Autonomy, value, and the first person

BackgroundCaring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home.MethodsThis Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients’ records were included in the study.An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework.ResultsThe analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer’s and professional caregiver’s need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer.ConclusionsIn order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.

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“…the ability to make decisions even if they do not have agent autonomy i.e. the ability to execute their choices [22]. …”

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

Smebye

Kirkevold

Engedal

2015

BMC Health Serv Res

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“…There is a range of familiar answers to this question; none of which will cover all possible cases, but each of which will cover some (c.f. Scoccia 1990;Groll 2012;Lillehammer 2012).…”

Section: Consent In the "Non-ideal" Casementioning

confidence: 99%

“…One obvious limitation of this explanation is that the practice of constraining behaviour by eliciting consent extends far beyond the domain of agents who satisfy the standard requirements of autonomous, self governing, rational agency (see e.g. McMahan 1996;Beauchamp 2005;Kittay 2005;Levy 2006;Nussbaum 2009;Lillehammer 2012). Cases in this category include persons with mental health 1 Parts of this paper have been previously presented at a workshop on The Theory and Practice of Informed Consent at Oslo and Akershus University College (now Oslo Metropolitan University) in June 2017.…”

Section: Introductionmentioning

confidence: 99%

“…. Nothing in the main text should be read so as to imply the endorsement of Darwall's account of that notion in his book, which, for reasons that should be clear from the main text, would be excessively demanding for the purposes of the present paper.16 As defined inLillehammer (2012), agent autonomy requires possession of the following marks of rational self-governance: i) manifestation of a capacity for higher order reflection and endorsement of practical options; ii) the actual manifestation of a capacity for planning and executing actions that accord with the practical options endorsed; iii) responsiveness of…”

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confidence: 99%

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Autonomy, Consent, and the “Nonideal” Case

Lillehammer

2020

The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine

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According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet, the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best interest. The question of how we should understand the rationale for eliciting consent in this range of “nonideal” cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such “nonideal” cases by appealing to a set of agency-based interests, including an interest in playing a meaningful part in joint decisions affecting ourselves and others.

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“…The basic idea is that to qualify as an autonomous agent and thus be agentially and morally responsible for one's actions, one must be capable of self‐control, self‐determination, and self‐governance. This, in turn, requires that one have a capacity for higher order reflection, for endorsement of particular desires and practical options, and for planning and executing actions that accord with the desires and practical options endorsed (Lillehammer : 198). I will argue that subjects with DID often find it difficult to exercise autonomous agency and that this raises doubts about the extent to which they are responsible for their wrongful acts.…”

Section: Moral Agency and Agent Autonomymentioning

confidence: 99%

Dissociative Identity Disorder, Ambivalence, and Responsibility

Maiese

2016

European J of Philosophy

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If someone with dissociative identity disorder (DID) commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill ordinary requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep‐seated needs and desires conflict, and she forms alter‐personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts.

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Autonomy, value, and the first person

Cited by 12 publications

References 22 publications

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

Autonomy, Consent, and the “Nonideal” Case

Dissociative Identity Disorder, Ambivalence, and Responsibility

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