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What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions

  • Aya Enzo
  • Taketoshi Okita
  • Atsushi Asai
Scientific Contribution

Abstract

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities.

Keywords

Chronic conditions Self-management Respect for autonomy Personal autonomy Respect for persons Kant 

Notes

Acknowledgements

This study was supported by JSPS KAKENHI, Grant Number 16K16681.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.

References

  1. Aujoulat, Isabelle, William d’Hoore, and Alain Deccache. 2007. Patient empowerment in theory and practice: Polysemy or cacophony? Patient Education and Counselling 6: 13–20.CrossRefGoogle Scholar
  2. Barclay, Linda. 2000. Autonomy and the social self. In Relational autonomy, eds. Catriona Mackenzie and Natalie Stoljar, 52–71. Oxford: Oxford University Press.Google Scholar
  3. Beauchamp, Tom L. 2010. The origins and evolution of the Belmont report. In Standing on principles, ed. Tom L. Beauchamp, 3–17. Oxford: Oxford University Press.Google Scholar
  4. Beauchamp, Tom L., and James F. Childress. 1989. Principles of biomedical ethics. 3rd ed. Oxford: Oxford University Press.Google Scholar
  5. Berlinger, Nancy, Bruce Jennings, and Susan M. Wolf. 2013. The Hastings Center guidelines for decisions on life-sustaining treatment and care near the end of life: Revised and expanded second edition. New York: Oxford University Press.CrossRefGoogle Scholar
  6. Byers, Philippa. 2016. Dependence and a Kantian conception of dignity as a value. Theoretical Medicine and Bioethics 37: 61–69.CrossRefGoogle Scholar
  7. Childress, James. 1990. The place of autonomy in bioethics. Hastings Center Report 20: 12–17.CrossRefGoogle Scholar
  8. Department of Health. 2001. The expert patient: A new approach to chronic disease management for the twenty-first century. London: Department of Health.Google Scholar
  9. Dillon, Robin S. 2016. Respect. In The Stanford encyclopedia of philosophy, winter 2016 edition, ed. Edward N. Zalta. https://plato.stanford.edu/archives/win2016/entries/respect/. Accessed 30 Oct 2017.
  10. Dodds, Susan. 2000. Choice and control in feminist bioethics. In Relational autonomy, eds. Catriona Mackenzie and Natalie Stoljar, 213–235. Oxford: Oxford University Press.Google Scholar
  11. Dove, Edward S., Susan E. Kelly, Federica Lucivero, Mavis Machirori, Sandi Dheensa, and Barbara Prainsack. 2017. Beyond individualism: Is there a place for relational autonomy in clinical practice and research? Clinical Ethics 12 (3): 150–165.CrossRefGoogle Scholar
  12. Feste, Catherine and Robert M. Anderson. 1995. Empowerment: From philosophy to practice. Patient Education and Counseling 26: 1–3.CrossRefGoogle Scholar
  13. Friedman, Marilyn. 2000. Autonomy, social disruption, and women. In Relational autonomy, eds. Catriona Mackenzie and Natalie Stoljar, 35–51. Oxford: Oxford University Press.Google Scholar
  14. Funnell, Martha M., and Robert M. Anderson. 2004. Empowerment and self-management of diabetes. Clinical Diabetes 22: 123–127.CrossRefGoogle Scholar
  15. Gibert, Sophia H., David DeGrazia, and Marion Danis. 2017. Ethics of patient activation: Exploring its relation to personal responsibility, autonomy and health disparities. Journal of Medical Ethics 43: 670–675.CrossRefGoogle Scholar
  16. Herman, Barbara. 1993. Mutual aid and respect for persons. In The practice of moral judgment, ed. Barbara Herman, 45–72. Cambridge: Harvard University Press.Google Scholar
  17. Jennings, Bruce. 2016. Reconceptualizing autonomy: A relational turn in bioethics. Hastings Center Report 46: 1–5.Google Scholar
  18. Jonsen, Albert R. 1998. The birth of bioethics. Oxford: Oxford University Press.Google Scholar
  19. Kant, Immanuel. 1996/1785a. Grundlegung zur Metaphysik der Sitten, translated as “Groundwork of the metaphysics of morals”. In Immanuel Kant practical philosophy, trans. and ed. Mary J. Gregor, Cambridge: Cambridge University Press.Google Scholar
  20. Kant, Immanuel. 1996/1797b. Die Metaphysik der Sitten, translated as “The metaphysics as morals.”. In Immanuel Kant practical philosophy, trans. and ed. Mary J. Gregor, Cambridge: Cambridge University Press.Google Scholar
  21. Kishi, Keiko, ed. 2015. Serufu-Negurekuto no Hito heno Shien [Support for persons with self-neglect], Chuou-Hoki-Syuppan-Kabushikigaisya (in Japanese).Google Scholar
  22. Kristinsson, Sigurdur. 2007. Autonomy and informed consent: A mistaken association? Medicine, Healthcare and Philosophy 10: 253–264.CrossRefGoogle Scholar
  23. Kukla, Rebecca. 2005. Conscientious autonomy: Displacing decisions in health care. Hastings Center Report 35 (2): 34–44.CrossRefGoogle Scholar
  24. Lanoix, Monique. 2013. The ethics of imperfect cures: Models of service delivery and patient vulnerability. The Journal of Medical Ethics l39: 690–694.CrossRefGoogle Scholar
