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The justfiable limitations of patient autonomy in contemporary South African medical practice
Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : University of Stellenbosch
2009
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| _version_ | 1867614112999014400 |
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| access_status_str | Open Access |
| author | Anthony, John |
| author2 | Van Niekerk, Anton A. |
| author_browse | Anthony, John Van Niekerk, Anton A. |
| author_facet | Van Niekerk, Anton A. Anthony, John |
| author_sort | Anthony, John |
| collection | Thesis |
| dc_rights_str_mv | University of Stellenbosch |
| description | Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/2859 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:46:52.458Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2009 |
| publishDateRange | 2009 |
| publishDateSort | 2009 |
| publisher | Stellenbosch : University of Stellenbosch |
| publisherStr | Stellenbosch : University of Stellenbosch |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/2859 The justfiable limitations of patient autonomy in contemporary South African medical practice Anthony, John Van Niekerk, Anton A. University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Philosophy. Informed consent Dissertations -- Philosophy Theses -- Philosophy Dissertations -- Applied ethics Theses -- Applied ethics Bioethics Autonomy (Philosophy) Informed consent (Medical law) Communitarianism Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009. ABSTRACT: The European Enlightenment secured man’s freedom from doctrinal thought. Scientific progress and technological innovation flourished in the 18th Century, radically changing the lives of all. Man’s mastery and transformation of his environment was matched by revolutionary political reform, resulting in the dissolution of empire and the transfer of power into the hands of the people. Social transformation saw the city-states of pre-modern man supplanted by a globalized community whose existence grew from time and space distantiation facilitated by the new technologies and the development of symbolic forms. These sweeping social, political and ideological changes of the 18th Century fostered the belief that man’s transformative authority was indeed his to command. Man believed he had a right to self-governance and to autonomous decision-making. Kant described moral autonomy as the freedom men have to show rational accountability for their actions and he saw in men a dignity beyond all price because of this moral autonomy. Personal autonomy is seen as the expression of the free will of individuals and is justifiably constrained by the need to respect the interests and agency of others. The principle of autonomy, in the context of medical practice, was not clearly articulated until the early 20th century. Prior to this, the ethical practice of medicine relied upon the beneficent intentions of the practitioners. The limits to patient autonomy have been delineated largely by issues of social justice based upon the need to share scarce resources fairly among members of society. However, autonomy remains a dominant principle and is most clearly exemplified by the process of informed consent obtained prior to any medical intervention. This thesis provides a conceptual analysis of autonomy in the context of informed consent. Following this, several different clinical scenarios are examined for evidence of justifiable limitations to patient autonomy. Each scenario is examined in the light of different moral theories including deontology, utilitarianism, communitarianism and principlist ethical reasoning. Kantian ethical reasoning is found to be resilient in rejecting any limitation to the autonomy principle whereas each of the other theories allow greater scope for morally-justified curtailment of individual autonomy. The thesis concludes with reflection on post-modern society in which the radicalization of what began with the European Enlightenment sees the transformation of pre-modern society into a global community in which epistemological certainty is no longer available. In this environment, the emerging emphasis on global responsibility requires ethical accountability, not only when individuals secure transactions between one another but also between individuals and unknown communities of men and women of current and future generations. The thesis concludes that patient autonomy is justifiably limited in South African medical practice because of issues related to social justice but that the impact of the new genetic technologies and post-modernity itself may in future set new limits to individual