Defense Date

1-30-2006

Graduation Date

Spring 2006

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

David F. Kelly

Committee Member

Aaron L. Mackler

Committee Member

R. Bryan Chambliss

Keywords

automaticity, autonomy, backstage cognition, cognitive distortion, depression, depressive realism, determinism, heuristics, medical ethics, philosophy, psychology, psychometrics, reductionism

Abstract

Many contemporary models of medical ethics champion patient autonomy to counterbalance historically paternalistic decision-making processes. These models tend to suggest an autonomous agent free from cognitive bias and systematic distortion (e.g., Kantian or Cartesian rational agents). Evidence is emerging from the fields of cognitive psychology, cognitive science, and neuroscience that fundamentally challenge this cognitive model, demonstrating the dependence of cognition on deeper, avolitional structures (e.g., backstage cognition, cognitive heuristics and biases, automaticity, emotionally-valenced memory, etc.), and hence, shifting the cognitive model towards reductionistic and deterministic philosophies and psychologies. Medical ethics models must adapt their sense of autonomy in light of these findings if the term is to have any meaning - absent this necessary adaptation, medical ethics centers around a cognitive agent that does not actually exist. In contrast to the homuncular models championed (i.e., overly rationalistic and lacking an account of empirically-validated cognitive phenomena), a cognitive model of autonomy is proposed, along with useful psychometrics and a case metric to assist clinicians in assessing the possibility of compromised autonomy in patients electing to forgo medical treatment.

Format

PDF

Language

English

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