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• Title: Autonomy Without Care: The History and Theory of Advance Care Plans (Report)
• Author : Traffic (Parkville)
• Release Date : January 01, 2008
• Genre: Reference,Books,
• Pages : * pages
• Size : 363 KB

Description

A woman born in Australia in 2005 can expect to live 30 years longer than a woman born in 1901 and she is much more likely to die in institutional care. (1) These changes, attributable to improved living standards, vaccinations, antibiotics and technological advances in medicine, have been associated with radical changes in the doctor-patient relationship. Dying in hospital often results in patients being actively treated leading up to their death with treatments that might stave off death, if only for a few hours or days. Decisions regarding the use of such treatments are fraught with the potential for conflict. Autonomy is hailed as the ethic to guide us through the quagmire created by these decisions, but its limitations may have been underestimated. Changes in medicine have been accompanied by changes in the law and society. All three have played a part in altering the dynamic of medical ethics. The four foundations of medical ethics--beneficence, non-maleficence, autonomy and justice--remain, but the balance of power has shifted such that autonomy has become the dominant value. Autonomy's ascendancy is illustrated by the move to enable people to formalise their treatment preferences in advance for medical decisions that may need to be made should they become incompetent. This process is known as advance care planning. In this essay I will explore autonomy in relation to advance care plans (ACPs). I will review the historical factors that resulted in the development of ACPs, different theoretical constructs of autonomy including the tension between autonomy and ACPs, and the empirical evidence around patients' preferences for autonomy. This discussion is limited to Western culture. Space constraints prevent a discussion of the cross-cultural aspects of autonomy; suffice to say not all cultures place the same value on autonomy as Western culture.

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