Advance Directives Refusing Treatment as an Expression of Autonomy: Do the Courts Practise What They Preach?

The principle of autonomy is at the heart of the right of a competent individual to make an advance directive that refuses life-sustaining medical treatment, and to have that directive complied with by medical professionals. That right is protected by both the common law and, to an extent, by legislation that has been enacted in the United Kingdom and many jurisdictions in Australia. The courts have a critical role in protecting that autonomy, both in those jurisdictions in which the common law continues to operate, and in those jurisdictions which are now governed by statute, and in which judicial determinations will need to be made about legislative provisions. The problem explored in this article is that while the judiciary espouses the importance of autonomy in its judgments, that rhetoric is frequently not reflected in the decisions that are reached. In the United Kingdom and Australia, there is a relatively small number of decisions that consider the validity and applicability of advance directives that refuse life-sustaining medical treatment. This article critically evaluates all of the publicly available decisions and concludes that there is cause for concern. In some cases, there has been an unprincipled evolution of common law principles, while in others there has been inappropriate adjudication through operational irregularities or failure to apply correct legal principles. Further, some decisions appear to be based on a strained interpretation of the facts of the case. The apparent reluctance of some members of the judiciary to give effect to advance directives that refuse treatment is also evidenced by the language used in the judgments. While the focus of this article is on common law decisions, reference will also be made to legislation and the extent to which it has addressed some of the problems identified in this article.

Local autonomy, tax morale, and the shadow economy

Policymakers often propose strict enforcement strategies to fight the shadow economy and to increase tax morale. However, there is an alternative bottom-up approach that decentralises political power to those who are close to the problems. This paper analyses the relationship with local autonomy. We use data on tax morale at the individual level and macro data on the size of the shadow economy to analyse the relevance of local autonomy and compliance in Switzerland. The findings suggest that there is a positive (negative) relationship between local autonomy and tax morale (size of the shadow economy).

Adapting to the work-life interface : the influence of individual differences, work and family on well-being, mental health and work engagement

Bronfenbrenner.s Bioecological Model, expressed as the developmental equation, D f PPCT, is the theoretical framework for two studies that bring together diverse strands of psychology to study the work-life interface of working adults. Occupational and organizational psychology is focused on the demands and resources of work and family, without emphasising the individual in detail. Health and personality psychology examine the individual but without emphasis on the individual.s work and family roles. The current research used Bronfenbrenner.s theoretical framework to combine individual differences, work and family to understand how these factors influence the working adult.s psychological functioning. Competent development has been defined as high well-being (measured as life satisfaction and psychological well-being) and high work engagement (as work vigour, work dedication and absorption in work) and as the absence of mental illness (as depression, anxiety and stress) and the absence of burnout (as emotional exhaustion, cynicism and professional efficacy). Study 1 and 2 were linked, with Study 1 as a cross-sectional survey and Study 2, a prospective panel study that followed on from the data used in Study1. Participants were recruited from a university and from a large public hospital to take part in a 3-wave, online study where they completed identical surveys at 3-4 month intervals (N = 470 at Time 1 and N = 198 at Time 3). In Study 1, hierarchical multiple regressions were used to assess the effects of individual differences (Block 1, e.g. dispositional optimism, coping self-efficacy, perceived control of time, humour), work and family variables (Block 2, e.g. affective commitment, skill discretion, work hours, children, marital status, family demands) and the work-life interface (Block 3, e.g. direction and quality of spillover between roles, work-life balance) on the outcomes. There were a mosaic of predictors of the outcomes with a group of seven that were the most frequent significant predictors and which represented the individual (dispositional optimism and coping self-efficacy), the workplace (skill discretion, affective commitment and job autonomy) and the work-life interface (negative work-to-family spillover and negative family-to-work spillover). Interestingly, gender and working hours were not important predictors. The effects of job social support, generally and for work-life issues, perceived control of time and egalitarian gender roles on the outcomes were mediated by negative work-to-family spillover, particularly for emotional exhaustion. Further, the effect of negative spillover on depression, anxiety and work engagement was moderated by the individual.s personal and workplace resources. Study 2 modelled the longitudinal relationships between the group of the seven most frequent predictors and the outcomes. Using a set of non-nested models, the relative influences of concurrent functioning, stability and change over time were assessed. The modelling began with models at Time 1, which formed the basis for confirmatory factor analysis (CFA) to establish the underlying relationships between the variables and calculate the composite variables for the longitudinal models. The CFAs were well fitting with few modifications to ensure good fit. However, using burnout and work engagement together required additional analyses to resolve poor fit, with one factor (representing a continuum from burnout to work engagement) being the only acceptable solution. Five different longitudinal models were investigated as the Well-Being, Mental Distress, Well-Being-Mental Health, Work Engagement and Integrated models using differing combinations of the outcomes. The best fitting model for each was a reciprocal model that was trimmed of trivial paths. The strongest paths were the synchronous correlations and the paths within variables over time. The reciprocal paths were more variable with weak to mild effects. There was evidence of gain and loss spirals between the variables over time, with a slight net gain in resources that may provide the mechanism for the accumulation of psychological advantage over a lifetime. The longitudinal models also showed that there are leverage points at which personal, psychological and managerial interventions can be targeted to bolster the individual and provide supportive workplace conditions that also minimise negative spillover. Bronfenbrenner.s developmental equation has been a useful framework for the current research, showing the importance of the person as central to the individual.s experience of the work-life interface. By taking control of their own life, the individual can craft a life path that is most suited to their own needs. Competent developmental outcomes were most likely where the person was optimistic and had high self-efficacy, worked in a job that they were attached to and which allowed them to use their talents and without too much negative spillover between their work and family domains. In this way, individuals had greater well-being, better mental health and greater work engagement at any one time and across time.

