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Choice and AutonomyEthical Issues in Women’s Health

Meredith SchwartzDalhousie University, Department of Philosophy

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Breast Implants

• Health Canada is currently deciding whether to allow silicone gel breast implants

Picture from a Mentor advertisement

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Breast Implants

• The discussion is couched in terms of allowing women the “choice”

• Does more choice always promote autonomy?

• What choices?

Picture from imaginis.com “Mammography Guidelines for Women with Breast Implants”

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Autonomy

• Self-Governance

• Self-Determination

• Informed Consent: Patients have a right to accept or refuse treatment after receiving complete information from their MD

• CHOICE

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Autonomy

• Four elements of Autonomy:– Competence (rationality)

• How do stereotypes interfere?

– Reasonable Choice• What choices are available?

– Adequate Information• Who decides?

– Free from Explicit Coercion• What counts?

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Breast Implants

• Does the “choice” enhance ♀’s autonomy on the traditional view?

Picture from Fuller Breasts by Dr. R Scott Smith

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Breast Implants

• Does the “choice” enhance ♀’s autonomy on a feminist view?

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Breast Implants

• Is the ♀’s “choice” simply personal?

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What is Normal?

• How many of the breasts in the picture represent “normal” women’s breasts?

• How do breast implants affect what we think of as normal?

Picture from Fuller Breasts by Dr. R Scott Smith

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Relational Autonomy

• Autonomy is a capacity or skill

• Autonomy is a social process, although the skill ultimately resides in individuals

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Questions? Comments?

Picture from Fuller Breasts by Dr. R Scott Smith

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Bibliography

Traditional Views of Autonomy• Beauchamp TL, Faden RR (1995) “Informed consent: II. Meaning and

elements of informed consent.” In: Reich WT, editor. Encyclopedia of Bioethics. rev ed. vol 3. New York: Simon & Schuster Macmillan:1240

• Mappes TA, DeGrazia D (2001) Biomedical Ethics: Fifth Edition. New York: McGraw-Hill

Feminist View of Relational Autonomy• Susan Sherwin (2004) “A Relational Approach to Autonomy in Health

Care” in Baylis F, Downie J, Hoffmaster B, Sherwin S (eds) Health Care Ethics in Canada: Second Edition. Toronto: Nelson a division of Thomson Canada

Autonomy in Canadian Law• Reibl v. Hughes, [1980] 2 S.C.R. 880; • Hopp v. Lepp, [1980] 2 S.C.R. 192. • Malette v. Shulman [1990] 67 DLR (4th) (Ont CA) at p 338.