Philosophical foundations of respect for autonomy

Understanding the philosophical foundations of the principle of respect for autonomy is essential for its proper application within medical ethics. The foundations provided by Immanuel Kant's principle of humanity and John Stuart Mill's principle of liberty share substantial areas of agreement including: the grounding of respect for autonomy in the capacity for rational agency, the restriction of this principle to rational agents, and the important distinction between influence and control. Their work helps to clarify the scope and role of the principle of respect for autonomy in health care delivery; its implications for truth telling, informed consent, and confidentiality; and its relationship to other moral principles, such as beneficence and distributive justice.     

Moral responsibility and respect for autonomy: meeting the communitarian challenge.

The principle of respect for autonomy has come under increasing attack both within health care ethics, specifically, and as part of the more general communitarian challenge to predominantly liberal values. This paper will demonstrate the importance of respect for autonomy for the social practice of assigning moral responsibility and for the development of moral responsibility as a virtue. Guided by this virtue, the responsible exercise of autonomy may provide a much-needed connection between the individual and the community.     

On the emotions associated with violations of three moral codes (community,autonomy, divinity)

According to CAD theory, different moral domains are associated with different emotions: (C) community violations with contempt, (A) autonomy violations with anger, and (D) divinity violations with disgust. Do people from different cultural groups make the same associations? Three studies (Ns?=?120, 240, 240) tested the CAD theory. Participants from three cultural groups—North Americans, North Indians, and South Indians—associated emotions (with words or facial expressions) with vignettes of moral violations. Across all three cultures, moral violations were associated with more than one emotion: all negative rather than positive, anger for most, and disgust for violations involving sex and pathogens. CAD faired poorly, with C and A collapsing, and D limited to sex and pathogens.     

Memory for emotions

It is argued that memory reproduces emotional data as well as cognitive information. Retrieval of feelings may be cue-dependent, emotionally mediated or coincidental. Infantile emotions can be presumed to vary strongly due to the lack of control, and, poorly labelled, they could produce powerful, but un-identifiable memories, possible components in various adult experiences. In later childhood there is greater independence, and moderately positive memories from this period have possibly fewer “withdrawal effects.” Though an event may be linked with certain remembered feelings at the time of impact, it can later be recombined with other echoes. Remembered emotions can be rewarding, and if they are found to be lacking, substitutes will often be sought, or repressed feelings may surface. These theoretical considerations are applied to the phenomena of anger, depression, and anxiety, each involving (reproduced) feeling-states influencing cognitive processing. “Turning down” the memory channel, or the timely retrieval of positive feelings could increase tolerance in this respect. Human attraction is also briefly analysed.     

Impact of compensatory secondary control on the recollection of emotions and the self in respect to past adversity1

Abstract: This study investigated a specific cognitive appraisal functioning as a form of compensatory secondary control that allows the individual to reevaluate positive aspects of adversity experienced in the past, and enhances emotional resources for further personal development through primary control. The impact of four kinds of present‐time appraisals on recollection of 11 types of emotions that 50 third‐year students initially experienced during preparations for university entrance examinations taken two and a half years earlier were examined. Cognitive appraisal of the experience of the adversity was found to function as compensatory secondary control. Positive emotions were overestimated whereas negative emotions were underestimated when the participants retrospectively evaluated their experience of exam preparation positively. Participants who regarded their exam preparations as a fruitful experience also positively evaluated the past struggle in that situation. These findings suggest a partial explanation for the role of cognitive appraisal in the directive, particularly analogous function of autobiographical memory in the individual's approach to immediate or future problems.     

Preference for negative emotions

This research demonstrates that preference for emotions sometimes cannot be equated with a positive-negative valence dimension. Participants were asked to make choices between pairs of affect-inducing options opposite in valence but equal in activation. The results showed that in absence of contextual cues or situational constraints, choices followed a pleasure-maximizing principle. However, when information was provided about a context cueing appropriateness of certain emotions over others, a preference reversal was observed so that negative emotions were preferred over positive emotions. These results are discussed in relation to current theories of pleasure-maximizing choice and behavior.     