Towards learner autonomy : an assessment for learning approach

Using Assessment for Learning (AfL) may develop learner autonomy however, very often AfL is reduced to a set of strategies that do not always achieve the desired outcome. This research adopted a different approach that examined AfL as a cultural practice, situated within influential social relationships that shape learner identity. The study addressed the question “What are the qualities of the teacher-student relationship that support student learning autonomy in an AfL context?” Three case studies of the interactions of Queensland middle school teachers and their classes of Year 7, 8 and 9 were developed over one year. Data were collected from field notes and video recordings of classroom interactions and individual and focus group interviews with teachers and students. The analysis began with a close look at the field data. Interpretations that emerged from a sociocultural theoretical understanding were helpful in informing the process of analysis. Themes and patterns of interrelationships were identified through thematic coding using a constant comparative approach. Validation was achieved through methodological triangulation. Four findings that inform an understanding of AfL and the development of learner autonomy emerged. Firstly, autonomy is theorised as a context-specific identity mediated through the teacher-student relationship. Secondly, it was observed that learners negotiated their identities as knowers through AfL practices in various tacit, explicit, group and individual ways in a ‘generative dance’ of knowing in action (Cook & Brown, 2005). Thirdly, teachers and learners negotiated their participation by drawing from identities in multiple communities of practice. Finally it is proposed that a new participative identity or narrative for assessment is needed. This study contributes to understandings about teacher AfL practices that can help build teacher assessment capacity. Importantly, autonomy is understood as an identity that is available to all learners. This study is also significant as it affirms the importance of teacher assessment to support learners in developing autonomy, a focus that challenges the singular assessment policy focus on measuring performance. Finally this study contributes to a sociocultural theoretical understanding of AfL.

