Legal and Ethical Issues
Marc E. Agronin in Alzheimer's Disease and Other Dementias, 2014
Any discussion of medical-legal issues should be rooted in several basic ethical principles, including autonomy, beneficence, justice, and confidentiality (Anfang & Appelbaum, 2011; Beauchamp & Childress, 2008). Autonomy or self-determination refers to an individual's right to make his or her own decisions and have those decisions respected by others. With dementia patients, autonomy may be restricted by a diminished capacity to understand the decision at hand and the ramifications of each choice. This issue will be discussed further within the context of capacity evaluations. Beneficence refers to the responsibility of all clinicians to act for the good of the patient. The corollary to beneficence is nonmaleficence—meaning “to do no harm” to the patient. Both concepts are based in part upon various religious, cultural, and ethical belief systems with respect to the value or sanctity of human life. With dementia patients, clinicians have a key responsibility to ensure that all decision-making is truly is in line with what would be best according to the impaired individual's own values or previously stated wishes. Such an approach will be highlighted when discussing the role of advance directives.
Informed consent
Joseph Tham, Alberto García Gómez, Mirko Daniel Garasic in Cross-Cultural and Religious Critiques of Informed Consent, 2021
As voluntariness is based on autonomy, it requires two conditions: liberty or freedom to choose an agent’s capacity for intentional action. Nevertheless, if we scrutinize these two conditions from Buddhism, we will find them somehow ambivalent. Autonomy means self-determination, self-governance or choosing without the controlling influence of others. However, the question is how “the controlling influence of others” be defined. According to the Buddhist doctrine of (inter)dependent-origination, absolute self-determination is impossible since “self” is causally produced by “others,” particularly in cultures like China and Japan, where the self cannot be fully defined without an adequate understanding of the family dynamics. In the case of informed consent, it is very often difficult for physicians (and patients) to determine if a patient’s deferral of decision-making is his/her own choice or the result of formative influences of the family. It follows that the patient’s capacity for intentional action is also questionable. Voluntariness involves the idea of “free will,” which would be problematic for Buddhists, and medical decision-making based entirely on patient-centred orientation would be problematic for Buddhists.
Power Issues in Social Work Practice
Arthur J. Katz, Abraham Lurie, Carlos Vidal in Critical Social Welfare Issues, 2014
Most social workers are convinced that in their practice, they automatically honor the client’s right to self-determination. This is often an illusion since many of clients can not be self-determining. True self-determination requires access to resources, access to opportunity, and access to power. Too often in this highly individualistic society in which pulling one’s self up by the bootstraps is the ideal, self-determination becomes the right to be left alone, or the right to be abandoned and neglected. A growing awareness of the limitations and often the hollowness of this professional promise of client self-determination has led social workers in the past two decades to adopt the notion of empowerment. This is a more assertive view of self-determination for clients, a view which recognizes that self-determination requires power.
Preparing for the future: multi-stakeholder perspectives on autonomous goal setting for adolescents with autism spectrum disorders
Published in Disability and Rehabilitation, 2018
Sandra Hodgetts, Kathryn Richards, Elly Park
Self-determination refers to the ability to be in charge or in control of making decisions in one’s own life. It involves having the intrinsic motivation to make choices independent of external influences, pressures, or interferences [2]. Children and adolescents develop self-determination as they mature across the life span and acquire the necessary attitudes and skills to act with self-motivated intent, including autonomy, competency, and relatedness [3]. Autonomy refers to independent choice, such as self-selecting a personal goal. Competency represents a sense of accomplishment or mastery, such as goal achievement. Relatedness denotes connectedness, such as the social supports that assist with meeting a set goal. Collectively, these attitudes and skills facilitate self-determination and ultimately enhanced well-being for people with and without disabilities.
Self-determination and Physical Functioning as Mediators of the Association between Self-reported Sensory Impairments and Happiness among Older Adults
Published in Experimental Aging Research, 2022
autonomies of individuals and social participation, such as in community activities, comprise self-determination (Heller et al., 2011; Ottenvall Hammar, Ekelund, Wilhelmson, & Eklund, 2014; Raymond, Grenier, & Hanley, 2014). This concept of self-determination is the freedom to decide on actions from a range of reasonable options, which leads to it being often related to having a successful or fulfilling life development. Arguably, this concept of self-determination can be characterized or measured through indices that have been used in other studies such as mobility, social participation, and capacity for household activities (Brown & Barrett, 2011; Xiang et al., 2020). In the cultural context of Thailand, self-determination, which is highlighted as the sense of belonging and the ability to contribute to the household and the community are considered important such that these aspects of household and community life manifest in health status and well-being upon old age (Hongthong et al., 2015; Pothisiri & Vicerra, 2021; Suttajit et al., 2010). Health impairments including sensory loss and functioning difficulties become important antecedents for achieving self-determination and ultimately, happiness.
Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives
Published in Disability and Rehabilitation, 2021
Elaine Biddiss, Daniela Chan-Viquez, Stephanie T. Cheung, Gillian King
The following briefly summarizes three contemporary theories of motivation: self-determination theory, expectancy-value theory, and social cognitive theory. In overview, self-determination theory posits that actions and choices are motivated by our intrinsic needs for autonomy (i.e., the need to experience personal control and pursue one’s own interests), competence (i.e., the need to experience mastery and feel confident in pursuing challenges), and relatedness (i.e., the need to feel connected to others) [17]. Expectancy-value theory postulates that actions, particularly those in achievement settings, are motivated by expectancies (“can I do the task?”) and values (“do I want to do the task?”). Social cognitive theory describes a goal-directed, cyclic process applying self-generated feedback to form self-efficacy beliefs, which in turn impact affective response and goal-directed behaviors. In social cognitive theory, self-efficacy is the primary driver of action. Individuals tend to pursue goals with a high likelihood for success. Self-determination theory, expectancy-value theory, and social cognitive theory each provide unique perspectives on motivation and human behavior that may lead to novel insights and implications [20] relevant to our understanding of engagement in interactive computer play-based motor therapies. The following presents a more detailed introduction to each of these theories.
Related Knowledge Centers
- Autonomy
- Sphere of Influence
- Age of Enlightenment
- Self-Governance
- Autonomous Administrative Division
- National Personal Autonomy
- Stateless Nation