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The person of the voice: narrative identities in informed consent
Author(s) -
McCormack Brendan
Publication year - 2002
Publication title -
nursing philosophy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.367
H-Index - 35
eISSN - 1466-769X
pISSN - 1466-7681
DOI - 10.1046/j.1466-769x.2002.00091.x
Subject(s) - autonomy , narrative , informed consent , identity (music) , social psychology , psychology , narrative identity , dementia , rationality , sociology , medicine , law , political science , aesthetics , philosophy , linguistics , alternative medicine , disease , pathology
This paper explores the dominant rational approach to informed consent and challenges the appropriateness of this approach to ethical decision‐making with people with dementia. In dementia care a dominant assumption exists that people are not autonomous because of their inability to make decisions and exercise freedom of choice. The rational understanding of autonomy being the capacity to exercise freedom of choice means that health and social care professionals feel justified in making decisions on behalf of the person with dementia. If a person cannot consent to an intervention then a proxy is used to make the decision. This paper argues that such an approach reinforces the mind‐body dualism that dominates health and social care discourse. Whilst acknowledging the place of proxy decision‐making, it is argued that there is a need to hear the voice of the person with dementia that goes beyond rational understandings of what is heard and that does not reinforce separation of the mind and body. An understanding of the person through their ‘narrative identity’ is proposed and illustrated through a case example. Drawing on the philosophy of Ricoeur it is argued that an individual's narrative identity can be developed and used to underpin informed consent decisions. Using a case example it is argued that paying attention to an individual's narrative identity provides a way of respecting the autonomy of the individual with dementia in a way that is consistent with their overall life plan.