Making Medical Decisions for the Profoundly Mentally Disabled

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MIT Press, 21.08.2009 - 320 Seiten

A legal and moral analysis of medical decision making on behalf of those with such severe cognitive impairments that they cannot exercise self-determination.

In this book, Norman Cantor analyzes the legal and moral status of people with profound mental disabilities—those with extreme cognitive impairments that prevent their exercise of medical self-determination. He proposes a legal and moral framework for surrogate medical decision making on their behalf. The issues Cantor explores will be of interest to professionals in law, medicine, psychology, philosophy, and ethics, as well as to parents, guardians, and health care providers who face perplexing issues in the context of surrogate medical decision making.

The profoundly mentally disabled are thought by some moral philosophers to lack the minimum cognitive ability for personhood. Countering this position, Cantor advances both theoretical and practical arguments for according them full legal and moral status. He also argues that the concept of intrinsic human dignity should have an integral role in shaping the bounds of surrogate decision making. Thus, he claims, while profoundly mentally disabled persons are not entitled to make their own medical decisions, respect for intrinsic human dignity dictates their right to have a conscientious surrogate make medical decisions on their behalf. Cantor discusses the criteria that bind such surrogates. He asserts, contrary to popular wisdom, that the best interests of the disabled person are not always the determinative standard: the interests of family or others can sometimes be considered. Surrogates may even, consistent with the intrinsic human dignity standard, sometimes authorize tissue donation or participation in nontherapeutic medical research by profoundly disabled persons. Intrinsic human dignity limits the occasions for such decisions and dictates close attention to the preferences and feelings of the profoundly disabled persons themselves. Cantor also analyzes the underlying philosophical rationale that makes these decision-making criteria consistent with law and morals.

 

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Inhalt

The Moral Status of the Profoundly Disabled Persons or Something Less?
13
Criteria of Personhood
17
The Legal and Moral Status of the Profoundly Disabled
20
The Role of Intrinsic Human Dignity
26
The Profoundly Disabled as Rights Holders No Rights the Same Rights as the Fully Capacitated or Some Rights? Attributing the Same Rights to the Pr...
33
A Constitutional Claim to Appropriate Medical Options
41
A Constitutional Right to Some Surrogate Decision on Behalf of the Disabled Person?
43
Who Decides for the Profoundly Disabled?
69
The Kantian Imperative
156
Existing Jurisprudence
159
The Legal and Moral Frameworks Governing Nontherapeutic Medical Research
164
Utilitarianism as a Rationale for Exploitation
169
Ascribing Altruism to Never Competent Persons
173
Parental ChildRearing Prerogatives
178
Social Fairness as a Justification for Using the Profoundly Disabled
186
The Limits of a Surrogates Imposition of Sacrifice
191

Minors Living with Their Parents
70
Disabled Persons Living in Institutions
94
Defining the Best Interests of Profoundly Disabled Persons
101
The Focus on a Never Competent Patients WellBeing
103
The Problematic of Assessing WellBeing
106
Quality of Life Dignity and Never Competent Persons
113
Must Medical Decisions Be in the Best Interests of a Profoundly Disabled Person?
127
Can the Interests of Others Be Included within a Patients Best Interests?
136
Forced Altruism The Problematic of Surrogate Consent to Nontherapeutic Medical Procedures
149
Reliance on the Best Interests of the Profoundly Disabled Patient
151
Discrimination against the Disabled
154
The Voice of the Profoundly Disabled Person
203
The Connection between Consultation and WellBeing
204
DignityBased Reasons for Soliciting Input
206
Limited SelfDetermination
207
Ambiguity of Expressions
211
Notes
215
References
275
Index of Cases and Statutes
293
Index
295
Urheberrecht

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Verweise auf dieses Buch

Ethical Issues in Neurology
James L. Bernat
Eingeschränkte Leseprobe - 2008
Ethical Issues in Neurology
James L. Bernat
Eingeschränkte Leseprobe - 2008

Über den Autor (2009)

Norman L. Cantor is Professor of Law and Justice Nathan Jacobs Scholar at Rutgers University School of Law.

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