Autonomy

Question 1

One foundational duty of deoltology

Answer 1

follow the CI

Question 2

Etymology of Autonomy

Answer 2

Autos = self
Nomos = Law/ rule
aka self rule.

Question 3

autonomy is about self-determination n

Answer 3

the right to make independent decisions concerning one’s own life & well being

Question 4

Respect for autonomy is allied most closely with

Answer 4

deontological theory

Question 5

Autonomy as free action

Answer 5

Libery/freedom to act in a certain way. You can do what you want & not be forced. Restriction of freedom = restriction of autonomy,
Libery to act.
BE able to do & not forced in what not to do.

Question 6

Patient autonomy as free action may be jeopardized by:

Answer 6

1) Agent-internal freedom limiting impedemtns like disease or pain
2) Agent-external freedom-limiting impediments like schedules, rules, ehcmical or physical restraintss

Question 7

Autonomy as effective deliberation

Answer 7

sometimes someones freedom to act may be justifiably inhibited because they are no autonomy in a decision making sense. Effectively make own decision. Effective deliberation nis necessary for autonomy decision making.
Need to know the notice issues ( the factors)
Just because a decision doesn’t seem best for them doesn’t mean they lack autonomy. they may have other reasons. As long as they have reasons it is ok.

Question 8

Effective dleiberation presupposes 2 main requirements

Answer 8

1) Knowlegde

2) Reasoning ability

Question 9

To deliberate effective the person must be able to understand & appreciate:

Answer 9

1) His or her situation
2) Relevant information
3) Risks, detriments & benefits
4) The logical relationship between the options under consideration & the desired outcome they want to obtain

Question 10

Autonomy as authenticity

Answer 10

Sometimes we wish to know not: whether a patient is acting autonomously or deliberating autonomy but if their decisions or values are AUTHENTIC.
Something may be autonomous if it is consistent with a persons true self & not autonomous would be out of character. Need to distinguish genuine expression of values fro inauthentic expression.
You need to understand genuine evolution of values & temporary shifts.

Question 11

Example of Autonomy as authenticity

Answer 11

at end of life it is difficult to tell whether a persons values, judgements or commitments are genuine or not. facing death can be life changing experience but an expressed change may be simply situation. It need to be consistent with character, values & beliefs.

Question 12

Autonomy as moral reflection

Answer 12

similar as to authenticity. Involves thinking for oneself rather than adopting moral judgement unconsciously & uncritically. In a healthcare context this applies to recipient & provers. Coming up with ways to support your decisions. Y

Question 13

Promoting & respecting informed decision-making

Answer 13

1 - Nurses provide persons in their care with the information they need to make informed decisions related to their health and well-being. They also work to ensure that health information is given to those persons in an open, accurate, understandable, and transparent manner. 2- Nurses respect the wishes of capable persons to decline to receive information about their health condition.
3- Nurses ensure that nursing care is provided with the person’s informed consent. …4- Nurses are sensitive to the inherent power differentials between care providers and those receiving care. They do not misuse that power to influence decision-making.
5- Nurses provide education to support the informed decision-making of capable persons. They respect the decision a person makes, including choice of lifestyles or treatment that are not conducive to good health, and continue to provide care in a non-judgmental manner
6 - For any person that is considered incapable of consenting to care, nurses promote that person’s participation in discussions and decisions regarding their care in a manner that is adapted to the person’s capabilities.

Question 14

Honoring dignity

Answer 14

1- Nurses, in their professional capacity, related to all persons receiving care with respect
2 - Nurses support persons receiving care in maintaining their dignity and integrity.
3- In health-care decision-making, in treatment and in care, nurses work with persons receiving care to take into account their values, customs and spiritual beliefs, as well as their social and economic circumstances without judgment or bias. 4 - Nurses intervene and report when necessary, when others fail to respect the dignity of a person they are caring for or a colleague (including students), recognizing that to be silent and passive is to condone the behaviours.

Question 15

Effective deliberation & capacity

Answer 15

It is crucial to decide if the person arrived at the decision through a process of reasoning that is at least minimally rational”

Question 16

How do we know who is competent / has capacity to decide?

Answer 16

Standards used:

1) Outcomes approach
2) Status approach
3) Functional approach

Question 17

1) outcomes approach

Answer 17

Look at what is decided. An agent with capacity chooses reasonably. Many of us make decision that towhees deem unreasonable. It’s a mistake for a healthcare provider to take his own values as terminating what’s reasonable. Assess WHY the patient is making the decisions, may be supported by their belief system.

Question 18

2) The status approach: Define capacity by group (Age, Impairment) membership

Answer 18

• It is conceivable, perhaps likely that some group members will have the capacity to make decision for themselves.
  Mature Minor - designation mentioned at several points In the text.

