Authenticity as a foundational principle of medical ethics. 1994

J V Welie
Department of Ethics, Philosophy and History of Medicine, Catholic University of Nijmegen, The Netherlands.

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.

UI MeSH Term Description Entries
D010817 Physician-Patient Relations The interactions between physician and patient. Doctor-Patient Relations,Doctor Patient Relations,Physician Patient Relations,Physician Patient Relationship,Doctor Patient Relation,Doctor-Patient Relation,Physician Patient Relation,Physician Patient Relationships,Physician-Patient Relation,Relation, Doctor Patient,Relation, Doctor-Patient,Relation, Physician Patient,Relation, Physician-Patient,Relations, Doctor Patient,Relations, Doctor-Patient,Relations, Physician Patient,Relations, Physician-Patient,Relationship, Physician Patient,Relationships, Physician Patient
D003657 Decision Making The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. Credit Assignment,Assignment, Credit,Assignments, Credit,Credit Assignments
D004992 Ethics, Medical The principles of professional conduct concerning the rights and duties of the physician, relations with patients and fellow practitioners, as well as actions of the physician in patient care and interpersonal relations with patient families. Medical Ethics
D005086 Existentialism Philosophy based on the analysis of the individual's existence in the world which holds that human existence cannot be completely described in scientific terms. Existentialism also stresses the freedom and responsibility of the individual as well as the uniqueness of religious and ethical experiences and the analysis of subjective phenomena such as anxiety, guilt, and suffering. (APA, Thesaurus of Psychological Index Terms, 8th ed.) Existential Psychology,Psychology, Existential
D005610 Freedom The rights of individuals to act and make decisions without external constraints. Liberty,Libertarianism,Freedoms
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D018864 Cultural Diversity Coexistence of numerous distinct ethnic, racial, religious, or cultural groups within one social unit, organization, or population. (From American Heritage Dictionary, 2d college ed., 1982, p955) Multiculturalism,Pluralism,Cultural Pluralism,Cultural Diversities,Diversities, Cultural,Diversity, Cultural,Multiculturalisms,Pluralism, Cultural,Pluralisms
D026684 Personal Autonomy Self-directing freedom and especially moral independence. An ethical principle holds that the autonomy of persons ought to be respected. (Bioethics Thesaurus) Autonomy, Personal,Free Will,Self Determination
D035502 Trust Confidence in or reliance on a person or thing.
D040821 Human Characteristics The fundamental dispositions and traits of humans. (Merriam-Webster's Collegiate Dictionary, 10th ed) Human Nature,Characteristic, Human,Characteristics, Human,Human Characteristic,Nature, Human

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