Familial determination, replete with its frequent usurping of patient autonomy, propagation of collusion, and circumnavigation of direct patient involvement in their own care deliberations, continues to impact clinical practice in many Asian nations. Suggestions that underpinning this practice, in Confucian-inspired societies, is the adherence of the populace to the familial centric ideas of personhood espoused by Confucian ethics, provide a novel means of understanding and improving patient-centred care at the end of life. Clinical experience in Confucian-inspired Singapore, however, suggests that (...) personhood is conceived in broader terms. This diverging view inspired a study of local conceptions of personhood and scrutiny of the influence of the family upon it. From the data gathered, a culturally appropriate, clinically relevant and ethically sensitive concept of personhood was proposed: the Ring Theory of Personhood that better captures the nuances of local conceptions of personhood. The Ring Theory highlights the fact that, far from being solely dependent upon familial centric ideals, local conceptions of personhood are dynamic, context dependent, evolving ideas delineated by four dimensions. Using the Ring Theory, the nature of familial influences upon the four dimensions of personhood – the Innate, Individual, Relational and Societal – are examined to reveal that, contrary to perceived knowledge, conceptions of personhood within Confucian societies are not the prime reason for the continued presence of this decision-making model but remain present within local thinking and practices as a sociocultural residue and primarily because of inertia in updating ideas. (shrink)

Self-concept and self-esteem: How the content of the self-concept reveals sources and functions of self-esteem The relations of content of self-concept to self-esteem may reflect the role of different factors in developing self-esteem. On the basis of theories describing sources of self-esteem, we distinguished four domains of self-beliefs: agency, morality, strength and energy to act, and acceptance by others, which we hypothesized to be related to self-esteem. In two studies, involving 411 university students, the relationship between self-esteem and self-concept was (...) examined. The results confirmed relative independence of these four domains. Self-evaluation of agency was the strongest predictor of self-esteem, followed by self-evaluation of strength and energy to act, and self-evaluation of acceptance by others. Self-evaluation regarding morality turned out to have either no or negative relationship with self-esteem. The results supported the theories assuming that either perception of one's own agency or acceptance by others are sources of self-esteem. (shrink)

Nicholas Agar argues that it is possible, and even likely, that radically enhanced human beings will turn out to be ‘post-persons’, that is, beings with a moral status higher than that of mere persons such as us.1 This would mean that they will be morally justified in sacrificing our lives and well-being not merely in cases of emergency, but also in cases of ‘supreme opportunities’ , that is, whenever such a sacrifice leads to ‘significant benefits for post-persons’. For this reason, (...) Agar believes, it would be morally wrong to allow any cognitive enhancement of people that might entail the risk of moral status enhancement.However, neither are there sufficient grounds to expect radically enhanced human beings to have a higher moral status than unenhanced human beings, nor would it, even if they did, be morally wrong to bring about their existence. We use moral status ascriptions mostly as a convenient shorthand to indicate a difference in capacities that strikes us as morally relevant. Rocks have zero moral status because they cannot feel or think, so we cannot hurt or kill them. Whatever we do to them, it does not affect them. Animals, on the other hand, …. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis of the ethical concepts (...) associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)