PHIL 235 Lecture Notes - Lecture 2: Surrogacy, Informed Consent, Anarchism In Russia
11 May 2018
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Lesson 2- Notes
2.2 Who Decides for the Patient? Autonomy, Competence & Surrogacy
A minimal Standard of Competence
• Patient is merely able to express a preference
• This standard respects every expressed choice of a patient, and so is not in
fact a criterion of competent choice at all.
• It thus fails to provide any protection for patient well-being, and it is insen-
sitive to the way the value of self-determination itself varies both with the
nature of the decision to be made and with differences in people’s
capacities to choose in accordance with their conceptions of their own
good.
An outcome of Standard of Competence
• Standards that look solely to the content or outcome of the decision
• The standard that the choice be a reasonable one, or be what other
reasonable or rational persons would choose.
• Failure bc although it maximally protects patient well-being, according to the
standard’s conception of well-being, it fails to respect patient self-
determination
A Relational Approach to Autonomy in Health Care
• Respect for patient autonomy (or self-direction) is broadly understood as
recognition that patients have the authority to make decisions about their
own health care
• Supposes an alternative approach to autonomy that is labeled, relational
Problems with the Autonomy Ideal
• we need to question how much control individual patients really have over
the determination of their treatment within the stressful world of health care
services.
• modern hospitals reveals that wide agreement about the moral importance
of respect for patient autonomy does not always translate into a set of
practices that actually respect and foster patient autonomy in any
meaningful sense.
• Informed consent→ accepted as the most promising mechanism for ensuring
patient autonomy
• The effectiveness of the actual procedures used to obtain informed consent
usually falls short of fully protecting patient autonomy.
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