The <Emphasis Type="Italic">Not Unreasonable</Emphasis> Standard for Assessment of Surrogates and Surrogate Decisions

Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician's responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient's decisions and a surrogate's and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate's decision. They have to assess the surrogate's decisional capacity and attitude toward the patient as well as the reasons that support the surrogate's decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment.     

Autonomy gone awry: a cross-cultural study of parents’ experiences in neonatal intensive care units

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices.     

On medicine, culture, and children's basic interests: a reply to three critics

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in Children, Ethics, and Modern Medicine. Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's or adolescent's basic interests. Questions about respect, in turn, focus attention on other's decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care.     

On Being Poor and Feeling Poor: Low Socioeconomic Status and the Moral Self

Persons of low socioeconomic status generallyexperience worse health and shorter lives thantheir better off counterparts. They alsosuffer a greater incidence of adversepsychosocial characteristics, such as lowself-esteem, self-efficacy, and self-masteryand increased cynicism and hostility. Thesepopulation data suggest another category ofharm to persons: diminished moral agency. Chronic socioeconomic deprivation can createenvironments that undermine the development ofself and capacities constitutive to moralagency – i.e., the capacity forself-determination and crafting a life of one'sown. The harm affects not only the choicesa person makes, but the chooser herself. Thismoral harm is particularly salient in modernWestern societies, especially in the UnitedStates, where success and failure is attributedto the individual, with little notice of thelarger social and political realities thatinform an individual's circumstances and choices.     

知识员工团队工作自主性与效能的关系研究

团队日益成为新经济时代背景下知识员工工作的主要方式。追求工作自主性同时也被认为是知识员工的核心特征之一。对杭州地区13家企业的35个工作团队的调查发现,工作自主性是一个二阶单因素结构,包含三个子维度:方法、进度和标准的自主性。回归分析显示:领导者信任在知识员工团队工作自主性与团队激励间起正向调节作用;反馈在团队激励与团队工作绩效及满意感间起负向调节作用。     

Assisted Suicide: Do We Own Our Bodies?

Abstract:  The ethics of physician‐assisted suicide is explored here in light of classic philosophical discussions of the ownership of one's body plus biblical discussions of the relationship of body and soul. Motives for individual and group suicide are brought to bear on bioethical principles such as that of autonomy. Ethical analysis is here challenged by the case of a 91 year‐old woman, Ragnhild, who lived after professional judgments that her life should be ended.     

Precedent Autonomy and Subsequent Consent

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her “precedent autonomy” by giving her what she used to want? There is a similar problem with “subsequent consent”: How can we justify interfering with someone's autonomy on the grounds that she will later consent to the interference, if she refuses now? Both problems arise on the assumption that, to respect someone's autonomy, any preferences we respect must be among that person's current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone's wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference.     

Is `Property' Necessary? On Owning the Human Body and its Parts

Courts usually treat control over human bodies and body parts as a property issue and find that people do not have property rights in themselves. This contradicts the liberal philosophical principle that people should be able to perform any self-regarding actions that do not cause harm to others. The philosophical inconsistencies under pinning the legal treatment of body parts arguably stem from a misplaced judicial preoccupation with‘property’. A better approach would be to hold a policy inquiry into the degree of liberty a society wishes to grant its inhabitants. Only once this substantive issue has been addressed should property be raised as a possible method of implementing the policy. This revised version was published online in August 2006 with corrections to the Cover Date.     

Chinese intimacy: Filial piety,autonomy, and romantic relationship quality

Due to its accurate representation of parent–child interaction quality in Confucian-influenced cultures, contemporary filial piety, which refers to general beliefs about how children are expected to behave toward their parents, has drawn increasing attention in academia. However, how filial piety associates with intimate relationships beyond the family setting is less clear. This study examined the relation between dual filial piety (i.e., reciprocal filial piety and authoritarian filial piety) and romantic relationship quality among Chinese youths. We explored a mediational model in which we tested whether dual autonomy (i.e., individuating autonomy and relating autonomy) would help explain how Chinese youths' beliefs in filial piety are linked to the quality of their romantic relationships. A total of 605 youths from Macau (N = 291) and Taiwan (N = 314) who are currently or once romantically involved participated in the study. We employed structural equation modeling to analyze the data. Results showed within-culture invariance regarding the direct and indirect associations between filial piety, autonomy, and romantic relationship quality. Specifically, young people in both Macau and Taiwan who endorsed higher reciprocal filial piety had more individuating autonomy, which in turn contributed to them having higher quality romantic relationships.     

The Relationship between Workplace Status and Workplace Religious Expression

A growing body of literature explores religious expression in workplaces, but comparatively little research examines how religious expression might be shaped by inequality in workplace status. We hypothesize that perceived work autonomy and socioeconomic status (SES) both function as mediating links between organizational status and religious expression. Drawing on a sample of employed adults from a nationally-representative survey in the United States (n = 8611), we examine three modes of religious expression at work: displaying faith, feeling comfortable talking about faith, and expressing views when observing unfair work practices that conflict with faith. Results revealed that workers at the bottom of their organizations express their religiosity less than those at the top. Religious expression in the workplace is thus not simply a reflection of individual religiosity or religious identity, but also workplace power. Although perceived work autonomy mediated the relationship, SES buffered the relationship. Findings have important implications for workplace policy.