real-will model (Dworkin)
Prudent, rational people agree to have their liberties limited for their own sake--this is when paternalism is justified. Applies in situations such as safety (seatbelts/helmets), times in which someone is in danger of significant and irreversible harm (like drugs), actions out of fear/social pressure/ignorance, when someone is going for the short-term benefit, weakness of will, ignorance, value delusion.
challenges to real-will model
You have to specify ahead of time when you want your liberties limited. Can't rule out all ultrahazardous activities (don't rule out things that play an important role in who someone is--self-defining activities).
strong-role differentiation (Goldman)
People think doctors have a position that allows them to ignore patients' rights to liberty.
Paterinalism NOT justified by moral argument. Self-determination has the ultimate intrinsic value. You can't assume people's value ranking puts health and life over quality of life. For rational people to continue to be rational, they need self-determination.
ideal value (Goldman)
There are goods and harms for you regardless of whether you acknowledge them as goods/harms or not. Ex. Self-determination.
Argues against the noninterference view of autonomy, which says that the MD is a good technician to restore the patient to a deliberating state and honest to then give all the medical information for the patient to decide. Says there are other constraints to autonomy (psychological/social, not just physical/cognitive). A good model for genuine respect must tell the MD what to do to restore autonomy.
return control model (Ackerman)
Interact: aggressively and proactively intervene not only discussing things with the patient but influence them. Empathize, trying to figure out what it means for that person to have an illness.
A belief that is in one's best interest, is practical or is consistent with other rational beliefs. If deliberated properly and the beliefs used to deliberate are not themselves irrational, then belief is rational.
consistent practical rationality
Judges rationality of acts in terms of consistency with beliefs. If the person's beliefs were true, the choice to do A is consistent with those beliefs.
theoretical rationality of beliefs
Action B is rational if the person has deliberated well about B and the beliefs used in the deliberation are themselves not irrational.
best interest practical rationality
It is practical and rational to do A provided that A is consistent with the person's best interest.
ideal (objective) account of best interest
There is an objective fact of the matter about what is in the individual's interest regardless of whether the individual or the society agrees that it is.
statistically objective view of best interest
Most of us humans would say that this is in an individual's interest, regardless of whether the individual does.
individual relative view of best interest
What is in the individual's best interest is determined by what the person is interested in (their desires and wants) and how the person would rank the importance of those desires.
outcome prudence (Gay-Williams)
The prudence of your action is determined by the outcome of the decision you actually make. Prudent if it accords with what is in one's interest, imprudent if it doesn't.
procedural prudence (Gay-Williams)
Your decision is prudent if the decision is the result of careful deliberation about the outcome (even if the outcome doesn't come about).
Evaluates actions by looking at whether a virtuous or vicious (someone with character flaws) person would do them.
human nature (virtue theory)
What distinguishes humans from other beings. Rational, have desires, social (need to be brought up and raised in a society). Morality not about principles/contract/consequences but about persons and virtues/vices of character. Not about right or wrong but how should I live my life? Virtues/vices defined by our nature. Our lives have a purpose.
doctrine of the mean (Aristotle)
A good human being is one that avoids excess and complete denial of something.
Excellence of character. A mean between two extremes of excess and deficiency. Require training to develop habits and knowledge and good judgment guiding the decision.
Active euthanasia is immoral because it goes against our nature. It is also against our interest and will lead to a decline in care. It is imprudent to allow oneself to make a decision that might go against our interest. Allowing euthanasia opens up the possibility that humans make decisions that might go against one's interest. A mistaken diagnosis or prognosis/experimental treatment coming about is possible.
One ought to tell the truth because it is what an autonomous person is owed. But when it is in a person's well being not to tell the truth, than this more fundamental value overrides the value of truth-telling. The only values that can trump truth-telling are survival of the individual or community survival. Suspending the truth can only be done for a time.