A Genealogy of Autonomy: Freedom, Paternalism, and the Future of the Doctor-Patient Relationship.

Although the principle of respect for personal autonomy has been the subject of debate for almost 40 years, the conversation has often suffered from lack of clarity regarding the philosophical traditions underlying this principle. In this article, I trace a genealogy of autonomy, first contrasting Kant's autonomy as moral obligation and Mill's teleological political liberty. I then show development from Mill's concept to Beauchamp and Childress' principle and to Julian Savulescu's non-teleological autonomy sketch. I argue that, although the reach for a new principle to guide choices in physician-patient relationships can rightfully be seen as important, the notion that is now called autonomy within bioethics has corollaries that undermine critical aspects of medical care. As such, there is need for a richer account of the interplay between the free choice of patients and the informed recommendations of doctors.

Dignity reevaluated: A theological examination of human dignity and the role of the Church in bioethics and end-of-life care.

Predominant among the terminological ambiguities that plague contemporary bioethics is confusion attending the meaning of the term "human dignity," particularly as it applies to so-called end-of-life discussions. This study surveys current trends in treatment of the concept of dignity, examining relevant thinkers who see dignity as redundant or as capability-dependent. These inadequate views are contrasted with an attitude, based theologically in Mark 5, that understands human dignity to represent an absolute characteristic that is donated graciously to all bearers of imago Dei. Human dignity must thus be affirmed as inviolable and independent of autonomy, rationality, or capability. A specific task of the Christian Church is to faithfully recognize and proclaim this dignity. This investigation is particularly relevant in the face of contemporary discussions regarding euthanasia and physician-assisted death. Lay Summary: Much of the polarization within the contemporary bioethical discussion proceeds out of confusion regarding how we ought to define the terms of the debate. If we may take the existing debates regarding euthanasia and physician-assisted death as an example, we may understand the vital need for a sensible definition of the term that stands at the heart of the arguments of both sides of the debate: "human dignity." As such, this study seeks to define dignity in a logical, theological, deeply personal, and highly practical fashion, and to outline the critical role of the Church within such an understanding. Sometimes, when I walk into the room, he ignores me. Sometimes he thinks I am someone else. Most often he is asleep, subjugated by drugs designed to prevent agitation, although "agitation" is the sterilized hospital word for what I would call unbridled panic, total disorientation. The night he had the stroke, they had to tie him to the bed just to keep him in the hospital. And they wouldn't let me see him because he had been calling my name. Very dramatic, but most of his suffering, and our grief, is not dramatic. It is just the mundane process of one man slowly fading, becoming, every day, more of a stranger to himself and to those he loves.

Phlebotomy treatment for elimination of perfluoroalkyl acids in a highly exposed family: a retrospective case-series.

BACKGROUND: Perfluoroalkyl acids (PFAAs) are a family of commonly used synthetic chemicals that have become widespread environmental contaminants. In human serum, perfluorohexane sulfonate (PFHxS), perflurooctane sulfonate (PFOS), and perfluorooctanoate (PFOA) are most frequently detected, in part owing to their long elimination half-lives of between 3.8 yrs (PFOA) and 8.5 yrs (PFHxS). These PFAAs also cross the placenta and have been associated with developmental toxicity, and some are considered likely human carcinogens. Interventions to eliminate PFAAs in highly contaminated individuals would reduce future health risks, but minimal research has been conducted on methods to facilitate accelerated human clearance of these persistent substances. METHODS: Six patients with elevated serum concentrations from a single family were treated by intermittent phlebotomy over a 4-5 year period at intervals similar to, or less frequent than what is done for routine blood donation at Canadian Blood Services. The apparent elimination half-life (HLapp) for PFHxS, PFOS, and PFOA in this treated population was calculated in each patient and compared to the intrinsic elimination half-lives (HLin) from a literature reference population of untreated fluorochemical manufacturing plant retirees (n = 26, age >55 yrs). RESULTS: For all three PFAAs monitored during phlebotomy, HLapp in each of the family members (except the mother, who had a low rate of venesection) was significantly shorter than the geometric mean HL measured in the reference population, and in some cases were even shorter compared to the fastest eliminator in the reference population. CONCLUSION: This study suggests significantly accelerated PFAA clearance with regular phlebotomy treatment, but the small sample size and the lack of controls in this clinical intervention precludes drawing firm conclusions. Given the minimal risks of intermittent phlebotomy, this may be an effective and safe clinical intervention to diminish the body burden of PFAAs in highly exposed people.