patient autonomy. OPSOMMING: Die Europese Verligting het die mensdom bevry van verstarde, dogmatiese denke. Wetenskaplike en tegnologiese ontwikkelinge het tydens the 18de Eeu die lewens van almal radikaal verander. Die mens se bemeestering en transformasie van sy omgewing het gepaard gegaan met revolusionêre politieke hervormings wat gelei het tot die ontbinding van tradisionele politieke ryke en die oordrag van mag aan die mens. Sosiale transformasie het veroorsaak dat die politieke ordeninge van voor-moderne mense deur ‘n globale gemeenskap vervang is wat ontstaan het as gevolg van onder meer die ontkoppeling van tyd en plek (Giddens), en wat deur nuwe tegnologiese ontwikkelings en die ontstaan van simboliese vorms moontlik gemaak is. Hierdie uitgebreide ontwikkelinge het die idee laat ontstaan dat niks vir die 18de Eeuse mens onmoontlik is nie. Die mens het geglo dat hy ‘n reg het op self-bestuur en outonome besluite. Kant het die morele outonomie van die mens beskou as sy vryheid om verantwoordlikheid te neem vir sy eie rasioneel-begronde handelinge en verder het hy ‘n besondere waardigheid in die mens geïdentifiseer vanweë sy morele outonomie. Omdat ‘n mens hierdie eienskap besit, beskik hy oor ‘n hoër waardigheid as alle alle ander lewensvorme. Persoonlike outonomie is die uitoefenimg van die vrye wil van die individu en word om geregverdigde redes beperk deur die regte van ander mense. Die beginsel van outonomie met verwysing na mediese etiek het nie voor die begin van die 20ste eeu prominent geword nie. Voor hierdie tyd het mediese etiek staatgemaak op die goeie voorneme van die praktisyn. Die grense van individuele outonomie word nou bepaal deur die noodsaak van sosiale geregtigheid. Al is dit die geval, bly die beginsel van outonomie die belangrikste beginsel in die etiese debat en word meestal gesien as ‘n deel van die proses van ingeligte toestemming. Hierdie tesis verskaf ‘n omvattende ontleding van outonomie met betrekking tot ingeligte toestemming. Daarna word verskillende kliniese gevalle beskryf en ontleed, en verskeie etiese teorieë gebruik om die wyse waarop pasiënt outonomie reverdigbaar ingekort behoort te word, te bespreek. Die teorie van Kant is in staat om enige inkorting van outonomie in alle gevalle the weerstaan. Elkeen van die ander teorieë verskaf redes waarom die outonomie van individuele pasiënte legitiem ingekort mag word. Hierdie werk sluit af met besinning oor die post-moderne gemeenskap wat ‘n globale samelewing moet aanvaar sowel as die ontoereikenheid van enige kenteoretiese sekerheid. Die ontwikkelende verantwoordelikheid vir die totale mensdom in hierdie wêreld veroorsaak dat individue nie meer slegs moet besluit oor die morele verhouding met sy medemens nie, maar ook oor sy verhouding met mense van gemeenskappe wat geskei is in tyd en ruimte, insluitend sy verhouding met die mense van toekomstige generasies. Hierdie werk sluit af met die gevolgtrekking dat pasiënt outonomie regverdigbaar beperk word in die Suid Afrikaanse mediese praktyk deur die noodsaaklikheid van sosiale geregtigheid. Die verwagte impak van nuwe genetiese tegnologieë en die ontwikkeling van ‘n post-moderne gemeenskap mag nuwe beperkings bring vir pasiënt outonomie. Masters 2009-11-19T10:05:43Z 2010-06-01T09:00:12Z 2009-11-19T10:05:43Z 2010-06-01T09:00:12Z 2009-12 Thesis http://hdl.handle.net/10019.1/2859 en University of Stellenbosch application/pdf Stellenbosch : University of Stellenbosch |
| spellingShingle | Informed consent Dissertations -- Philosophy Theses -- Philosophy Dissertations -- Applied ethics Theses -- Applied ethics Bioethics Autonomy (Philosophy) Informed consent (Medical law) Communitarianism Anthony, John The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title | The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title_full | The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title_fullStr | The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title_full_unstemmed | The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title_short | The justfiable limitations of patient autonomy in contemporary South African medical practice |
| title_sort | justfiable limitations of patient autonomy in contemporary south african medical practice |
| topic | Informed consent Dissertations -- Philosophy Theses -- Philosophy Dissertations -- Applied ethics Theses -- Applied ethics Bioethics Autonomy (Philosophy) Informed consent (Medical law) Communitarianism |
| url | http://hdl.handle.net/10019.1/2859 |
| work_keys_str_mv | AT anthonyjohn thejustfiablelimitationsofpatientautonomyincontemporarysouthafricanmedicalpractice AT anthonyjohn justfiablelimitationsofpatientautonomyincontemporarysouthafricanmedicalpractice |