1. 1 Choice and Autonomy Ethical Issues in Women’s Health Meredith Schwartz Dalhousie University, Department of Philosophy

2. 2 Breast Implants Health Canada is currently deciding whether to allow silicone gel breast implants Picture from a Mentor advertisement

3. 3 Breast Implants The discussion is couched in terms of allowing women the “choice” Does more choice always promote autonomy? What choices? Picture from imaginis.com “Mammography Guidelines for Women with Breast Implants”

4. 4 Autonomy Self-Governance Self-Determination Informed Consent: Patients have a right to accept or refuse treatment after receiving complete information from their MD CHOICE

5. 5 Autonomy Four elements of Autonomy: –Competence (rationality) How do stereotypes interfere? –Reasonable Choice What choices are available? –Adequate Information Who decides? –Free from Explicit Coercion What counts?

6. 6 Breast Implants Does the “choice” enhance ♀’s autonomy on the traditional view? Picture from Fuller Breasts by Dr. R Scott Smith

7. 7 Breast Implants Does the “choice” enhance ♀’s autonomy on a feminist view?

8. 8 Breast Implants Is the ♀’s “choice” simply personal?

9. 9 What is Normal? How many of the breasts in the picture represent “normal” women’s breasts? How do breast implants affect what we think of as normal? Picture from Fuller Breasts by Dr. R Scott Smith

10. 10 Relational Autonomy Autonomy is a capacity or skill Autonomy is a social process, although the skill ultimately resides in individuals

11. 11 Questions? Comments? Picture from Fuller Breasts by Dr. R Scott Smith

12. 12 Bibliography Traditional Views of Autonomy Beauchamp TL, Faden RR (1995) “Informed consent: II. Meaning and elements of informed consent.” In: Reich WT, editor. Encyclopedia of Bioethics. rev ed. vol 3. New York: Simon & Schuster Macmillan:1240 Mappes TA, DeGrazia D (2001) Biomedical Ethics: Fifth Edition. New York: McGraw-Hill Feminist View of Relational Autonomy Susan Sherwin (2004) “A Relational Approach to Autonomy in Health Care” in Baylis F, Downie J, Hoffmaster B, Sherwin S (eds) Health Care Ethics in Canada: Second Edition. Toronto: Nelson a division of Thomson Canada Autonomy in Canadian Law Reibl v. Hughes, [1980] 2 S.C.R. 880; Hopp v. Lepp, [1980] 2 S.C.R. 192. Malette v. Shulman [1990] 67 DLR (4th) (Ont CA) at p 338.