Academic journal article The Hastings Center Report

From the Editor

Academic journal article The Hastings Center Report

From the Editor

Article excerpt

Bioethics has in recent years emphasized the ways in which decisionmaking about a patient's care involves people other than the patient. Good decisionmaking is not just a matter of letting the patient decide. The motivation for this view is partly that the picture of the patient as a solitary thinker, exercising pure autonomy, uninfluenced from without, is a picture that many don't like, both because it discourages one from recognizing how individual autonomy ought to be bounded by the needs and values of the community in which the individual is situated, and because the picture of an agent not fundamentally situated in a web of relationships comes eventually to seem rather desolate.

So the lone agent is not the ideal. Another reason for not thinking of patients as making decisions entirely independently, however, is that this is not even the best way of promoting autonomy. Given the links between people, promoting a patient's autonomy can require that others support and encourage the patient in complex ways. Promoting autonomy cannot mean leaving someone alone.

Articles in this issue underline this point in different ways, with different purposes. Kevin Gibson advances reasons for thinking that mediators should renounce absolute neutrality as their guiding principle. Although part of the reason for maintaining neutrality is that it allows the disputants to practice autonomy--since they are supposed to work out their differences themselves--Gibson suggests that mediator neutrality can actually conflict with this goal. When the doctor and the patient disagree, yet the patient decides not to simply find another doctor, the mechanics of the relationship--the balance of power and the encumbrances bearing on the patient--should often encourage a mediator to support the patient in various ways, perhaps challenge the patient's and doctor's proposed solutions, perhaps even propose new solutions.

Arti Rai, Mark Siegler, and John Lantos also argue for a richer, more empathizing approach to making decisions. …

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