PHI 237 1st Edition Lecture 11Christopher Boorse’s “Goals of Medicine”CONT.- Medicine has a path-acentric essence o Upshot of IMM – DR should only fight disease, prevent it, treat it, and its immediate effects like pain and they shouldn’t do anything else- Can refrain from inducing pathology if you are a practitionero But can refrain if isn’t aimed at doing pathologyBeauchamp and Childress: “Respect for Autonomy”I. Introduction2. The word ‘autonomy’ is derived from the Greek words autos (self) And nomos (rule, governance or law)- Autonomous human beings that give rule to people- Self chosen to people how they can act freely and manage their plan- 2 conditionso Liberty & free from eternal certaintieso Free from this controlo Liberty and agency are a hallmarko1. Medicine has traditionally been more concerned with the patient’s well being than her autonomy. Medical codes didn’t begin to stress patient autonomy until the last century - Well being determines if they are flourishing or thriving- Well being go up and down and flourish and thrive- Well being deals with health in this class- Closest to autonomy is confidentiality- Patients will make autonomous choices that will affect their values and where they want to live ... will be at odd of their medical well being- Conflict between autonomy and well being3. Beauchamp and Childress concentrate upon autonomous choice rather than ongeneral capacities for governance and self-managementThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- Are the choices they make in a medical setting autonomous????- Competency is similar but different from autonomy4. The dominant virtue of medicine had been beneficence, where the doctors are concerned with the health and happiness of the patient, not their autonomy. - Good will and concern of the people- Old codes like do not harm5. The traditional insignificance of autonomy meant that doctors were often paternalistic and withheld the truth from patients where they thought it would harmful- Paternalistic laws restrict freedoms for own good o Ex) wearing helmet while on a motorcycleo Drs. have been acting like parents being treated like childreno Doctors didn’t use c words for decades  “cancer”o Lou Gehrig wasn’t told that he has this diseaseo Deception is broader than lieso Whenever you lie you gage in deceptiono Deception can be deeper than lies thougho Get self – fulfilling prophecies- When doctors went without patients consent it was just for reason- Dr. compete for patients and wasn’t well regulated in the past- II. Theories of Autonomy- 1. Beauchamp & Childress reject a Frankfurt-inspired account of autonomy in which there is no gap between first and second order-desires or preferences. - Second order of desire leads to guilt- Not autonomous- Second order of desire not opposed to the first- Change mind- Main criticism is that the second order of desire is to be a content alcoholic- Likewise of autonomy is being in control of your actions-- 2. Beauchamp and Childress claim it is not enough for there to be an identification of first and second-order desires because the second order could be manipulated or people may not reflect on them-- 3. Beauchamp and Childress maintain autonomous action is understood in termsof choosers who act 1) intentionally 2) with understanding 3) without controllinginfluences that determine their actions- 4. An action is autonomous for Beauchamp and Childress if it possesses a substantial degree of understanding and freedom from constraint, not a full understanding or a complete absence of influence.o Don’t have to know everything about it to be autonomouso Have to have enough relevance of understandingo Not full autonomy that you want but threshold has to be autonomouso Likely-hood of everythingIII. Autonomy & Authority1. B & C believe autonomy and submission to authority are compatible if individuals autonomously choose to accept an institution, tradition etc. as a legitimate authority- Deferring from authority doesn’t make autonomy impossible- If you have enough judgment then that is good- Make autonomous decision to defer autorut--3. Authority and autonomy are not incompatible concepts, a clash only arises when the authority has not been properly delegated or accepted. - Be understanding and the absence of control and influence-IV. The Principle of Respect for Autonomy1. To respect autonomous agents is to acknowledge their right to hold views, to make choices and to take actions based on their personal values and beliefs-2. It requires more than noninterference in others’ affairs; one must promote their capacities for autonomous choice while helping to prevent factors that undermine autonomy.- Not just doing something you don’t want to do - But doing something of autonomous choice- To make patient think more clearly think of patients eyes- Increase ability to understand and make reasonable decision- Talk to them when they aren’t undermined by some mood swing-3. Kant argued respect for autonomy flowed from the unconditional value of all rational agents who could determine and then freely act on the basis of the moral law- Reflect to work of moral law- Value in itself- Good in it of itself- Value of reason is capacity of cultures warmth- Desire to appreciate it and be rational- Cant morally reason- Reason so valuable is because of rationality- Have dignity if you have rationality- Have rationality if you act in a dignified manner- Dignity is this ting you have in rationality- Have dignity respect value of yourself and others- Act autonomously when you follow moral law-4. To violate the person’s autonomy was to treat them merely as a means, not as an end in themselves. - To respect autonomy treat as end itself- Recognize that they have this value in there-self- Treat in end is a way they will agree to itself- Treat as means use there as your benefit-5. Autonomy can be construed as involving a negative obligation of non-interference and a positive obligation of disclosing information and fostering decision-making- Don’t put hands on patients- Increase ability to make judgments6. In health care & research involving human subjects, respect for autonomy means disclosing info, determining that disclosure is understood, ensuring voluntarily action, foster adequate decision making- Respect for autonomy means