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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/2859 |
| Date | 12 1900 |
| Creators | Anthony, John |
| Contributors | Van Niekerk, A. A., University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Philosophy. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | Unknown |
| Type | Thesis |
| Rights | University of Stellenbosch |
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