  25. Mcleod, Carolyn, and Susan Sherwin. 2000. Relational autonomy, self-trust, and health care for patients who are oppressed. In Relational autonomy, eds. Catriona Mackenzie and Natalie Stoljar, 259–280. Oxford: Oxford University Press.Google Scholar
  26. Naik, Aanand D., Carmel B. Mark, Mark E. Kunik, and Laurence B. McCullough. 2009. Patient autonomy for the management of chronic conditions: A two-component re-conceptualization. American Journal of Bioethics 9 (2): 23–30.CrossRefGoogle Scholar
  27. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1979. The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research. Department of Health, Education, and Welfare. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html. Accessed 30 Oct 2017.
  28. O’Neill, Onora. 1989. Constructions of reason: Explorations of Kant’s practical philosophy. Cambridge: Cambridge University Press.Google Scholar
  29. O’Neill, Onora. 2002. Autonomy and trust in bioethics. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  30. Pugh, Jonathan. 2014. Enhancing autonomy by reducing impulsivity: The case of ADHD. Neuroethics 7: 373–375.CrossRefGoogle Scholar
  31. Reach, Gérard. 2014. Patient autonomy in chronic care: Solving a paradox. Patient Preference and Adherence 8: 15–24.Google Scholar
  32. Ringstad, Øystein. 2016. Being an autonomous person with chronic disease. Croatian Medical Journal 57 (6): 608–610.CrossRefGoogle Scholar
  33. Roberts, Joseph T. F. 2017. Autonomy, competence and non-interference. HEC Forum: An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues,  https://doi.org/10.1007/s10730-017-9344-1.Google Scholar
  34. Rolf, Sibylle. 2012. Humanity as an object of respect: Immanuel Kant’s anthropological approach and the foundation for morality. The Heythrop Journal 53 (4): 594–605.CrossRefGoogle Scholar
  35. Saad, Toni C. 2018. The history of autonomy in medicine from antiquity to principlism. Medicine, Health Care and Philosophy 21 (1): 125–137.CrossRefGoogle Scholar
  36. Sandman, Lars, Bradi B. Granger, Inger Ekman, and Christian Munthe. 2012. Adherence, shared decision-making and patient autonomy. Medicine, Health Care and Philosophy 15 (2): 115–127.CrossRefGoogle Scholar
  37. Secker, Barbara. 1999. The appearance of Kant’s deontology in contemporary Kantianism: Concepts of patient autonomy in bioethics. Journal of Medicine and Philosophy 24 (1): 43–66.CrossRefGoogle Scholar
  38. Sherwin, Susan and Meghan Winsby. 2011. A relational perspective on autonomy for older adults residing in nursing homes. Health Expectations 14 (2): 182–190.CrossRefGoogle Scholar
  39. Shimizu, Tetsuro. 2012. Palliative care, In Encyclopedia of applied ethics, 2nd ed., vol. 3, eds. Ruth Chadwick, Dan Callahan, and Peter Singer, 328–337, London: Academic Press.CrossRefGoogle Scholar
  40. Shimizu, Tetsuro and Kaoruko Aita. 2013. Shu-matuki kea ni okeru ishi kettei purosesu. In Siri-zu seimei-rinri: Syumatuki iryou [Decision-making process in end-of-life care. In The Japanese Bioethics Series: End-of-Life Care], ed. Awaya Tsuyoshi, 20–41, Tokyo: Maruzen-Shyuppan-Kabushikigaisya (in Japanese).Google Scholar
  41. Stirrat, G. M., and R. Gill. 2005. Autonomy in medical ethics after O’Neill. Journal of Medical Ethics 31: 127–130.CrossRefGoogle Scholar
  42. Taylor, James S., ed. 2008. Personal autonomy. Cambridge: Cambridge University Press.Google Scholar
  43. The Japan Geriatrics Society. 2012. Koreisha kea no ishi kettei purosesu ni kansuru gaidorain [JGS guidelines for decision-making process in elderly care focusing on indications of artificial hydration and nutrition] (in Japanese). https://www.jpn-geriat-soc.or.jp/proposal/pdf/jgs_ahn_gl_2012.pdf. Accessed 30 Oct 2017.
  44. Veatch, Robert M. 2002. The basics of bioethics. 2nd ed. New Jersey: Prentice Hall.Google Scholar
  45. Veatch, Robert M. 2010. The basics of bioethics. 3rd ed. New York: Routledge.Google Scholar
  46. Wardrope, Alistair. 2015. Relational autonomy and the ethics of health promotion. Public Health Ethics 8 (1): 50–62.CrossRefGoogle Scholar
  47. Wardrope, Alistair. 2016. Reinterpreting respect for relationally and biologically informed autonomy. The American Journal of Bioethics 16 (2): 50–52.CrossRefGoogle Scholar
  48. Willems, Dick. 2000. Managing one’s body using self-management techniques: Practicing autonomy. Theoretical Medicine and Bioethics 21 (1): 23–38.CrossRefGoogle Scholar
  49. Williamson, Laura. 2014. Patient and citizen participation in health: The need for improved ethical support. The American Journal of Bioethics 14 (6): 4–16.CrossRefGoogle Scholar
  50. Wilson, James. 2007. Is respect for autonomy defensible? Journal of Medical Ethics 33: 353–356.CrossRefGoogle Scholar
  51. Zimmerman, Frederick J. 2017. Public health and autonomy: A critical reappraisal. Hastings Center Report 47 (6): 38–45.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medical Ethics, Graduate School of MedicineTohoku UniversitySendaiJapan

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