Article Text
Statistics from Altmetric.com
In the Journal of Medical Ethics, Joffe et al recently published an article titled “What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics”.1 This empirical study evaluates whether patients’ willingness to recommend their hospital to others is more strongly associated with their belief that they were treated with respect and dignity than with their belief that they had an adequate say in their treatment.* Joffe et al go on to suggest that confirmation of these empirical hypotheses would constitute a prescription for elevating the principle of respect for persons to the level that the principle of respect for autonomy currently enjoys in our model of the ideal patient–physician relationship (p 104).1 In other words, they suggest that by some means empirical findings could influence our ranking of the normative principles. Earlier in the article, they make an even stronger claim about the influence of empirical data on our acceptance of normative principles. They suggest that, if it were demonstrated empirically that some patients prefer to delegate medical decisions to health care professionals, a serious challenge would be levied against the normative assumptions underlying the principle of respect for autonomy, at least under the mandatory autonomy view, which holds that patients not only have a right but also an obligation to act autonomously (p 103).1 In the light of many recent empirical studies challenging the centrality of patient autonomy and shared decision making in bioethical theory, I think it is instructive to evaluate the means by which empirical findings, like those offered in Joffe et al, strengthen or weaken our arguments for ethical principles. In particular, I would be interested in how these authors propose that their data led them to the normative conclusions they reached.
In the last …
Footnotes
-
↵* Joffe et al also evaluate whether patients’ reports that they had confidence and trust in their health care providers significantly predicted whether they would recommend the hospital to others. For simplicity’s sake, I address only Joffe et al’s treatment of the respect for persons and the respect for autonomy principles in this response.
-
↵† See, for instance, Delden and Theil,5 in which the authors argue convincingly that a reflective equilibrium-like method may be valuable for capturing the norms of health care providers and that knowledge of these norms may guide individual providers.
-
↵‡ I say “a Rawlsian view” rather that “Rawls’s view” because, in his theory of Justice, Rawls advocates balancing a single person’s considered moral judgements (for example, Rawls’s or his reader’s) with a single person’s moral principles (p 50).3 Although he later gestures towards reflective equilibrium as an exercise that involves the considered moral judgements of others (p 8),6 it is probably safer to say “Rawlsian”.