Feminist ethics and menopause : autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners’ accounts of menopause and treatment in Australia, women's ‘choice’, ‘informed decision-making’ and ‘empowerment’ were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of ‘informed decision-making’ in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an ‘ethic of autonomy’ and an ‘offer of choice’ in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Autonomy supportive curriculum design : a salient factor in promoting law students' wellbeing

There is increasing awareness and concern about law students' elevated distress levels amongst members of the Australian legal academy and the broader legal community. Disproportionately high levels of psychological distress, including depression, anxiety, and substance abuse, have been consistently documented in decades of research on American law student samples. Questions about whether these trends were an American phenomenon, and due to 'differences in demographics, pedagogy and culture' may not apply to Australian law students, began to be empirically addressed with the publication of the Brain and Mind Research Institute's Courting the Blues monograph in 2009. Amongst other findings, the comprehensive research in this monograph indicated that more than one-third of the surveyed law students from Australian universities experience high levels of psychological distress. Recent empirical research at a number of individual Australian law schools reveals similar trends, suggesting that aspects of the legal education experience may contribute to widespread distress levels amongst law students in Australia, as in the United States.

Within-person relationships between daily individual and job characteristics and daily manifestations of career adaptability

Previous research showed that daily manifestations of career adaptability fluctuate within individuals over short periods of time, and predict important daily job and career outcomes. Using a quantitative daily diary study design (N = 156 employees; 591 daily entries), the author investigated daily job characteristics (i.e., daily job demands, daily job autonomy, and daily supervisory career mentoring) and daily individual characteristics (i.e., daily Big Five personality characteristics, daily core self-evaluations, and daily temporal focus) as within-person predictors of daily career adaptability and its four dimensions (concern, control, curiosity, and confidence). Results showed that daily job demands, daily job autonomy, daily conscientiousness, daily openness to experience, as well as daily past and future temporal focus positively predicted daily career adaptability. Differential results emerged for the four career adaptability dimensions. Implications for future research on within-person variability in career adaptability are discussed.

Collective action and individual choice: rethinking how we regulate narcotics and antibiotics.

Governments across the globe have squandered treasure and imprisoned millions of their own citizens by criminalising the use and sale of recreational drugs. But use of these drugs has remained relatively constant, and the primary victims are the users themselves. Meanwhile, antimicrobial drugs that once had the power to cure infections are losing their ability to do so, compromising the health of people around the world. The thesis of this essay is that policymakers should stop wasting resources trying to fight an unwinnable and morally dubious war against recreational drug users, and start shifting their attention to the serious threat posed by our collective misuse of antibiotics.

Dimensions of Financial Autonomy in Low-/Moderate-Income Couples from a Gender Perspective and Implications for Welfare Reform

The ‘unitary household’ lives on in policymakers’ assumptions about couples sharing their finances. Yet financial autonomy is seen as a key issue in gender relations, particularly for women. This article draws on evidence from semi-structured individual interviews with men and women in thirty low-/moderate-income couples in Britain. The interviews explored whether financial autonomy had any meaning to these individuals; and, if so, to what extent this was gendered in the sense of there being differences in men's and women's understanding of it. We develop a framework for the investigation of financial autonomy, involving several dimensions: achieving economic independence, having privacy in one's financial affairs and exercising agency in relation to household and/or personal spending. We argue that financial autonomy is a relevant issue for low-/moderate-income couples, and that women are more conscious of tensions between financial togetherness and autonomy due to their greater responsibility for managing togetherness and lower likelihood of achieving financial independence. Policymakers should therefore not discount the aspirations of women in particular for financial autonomy, even in low-/moderate-income couples where there remain significant obstacles to achieving this. Yet plans for welfare reform that rely on means testing and ignore intra-household dynamics in relation to family finances threaten to exacerbate these obstacles and reinforce a unitary family model.

Scotland’s Curriculum for Excellence: a defence of autonomy and personhood.

Curriculum for Excellence, Scotland’s 3-18 curriculum, has been described as ‘the most significant curricular change in Scotland for a generation’ (McAra, Broadley and McLauchlan, 2013:223). The purpose of the curriculum is ‘encapsulated’ in four capacities in order that learners become i) successful learners, ii) confident individuals, iii) responsible citizens, and iv) effective contributors. With particular reference to these capacities, we explore the principle of autonomy as it pertains to both individual and collective flourishing seeking to disarm commonplace criticisms of autonomy by arguing that it might be put to work in CfE as a potentially multi-dimensional, context-sensitive concept that is relational as well as individual. We conclude that the four capacities lend themselves to re-consideration and re-mapping in pursuit of autonomy and flourishing premised on the principles of liberal personhood.

