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Results for “Professional Autonomy”

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At least 1,279 records · Page 71Linked to original sources
PubMed1998

A transcultural, preventive ethics approach to critical-care medicine: restoring the critical care physician's power and authority.

This article comments on the treatment of critical-care ethics in four preceding articles about critical-care medicine and its ethical challenges in mainland China, Hong Kong, Japan, and the Philippines. These articles show how cultural values can be in both synchrony and conflict in generating these ethical challenges and in the constraints that they place on the response of critical-care ethics to them. To prevent ethical conflict in critical care the author proposes a two-step approach to the ethical justification of critical-care management: (1) the decision to resuscitate and initiate critical-care management, which is based on the obligation to prevent imminent mortality without permanent loss of consciousness; and (2) the decision to continue critical-care management, which is based on the obligation both to prevent imminent death without permanent loss of consciousness and to avoid unnecessary, significant iatrogenic costs to the patient and psychosocial costs to the family when the reduction of mortality risk is marginal. Physicians and hospitals should restore the critical-care physician's authority and power -- against prevailing cultural values, if necessary -- to control when critical-care intervention is offered, when it is recommended to continue, and when it is recommended to be discontinued and the patient allowed to die.

Beneficence↗
PubMed1997

Ethical issues raised by managed care.

Health care costs have risen steadily for many years as a result of an inflationary reimbursement system, technologic advances, an aging population, and increasing patient expectations. The growth of managed care organizations (MCOs) has accelerated rapidly in recent years as an attempt to control costs. Because MCOs are involved with medicine, a moral enterprise, they enter the ethical arena. In this report several of the ethical issues raised by the attempted union of potentially conflicting systems are explored. The discussion focuses on four sets of relationships: physician-patient, physician-physician, patient-MCO and medicine-MCO as systems. Some remedies for dealing with the conflicts raised are offered.

Disclosure↗
PubMed1995

The basis and limits of physician authority: a reply to critics.

This paper develops a model of the nurse/physician authority relationship presented in an earlier issue of this journal, and responds to criticisms raised against that model in commentaries on that article. Specifically, I examine the discrepancy which exists between medical knowledge and nursing education, and show this discrepancy to be a difference in type, not quality. The implication is that improvements in nursing education will not affect the authority relationship between physician and nurse. To affect this relationship the nature of nursing education must change.

Authoritarianism↗
PubMed1993

Prolegomena to any future code of ethics for bioethics.

If bioethicists, qua bioethicists, restrict themselves to the humble but honorable task of education and delimit their authority accordingly, they will be on solid ethical ground. Moreover, by adopting and professing this role, bioethicists should ensure that they will continue to be held in high regard by those who, suspicious of partisans and advocates, will turn to them for help, not for certainties and answers, to be sure, and certainly not for moral authority, but rather for a measure of clarity and distinctness in an increasingly complex world. What the bioethicist is rightfully authorized to do or say speaking-as-a-bioethicist is valuable enough and can make a difference.

Bioethics↗
PubMed2002

Compassion and patient centred care.

BACKGROUND: The essence of medicine is a relationship based upon a concern for suffering. Western medicine, arising from a modernistic philosophy, has a tradition of paternalistic 'doctor centred' care. There are significant criticisms of this approach. OBJECTIVE: Drawing on postmodern perspectives, this article discusses the nature of patient centred care. Patient centred care requires a reconciliation of the patient's and doctor's agenda via attention to communication, power and patient autonomy. Patient centred care has been defined by six domains: the illness experience, the context, finding common ground, partnership, health promotion, and consultation limitations. DISCUSSION: Patients strongly desire patient centred care. It has been associated with improved patient and doctor satisfaction, greater compliance, fewer investigations, referrals and malpractice complaints, and no change in consultation time. Patient centred care exerts a positive influence on health outcomes and is especially applicable in general practice, providing an efficacious and compassionate response to suffering.

Australia↗
PubMed2004

Unilateral withholding and withdrawal of potentially life-sustaining treatment: a violation of dignity under the law in Canada.

In this paper, I review Canadian law in relation to the unilateral withholding or withdrawal of potentially life-sustaining treatment, and I look at such questions as whether physicians are legally permitted to unilaterally put a do-not-resuscitate (DNR) order on a patient's chart. I explore who has the legal authority in Canada to decide on withholding and withdrawal of potentially life-sustaining treatment, and I conclude that unilateral withholding and withdrawal is a violation of the strong social commitment to dignity as it is understood and reflected in the law by the Supreme Court of Canada. I then offer a concrete proposal for institutional policy with respect to unilateral withholding and withdrawal of treatment in light of the law.

Advance Directives↗
PubMed1994

The Nightingale pledge: 100 years later.

Written in 1893, the Nightingale Pledge reflected the opinion of a small group of nurses, physicians and lay women about the required characteristics of American nursing. This Pledge serves as a professional mission statement, one that truly reflects the deep-seated vision and values of nursing. A modern analysis of this classic work creates a frame of reference to measure nursing practice.

Ethics, Nursing↗
PubMedDate not supplied

Reasonable refusal?--an ethical dilemma.

Ethical decision-making can lead to fairer and collegiate decisions, which are made collectively with the patient. This paper considers the role of the nurse in the ethical decision-making process. The experience of being involved in the decision-making process is shared. The importance of nurses becoming involved in ethical decision-making in an impartial and non-judgmental way is advocated.

Critical Care↗
PubMed2001

Pseudoaccountability.

The public has long entrusted the medical profession to regulate its own practices, but our efforts to do so have been uneven. In place of rigorous, enforceable standards, we have sometimes reverted to pseudoaccountability: weak regulations that only give the appearance that we have been responsible in setting and enforcing high standards. We have failed to deal effectively with substandard practitioners, lagged in preventing medical errors, inadequately documented patient care in the medical record, slipped up in protecting patients in clinical research projects, and accepted financial arrangements with industry that may affect our judgment. In response, government has intervened, and threatens to intervene further with regulations that sometimes are excessively intrusive and cumbersome. To preserve our remaining autonomy, we must show that we are serious about protecting the public. Professional membership organizations must stop promulgating weak guidelines and offering evaluative methods to assess and regulate their own coveted members. Instead, they must turn over assessment of their members to arm's-length, disinterested groups. Regulatory programs must have provisions with impeccable standards, surveillance processes, and methods to deal with infractions. In planning new self-regulatory approaches, we should invite open discussion and genuine involvement by independent members of the public or the government to help ensure that our decisions about standard setting are not self-serving. Our profession has already lost much authority. We can ill afford to lose more.

Documentation↗
PubMed2003

Feminist ethics and menopause: autonomy and decision-making in primary medical care.

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Australia↗