Slide 1Slide 2What ought to be done...…in a given situation...…all things considered?What ought to be done in a given situation, all things considered?Slide 7Snapshot vs. videotapeSlide 9(Respect for) AutonomyPaternalismPaternalism and PrinciplesWhy paternalism and not parentalism?Paternalism and the history of U.S. medical ethicsSlide 15Autonomy: Problems to flagModels of P-patient relationshipMiller, 4 senses of autonomyAutonomy and RelationshipEmanuels’ ModelsSlide 21What is ethics?What is autonomy?Models of the health-professional-patient relationshipWhat ought to be done in a given situation, all things considered?--Benjamin and CurtisWhat ought to be done...Action orientedImplies personal ownership and responsibilityImplies choiceImplies reasonable control…in a given situation...All ethics is “situation ethics”Concrete facts matterWhat makes one situation like another situation in ethically relevant ways?…all things considered?There is no “ethical point of view” distinct from other (“practical”) points of viewGood ethical reasoning is not a new viewpoint but an integration (and critical analysis) of all existing viewpointsCan we ever in practice “consider all things” finally and irrevocably? (Provisional nature of ethical conclusion)What ought to be done in a given situation, all things considered?Is this the only “ethical”question?Snapshot ethics vs.Videotape ethicsSnapshot vs. videotapeWhat does it mean to do the right thing now?What does it mean to live a morally good life?Snapshot vs. videotapeWhat does it mean to do the right thing now?Rules, principles, case studyWhat does it mean to live a morally good life?Virtue(Respect for) AutonomyNot interfering in another’s wishes and choicesTreat others as ends-in-themselves and not as means only (Kant)= Self-determinationAssumes “adult” capacitiesPaternalismRefusing to acquiesce in another person’s wishes or choices for that person’s own benefit.--ChildressPaternalism and PrinciplesPaternalism = principle of benefit/harm takes priority over principle of autonomyOther, non-benefit-based reasons to reject autonomy not paternalismIs it “really” paternalism if principle of autonomy does not apply due to lack of capacity?Why paternalism and not parentalism?Is concept gender-specific?Does it derive from a gender-specific role?“Father Knows Best” (TV show, 1950’s)Paternalism and the history of U.S. medical ethicsHippocratic ethic: no challenge to physician paternalism1960’s: traditional authority questionedVeatch: Contractual vs. priestly model of physician-patient relationship, 1972Veatch, “generalization of expertise,” 1973Paternalism and the history of U.S. medical ethicsMuch of U.S. medical ethics since the 1960’s amounts to the refutation of physician paternalismAutonomy: Problems to flagIs autonomy culturally specific?Is autonomy gender biased?Does autonomy favor some life stages over others?Does autonomy focus on individual in isolation rather than as member of family and community?Models of P-patient relationshipVeatch, 1972: Priestly vs. Contractual modelsMiller, 1981: 4 senses of autonomyEmanuels, 1992: Paternalistic vs. Informative models-- and moreMiller, 4 senses of autonomyFree actionAuthenticityEffective deliberationMoral reflection--Miller, Hastings Cen Rep 1981Autonomy and RelationshipMiller: Sense ofAutonomyEmanuels: Model ofRelationshipEffective Deliberation InformativeAuthenticity InterpretiveMoral reflection DeliberativeEmanuels’ ModelsInformative Competent technical expertInterpretive Counselor or adviserDeliberative Teacher or friendIf you went to your physician for medical care, what role would you want him or her to play, and why?Would it matter what the medicalproblem