An Ethic of Connectedness: Book Review of The Connected Self: The Ethics and Governance of the Genetic Individual

Compte-rendu / Review

Embodied Autonomy in Digital Ecosystems: From Bio-Inspired Agents to Cognitive Systems

This paper proposes to promote autonomy in digital ecosystems so that it provides agents with information to improve the behavior of the digital ecosystem in terms of stability. This work proposes that, in digital ecosystems, autonomous agents can provide fundamental services and information. The final goal is to run the ecosystem, generate novel conditions and let agents exploit them. A set of evaluation measures must be defined as well. We want to provide an outline of some global indicators, such as heterogeneity and diversity, and establish relationships between agent behavior and these global indicators to fully understand interactions between agents, and to understand the dependence and autonomy relations that emerge between the interacting agents. Individual variations, interaction dependencies, and environmental factors are determinants of autonomy that would be considered. The paper concludes with a discussion of situations when autonomy is a milestone

Learner autonomy : a guide to developing learner responsibility.

Ofrece orientación práctica para ayudar a los estudiantes a darse cuenta de la importancia de su contribución al proceso de enseñanza-aprendizaje y animarlos a tomar parte activa en su propio aprendizaje. Las actividades están diseñadas para desarrollar una amplia gama de habilidades y actitudes tales como motivación, estrategias de aprendizaje, autocontrol y cooperación.

Autonomy and the socialisation of architects

The socio-cultural production of architects' identities, and their professional personas, is a lively source of continuing debate. At one extreme, there is the claim to autonomy that highlights the distinctiveness of architecture and its cultural and disciplinary specificity. This view is challenged by those who emphasise architects' dependence, for acting and actions, on their embeddedness into collective, social, settings and relationships. In the paper, we consider what it may mean to be ‘autonomous of’ and ‘dependent on’ in relation to the actions of architects. There is limited specification in architectural writings about what autonomy and dependence are, and we suggest that there is a need not to discount such terms, but to reformulate them by recognising that the socially constructed self is an integral part of individual action. In this respect, we seek to amplify, and evaluate, the concept of relational autonomy that distances the notion of autonomy from individualistic, under-socialised, accounts of architects and their practices. Referring to three empirical examples of practice, we amplify this understanding by, first, outlining what a relational autonomous approach to architecture might entail, and, secondly, assessing how far it may enable a conception of the practices of architects in ways whereby, following Tony Fry's observations, they are conceived as much broader than ‘the specificity of any particular activity’ that expresses their existence.

A model for the enhancement of autonomy

Este artigo apresenta um modelo para o fomento da autonomia dos aprendentes, mostra alguns resultados alcançados na aplicação desse modelo e discute desafios ainda a serem enfrentados. O modelo comporta a investigação de áreas problemáticas do processo individual de aprendizagem de cada sujeito, a identificação de seus estilos preferenciais de aprender, o uso de ferramentas tecnológicas para melhorar a autonomia na aprendizagem, o desenvolvimento de um leque maior de estratégias de aprendizagem de línguas e a implementação de rotinas de auto-monitoramento e auto-avaliação. Este modelo tem sido aplicado nos últimos três anos com alunos de Letras cursando Licenciaturas em Alemão, Francês ou Inglês. Três ordens de resultados emergem dos dados da pesquisa: primeiramente, o modelo provou sua eficácia em prover um andaime para a aprendizagem autônoma de línguas dos alunos; em segundo lugar, as experiências de aprendizagem autônoma vividas pelos futuros professores de línguas poderão ser espelhadas em suas vidas profissionais futuras com seus próprios alunos; finalmente, os dados emanados dos participantes da pesquisa podem lançar uma luz sobre a variedade de maneiras pelas quais as pessoas aprendem no contexto local.