Respecting autonomy in the setting of acute traumatic quadriplegia

Surgery (Impact Factor: 3.38). 02/2014; 155(2):355-60. DOI: 10.1016/j.surg.2013.11.006
Source: PubMed
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    ABSTRACT: Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the "right to die" is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people.
    Theoretical Medicine and Bioethics 02/2004; 25(3):171-98. DOI:10.1023/B:META.0000040058.24814.54 · 0.78 Impact Factor
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    Medical Decision Making 01/2005; 25(1):96-105. DOI:10.1177/0272989X04273799 · 3.24 Impact Factor
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    ABSTRACT: Recent medical advances have complicated decisions regarding terminal care. Surgeons should be familiar with the ethical issues that contribute to end-of-life decision-making. Four clusters of ethical principles (autonomy, nonmaleficence, beneficence, and justice)are used commonly in ethical deliberations. Artificial ethical distinctions between withholding versus withdrawing care or ordinary versus extraordinary treatments can confuse clinical decision-making at the end of life. An ethics of death and dying requires that the intent and the action of the moral agent be considered.
    Surgical Clinics of North America 05/2005; 85(2):273-86, vii. DOI:10.1016/j.suc.2004.11.006 · 1.88 Impact Factor
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