrogate Decision Making (Book Review of DECIDING for OTHERS: THE ETHICS of SURROGATE DECISION- MAKING, by A.E. Buchanan and D.W. Brock) Arnold, Robert M. and Forrow, Lachlan (1991-01)