Question 19

3) Functional approach assess

Answer 19

Capacity based on an understanding of the persons decision making skills and abilities as applied to the particular decision to be made at a particular time.

• Rejects the idea that capacity is an all or nothing thing
• Embraces the idea that capacity is a sliding scale, with thresholds depending on the seriousness of the decision.
• Rejects the idea that capacity encompasses all decisions.
• Embraces the idea of capacity for some choice and not necessarily for another.
• Rejects the idea that capacity is necessarily stable.
• Embraces the idea that capacity can fluctuate. E.g., the “sundowning” effect

Question 20

Inform Consent

Answer 20

1) Capacity
2) Voluntariness: Action & deliberation must be free from coercion
3) Information: Deliberation & action must take place with understanding & appreciation form the information related to the situation & decision at hand

Question 21

Information in the healthcare context

Answer 21

In the past, frequently information was withheld or presented in a misleading way to avoid causing the patient worry or harm”
This is seen now as paternalism, something to which we’ll return later on.
Today nurses play an important role(s) in the informed consent process.
Davis describes five: watchdog, advocate, resource person, coordinator, and facilitator (154)

Question 22

Informed Consent or consent by form

Answer 22

• Davis found that nurses tend to view informed consent as a process that occurs over time rather than as a one-time, all or nothing event
• This can distinguish it from institutionalized informed consent procedures.
• Moreover, the process of obtaining informed consent often amounts to little more than an empty ritual enacted to satisfy the letter of the law” (155)

Question 23

What does promote autonomy entail for the nurse/ healthcare provider

Answer 23

In the consumer model it means non interference (liberty or free action)
In existential advocacy model (helping patients to clarify relevant values & to decide what they really want to do in light of these values.

Question 24

In asking what the commitment to promoting autonomy entails, we should keep in mind

Answer 24

• Autonomy is not the only moral value we or those we encounter have.
• Autonomy is of varying value in a multicultural society.

Question 25

When if ever may autonomy be limited?

Answer 25

Autonomy is very valued in society in the healthcare. It often clashes with the principle of beneficence. When there is such a clash there is a risk of paternalism. Patenralism for the present purposes is “Restricting or limiting peoples autonomy for their own good”

Question 26

Three bases for limiting autonomy

Answer 26

• In deciding whether to refuse to promote, or even to inhibit, a patient’s autonomy, a nurse may make three different kinds of arguments:
• Argument from the capacity of the person. Incapacitation in one of the respects considered earlier.
• Argument from harm to others. Beneficence or non-maleficence to others besides the patient is a greater consideration.
• Argument from harm to the patient. Beneficence or non-maleficence to the patient.

Question 27

Argument for harm to the patient

Answer 27

• Weak paternalism: a person’s autonomy may be overridden by beneficence or non-maleficence if it is for his own good and he lacks capacity.
• Strong paternalism: a person’s autonomy may be overridden by beneficence or non-maleficence if it is for his own good whether or not he lacks capacity.
• Strong paternalism receives much criticism, philosophically and in healthcare.

Question 28

Conclusion of autonomy

Answer 28

Whatever the reason for limiting patient autonomy in all senses, the limitation must be the least invasive or restrictive of liberty under the circumstances, and no more than is necessary to accomplish the desired purpose

Question 29

Substitute decision making

Answer 29

Must happen in all circumstances except emergency.

1) The patients wishes & advanced directive
2) Patients best interest

Question 30

what is limiting autonomy

Answer 30

PAtenralism - Protection of third parties & justice.

Question 31

Limited paternalism

Answer 31

takes into account the possibility that the autonomy of the sick person may be greatly diminished because of sickness & satisfied paternalistic intervention so far as its ultimate end is restoration of autonomy

Question 32

Strongest Paternalism

Answer 32

Limiting liberty when the persons capacity to make decisions in not in question. Limiting autonomy of a capable person for their own good.

Question 33

Paternalism is most prevalent

Answer 33

in mental illness nursing

Question 34

Limiting autonomy `

Answer 34

1) Paternalism & the limitation of autonomy
2) Protection of third parties & limitation of autonomy
3) Justice & the limitation of autonomy

Question 35

Protecting 3rd parties

Answer 35

According to mill it is not justifiable to limit someone else’s autonomy for their own good but it’s ok to protect someone else

Question 36

Justice & limitation of autonomy

Answer 36

Resources are not infinite.

Meeting needs before wishes

Question 37

End of life decisions

Answer 37

1) Palliative care
2) right to refuse treatment
3) Lifesaving interventions deemed to be futile
4) Request for assisted suicide
5) Involuntary active euthanasia

Question 38

Relational autonomy

Answer 38

Identifies a broader range of barrier to autonomous choice, considers embodies social location & experience.
Social influence to priorities, concerns & beliefs. Social location is influenced to priories, concerns & beliefs. Social & political circumstances
Protecting those who are aging