Autonomy and Beneficence

 Right to make one’s own choices  Respect for persons- not to interfere with choice of another, though persuasion permitted.  Obligation to treat persons as capable of choice unless good evidence against.

 Free action: (1) Voluntary without coercion; (2) Intentional- informed and understand consequences.  Authentic choice- consistent with one’s beliefs, values and life plan.  Effective deliberation- aware of alternatives and consequences.

 Agent intends to influence other person by presenting a severe threat which must be (a) credible and (b) irresistible.

Intentional and successful influence of a person by noncoercive altering of (a) choices available to the person or (b) perception of these choices.

 One ought to do or promote good.  Non-malficience- not to inflict harm or evil.

Must the help be active or passive? How does one know what is the good of the other?

 What is the level of good intended or level of harm risked or permitted?  What is the probability of the good or harm? What are the actual causal influences?

 Context: Applied only if not against individual autonomy and dignity.  There must be proportionate good to permit risk of harmful.  Are there alternatives?

 A is acting paternalistically toward S in and only if A’s behavior indicates that (1) The action benefits S; (2) The action involves violating a moral rule with regard to S; (3) The action does not have S’s present or forth-coming consent; and (4) S is competent to give consent.

Goals of Informed Consent Professional Obligation  Protect subject’s status as a human being (dignity rights)  Promote individual autonomy  Prevent fraud and duress

Must be autonomous Effects on life, health, lifestyle, values, family, religious beliefs, friends and society.  Must be competent to consent. -able to rationally deliberate; to have adequate understanding and to give reasonable assessment of consequences.  Must be free from coercion or manipulation.  Must have adequate and relevant information-  Four standards: (1) Patient preference; (2) Professional custom; (3) Prudent (reasonable) person; and (4) Subjective substantial rule.

Medical Practice Ethical Practice  Standard medical practice-  Primary exceptions: (1) Therapeutic privilege-withhold information to protect the health of the patient.- watch for paternalism  (2) Emergency conditions- unable to consent, life is in danger and immediate treatment is needed.  Major question- informed consent ever be over-ridden?