The history of autonomy in medicine from antiquity to principlism

Saad, Toni C

doi:10.1007/s11019-017-9781-2

Cited by 30 publications

(17 citation statements)

References 31 publications

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“…The first author realised the enormity of the divide between French and British practices in 2001, when asked to write an endorsement for The Silent Child: Exploring the World of Children Who Do Not Speak by Laurent Danon-Boileau. 1 The book's author was described as one of France's most respected child psychoanalysts, with a particular interest in language. The book contained a series of case studies of children who did not have any formal diagnoses but appeared to fit criteria for autism, intellectual disability or dyslexia.…”

Section: Psychoanalysis As An Intervention For Child Language Disordersmentioning

confidence: 99%

The case for cautious paternalism in the emergency management of patients with borderline personality disorder

Newton‐Howes

2021

BJPsych Bull

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Summary Principlism is the dominant ethical theory in modern medicine. Autonomy is ‘king’ of the principles espoused and operationalised in consent. Consent is the mechanism by which all medical interactions occur. In borderline personality disorder (BPD) there is often a diffuse sense of self, emotional instability and impulsivity that can lead to medically dangerous non-suicidal self-injury, acute medical intervention and then a withdrawal of consent while the potential threat to the person's well-being remains high. Claims of lack of capacity lack veracity, and simply acting against the patient's will may be illegal. Understanding the will and preferences of patients is a step forward, but it is not always possible in time-sensitive situations. A cautious paternalism is therefore warranted both to ensure the patient's well-being while being honest as to the reasons for this, and to possibly build epistemic trust between the medical system and the patient with BPD.

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Section: Psychoanalysis As An Intervention For Child Language Disordersmentioning

confidence: 99%

The case for cautious paternalism in the emergency management of patients with borderline personality disorder

Newton‐Howes

2021

BJPsych Bull

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“…Respect for autonomy and the empowering of individuals to make choices about their lives has been a central principle of modern medical ethics since around the 1970s (Saad 2018 , p. 125; Morley and Floridi 2019 , p. 1160) and as a result, notions of medical coercion have become not just unpopular, but in most instances, unjustifiable. As a result, it is easy to see why basing the justification of PST on respecting and enhancing autonomy might have a strong appeal.…”

Section: The Role Of a Historical Review In The Debate Around The Ethmentioning

confidence: 99%

Is routine prenatal screening and testing fundamentally incompatible with a commitment to reproductive choice? Learning from the historical context

Nakou

2020

Med Health Care and Philos

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An enduring ethical dispute accompanies prenatal screening and testing (PST) technologies. This ethical debate focuses on notions of reproductive choice. On one side of the dispute are those who have supported PST as a way to empower women’s reproductive choice, while on the other side are those who argue that PST, particularly when made a routine part of prenatal care, limits deliberate choice. Empirical research does not resolve this ethical debate with evidence both of women for whom PST enhances their choices but also persistent evidence of recurrent problems between PST and women’s autonomous decision-making. While there have been attempts to remove challenges to reproductive choice, it has been argued that these challenges cannot be removed entirely. In this paper I provide a historical review of PST technologies’ development and in doing so provide a detailed insight into the root causes of this tension between the opposing sides of this debate. This historical account provides evidence that those who championed the early use of these technologies did so in order to achieve a number of wholly different goals other than women’s choice and empowerment. These different aims focus on scientific discovery and eugenic goals and, I argue, are irreconcilable with women’s choice and empowerment. It thus may not be surprising that the resulting practice of PST continues to resist compatibility with women’s choice and empowerment. Ultimately, by understanding the historical foundations of PST we can more effectively assess how to reconcile women’s reproductive autonomy with routine prenatal screening.

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“…Although trust is 'a theme with ancient roots' (Saad, 2018), it is important to clarify what we mean when we use the term in this context, since the 'traditional model of the trusting doctor-patient relationship has been subject to multiple criticisms for many years' (O'Neill, 2002: 17). One concern is around the deep association between trust and medical paternalism; as O'Neill has observed:…”

Section: The Incompatibility Thesismentioning

confidence: 99%

Is conscientious objection incompatible with healthcare professionalism?

Neal

Fovargue

2019

The New Bioethics

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Is conscientious objection (CO) necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is and make various types of claim about the source of the incompatibility. In this paper, we begin by outlining the positive case for accommodating CO, before addressing one particular type of incompatibility claim, namely that CO is fundamentally incompatible with proper healthcare professionalism. The attitude of the conscientious objector, it is claimed, exists in opposition to the sort of disposition (attitudes and underlying character) that we are entitled to expect from a 'good' healthcare professional. We begin here by asking whether this claim is true in principle: what is the disposition of a 'good' healthcare professional, and how does CO align with or contradict it? Having concluded that, at least in principle, CO need not contradict or undermine good professionalism, we move on to consider practical compatibility, acknowledging that this will involve the identification of appropriate limits on the exercise of CO and considering briefly what those limits might be. Ultimately, we reject the suggestion that CO is fundamentally incompatible-either in principle or in practice-with good healthcare professionalism.

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The history of autonomy in medicine from antiquity to principlism

Cited by 30 publications

References 31 publications

The case for cautious paternalism in the emergency management of patients with borderline personality disorder

The case for cautious paternalism in the emergency management of patients with borderline personality disorder

Is routine prenatal screening and testing fundamentally incompatible with a commitment to reproductive choice? Learning from the historical context

Is conscientious objection incompatible with healthcare professionalism?

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