Depression, Volition, and Death: The Effect of Depressive Disorders on the Autonomous Choice to Forgo Medical Treatment

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.

Name thesis:degree_name

PhD

Level thesis:degree_level

Immediate Access

Discipline thesis:degree_discipline

Health Care Ethics

Year dc:date.available

2006

Author dc:creator

• Butkus, Matthew

Contributors dc:contributor

• David F. Kelly
• Aaron L. Mackler
• R. Bryan Chambliss

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

Language dc:language

English

Repository record dc:identifier

https://dsc.duq.edu/etd/370

OAI identifier oai:identifier

oai:dsc.duq.edu:etd-1383