Respect for autonomy and medical paternalism reconsidered

We offer a critique of one prominent understanding of the principle of respect for autonomy and of analyses of medical paternalism based on that understanding. Our main critique is that understanding respect for autonomy as respect for freedom from interference is mistaken because it is overly influenced by ‘four-alarm’ cases, because it fails to appreciate the full dimensions of legal self-determination (one of its main sources), because it conflates the research and therapeutic settings, and because it fails to appreciate themes of authority and power that have historically shaped the principle of respect for freedom from interference. We argue that respect for autonomy involves more than just freedom from interference and, on this basis, offer a critique of prevailing accounts of medical paternalism.     

Hysterectomy and autonomy

Hysterectomy (or hysterectomy with oophorectomy) is the most frequently performed major surgery in the United States, affecting approximately 700,000 women each year (Easterday, 1983). There has long been interest in the psychological effects of these surgeries. However, apart from the concern that some hysterectomies may be unnecessary (Pearse, 1976), there has been little attention to bioethical issues relating to hysterectomy. Physicians and nurses are ethically obligated to respect the woman who may have a hysterectomy by treating her as an autonomous agent. Informed consent within the context of a decision for hysterectomy should include balanced information and supportive exploration of the woman's values, goals, and life plan. Care of the patient should assist her adjustment, thereby also promoting her autonomy. Physician attitudes toward hysterectomy and the hysterectomy patient can have a major influence on patient self-determination.     

Japanese and American folk vocabularies for emotions

The authors investigated how emotions are labeled and conceptualized by individuals representing widely varying ages and educational backgrounds, who live in rural areas of Japan and the United States. The authors gathered data in 2 phases: 30 participants in each country first produced emotion terms, and another 2 groups of 28 (1 group from each country) sorted out those emotion terms by similarities. Results indicated that these laypersons' emotion vocabularies were larger than those typically studied in psychological research; both American and Japanese participants produced many terms referring to physical sensations or evaluative reactions. Also, the authors found both similarities and differences in how speakers of American English and Japanese conceptualized emotions, bringing into question the often simplistic notions of cultural differences reported in the previous literature (P. Ekman, 1994; P. Ekman & W. V. Friesen, 1971; P. Ekman et al., 1987).     

Further evidence for mixed emotions

Emotion theorists have long debated whether valence, which ranges from pleasant to unpleasant states, is an irreducible aspect of the experience of emotion or whether positivity and negativity are separable in experience. If valence is irreducible, it follows that people cannot feel happy and sad at the same time. Conversely, if positivity and negativity are separable, people may be able to experience such mixed emotions. The authors tested several alternative interpretations for prior evidence that happiness and sadness can co-occur in bittersweet situations (i.e., those containing both pleasant and unpleasant aspects). One possibility is that subjects who reported mixed emotions merely vacillated between happiness and sadness. The authors tested this hypothesis in Studies 1-3 by asking subjects to complete online continuous measures of happiness and sadness. Subjects reported more simultaneously mixed emotions during a bittersweet film clip than during a control clip. Another possibility is that subjects in earlier studies reported mixed emotions only because they were explicitly asked whether they felt happy and sad. The authors tested this hypothesis in Studies 4-6 with open-ended measures of emotion. Subjects were more likely to report mixed emotions after the bittersweet clip than the control clip. Both patterns occurred even when subjects were told that they were not expected to report mixed emotions (Studies 2 and 5) and among subjects who did not previously believe that people could simultaneously feel happy and sad (Studies 3 and 6). These results provide further evidence that positivity and negativity are separable in experience.     

An argument for basic emotions

Abstract

Emotions are viewed as having evolved through their adaptive value in dealing with fundamental life-tasks. Each emotion has unique features: signal, physiology, and antecedent events. Each emotion also has characteristics in common with other emotions: rapid onset, short duration, unbidden occurrence, automatic appraisal, and coherence among responses. These shared and unique characteristics are the product of our evolution, and distinguish emotions from other affective phenomena.