Respect for Patient Autonomy in Veterinary Medicine: A Relational Approach

摘要

This thesis considers the prospects for including respect for patient autonomy as a value in veterinary medical ethics. Chapter One considers why philosophers have traditionally denied autonomy to animals and why this is problematic; I also present contemporary accounts of animal ethics that recognize animals' capacity for and exercise of autonomy (or something similar, such as agency) as morally important. In Chapter Two, I review veterinary medical ethics today, finding that respect for patient autonomy is undiscussed or rejected outright as irrelevant. Extrapolating mainstream medical ethics' account of autonomy to veterinary medicine upholds this conclusion, as it would count all patients as "never-competent" and consider determining their autonomous choices impossible; thus welfare alone would be relevant. Chapter Three begins, in Part I, by describing the ways we routinely override patient autonomy in veterinary practice, both in terms of which interventions are selected and how care is delivered. I also show that some trends in the field suggest a nascent, implicit respect for patient autonomy. Part II of Chapter Three presents feminist criticisms of the mainstream approach to patient autonomy. I argue that the relational approach to autonomy advocated by such critics can be meaningfully applied in the veterinary realm. I advance an approach that conceives respect for patient autonomy in diachronic and dialogic terms, taking the patient as the foremost locus of respect. In Chapter Four, I turn to issues of practical implementation, such as interpreting what constitutes an animal's values and concerns, and assessing the effect of positive reinforcement training on autonomy. The Conclusion offers areas for future research while refuting the objection that a simpler, expanded welfare-based approach would yield the same substantive recommendations as my account.