Compromised autonomy
Başlık:
Compromised autonomy
Yazar:
Miller, Saul Nicholas, author.
ISBN:
9780438060494
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (126 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Advisors: R. S. Downie.
Özet:
Autonomy is widely held to be a vital moral concern in modem liberal society in general and in health care in particular. In Part I of this thesis a review of the development of the concept of autonomy is conducted, taking into account both the views of influential past writers and also those of modem health care writers. From this review is derived a clear and concise conception of autonomy that is applicable within the health care setting. According to this conception, autonomy is a capacity that most people have and that consists of three component capacities: free action, competence and self-govemance. In Part II constraints on patients' autonomy are considered via a consideration of constraints on each of its three component capacities. With regard to the capacity for free action, it is indicated that individuals can impose (internal) constraints on their own ability to act freely. This is what self-governance involves, for example. But sometimes individuals impose excessive restrictions on themselves. Illnesses, inabilities and disabilities are further internal constraints on free action that are discussed. Externally derived constraints on patients' ability to act freely include physical barriers such as locked doors, coercion or manipulation by health care personnel, miles and an inadequacy of resources (both in social and in health care terms). Rationing is discussed in the context of this latter type of constraint. Patients' competence is discussed primarily in terms of intelligence and knowledge (definitions of competence are considered separately, in the Appendix). The difficulties of defining and measuring intelligence are highlighted, along with those circumstances in which intellectual functioning can be impaired. The role of knowledge is explored too. The difference between experiential and non-experiential knowledge is explained and patients' frequent dependence on information given by those health care workers attending them considered as a potential constraint on their acquisition of accurate non- experiential knowledge. Factors such as presentation, selection and receptiveness affect the knowledge derived from information provided. The existence of common moral values is essential to the existence of a society. Self- govemance, the ability to govern one's acts in accordance with such common values, is argued to be the condition for autonomy that most clearly distinguishes it from the concept of responsibility for actions. It is also argued that, as values cannot be directly observed, they cannot be directly imposed, only indirectly imposed via informational manipulation that leads to a voluntary' alteration of them. In Part III, following the same format as in Part II, constraints on doctors' professional autonomy are considered. With regard to doctors' capacity for free action, defensive medicine is first rejected as a significant constraint. Secondly, deficiencies of technical ability are discussed, this leading on to a justification of the concept of revalidation. Thirdly, the extent and hierarchy of rules and regulations is outlined along with their relation to ideas of justice. The primacy of ideas of justice over ideas of autonomy is asserted. Inadequate intelligence is argued to be an uncommon competence constraint for doctors, meaning that inadequate knowledge is much more likely to be the problem when doctors fail to act competently. A discussion of this leads back to the issue of revalidation. The government's drive to improve quality assurance procedures in the NHS, summarised by the term clinical governance, is noted to have very similar aims to revalidation. It is concluded that there is much scope to link the two processes directly. The three main constraints on doctors' ability to self-govem are argued to be a lack of awareness of others' values, a lack of insight into their own, and the possession of idiosyncratic values. Medical school culture as a potential source of some of these constraints is discussed as well as some of the recent curriculum changes that may help to counteract this. The use of the arts as a method of remedying these constraints is acknowledged. Finally the role of ethical codes is discussed in some detail. Oaths and statements of core values are ultimately rejected as being very unlikely to contribute to improvements in doctors' ability to be self-governing. Deontological codes are, on the other hand, accepted as being likely to do this.
Notlar:
School code: 0547
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(684818.1) | 684818-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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