PP217 Lecture Notes - Lecture 4: Scott Storch, Paternalism
Paternalistic- specific kind of violation of autonomy; we act paternalistically
when we override someone's autonomy for his/her own good
•
Historically was standard practice
•
Warranted towards young children
Nurse as Mother, Friend, Servant
•
Features; being based on trust, keeping promises, dedication, nurturing,
protection and a commitment to never abandon a patient in need
•
Storch points out that if we identify the nurse as a mother, we're
identifying it as mainly the work of women, self-sacrificing mother. The
comparison ignores the technical knowledge and training nursing
requires
•
Nurse as a friend has similar problems, friend relationship is supposed to
be one of equals, in the nurse-patient relationship the patient is often
vulnerable
•
Nurse as servant - someone who simply follows orders from the physician
and fills in the gaps
•
Until 1970s nurses would pledge devotion to the physician, after 1970
the International Council of Nurses Code of Ethics stated the nurses
primary responsibility is to the patient
Nurse as technician
•
Focusing on technical medical knowledge addresses some of Stroch's
concerns. However, this ignores an important part of nursing; bringing a
sense of comfort to the patient
•
Stroch points out that although nurses tasks may look the same as the
physicians, they actually fulfill a different, complementary role
Nurse in Conventional relationship, as healer, advocate
•
Nurse should have a conventional relationship. They are 'bound to one
another' they're members of a community with their patient
• Nurse as healer- nurse is often present with a patient in a one-on-one
role, this relationship can help the client heal
• Nurse as patient advocate- arose in 1970s where the nurse is seen to be
managing and coordinating services for their patient. Take on the role of
standing in to ensure patients have a voice in their medical care
• These metaphors emphasize the moral commitment of nurses to be a
comforting presence; have a patient relationship, advocate on client's
behalf
Autonomy in context
• Sherwin states that common conceptions have some gender-based blind
spots
• Autonomy may conflict with justice
○Amount to the libertarian position that anything that happens in a
free market must be allowed
• The usual approach to informed consent does not consider whether the
patient is a member of an oppressed group, someone who may not be
entirely free to give or withdraw consent due to pressures faced outside
the doctors office
○Information may be limited in scope, as may ne the options
presented
• The classical model of autonomy encourages us to focus on individuals as
though they were isolated atoms. Institutional emphasis on individual
diseases rather than public health, and a tendency to ignore oppressive
circumstances that limit autonomy
• Agency vs autonomy; a person has agency whenever she is able to make
a choice and act on it. Autonomy requires that we are in no way
oppressed
• Sherwin offers a developmental version of relational autonomy- persons
develop continuously within a network of relationships, this network can
foster or suppress autonomy
• Conceptual version of relational autonomy- autonomous is not to be
independent, because we can’t do anything without our relationships,
rather it is to be free from oppression
Limits to autonomy
• No moral theory claims complete autonomy, it is justly limited to prevent
harm to others
• If I exercise my autonomy in such a way as to infringe on yours, I can
justly be restrained
○Does not apply to harm that is self-inflicted
Medical Relationships and Autonomy
Saturday, May 19, 2018
10:26 PM
Document Summary
Paternalistic- specific kind of violation of autonomy; we act paternalistically when we override someone"s autonomy for his/her own good: historically was standard practice, warranted towards young children. Nurse as technician: focusing on technical medical knowledge addresses some of stroch"s concerns. However, this ignores an important part of nursing; bringing a sense of comfort to the patient: stroch points out that although nurses tasks may look the same as the physicians, they actually fulfill a different, complementary role. Nurse in conventional relationship, as healer, advocate: nurse should have a conventional relationship. They are "bound to one: nurse should have a conventional relationship. Take on the role of standing in to ensure patients have a voice in their medical care: these metaphors emphasize the moral commitment of nurses to be a comforting presence; have a patient relationship, advocate on client"s behalf. Autonomy in context: sherwin states that common conceptions have some gender-based blind spots, autonomy may conflict with justice.
