Relational autonomy, care, and Jehovah's Witnesses in Germany

Fostering relational autonomy in end-of-life care: a procedural approach and three-dimensional decision-making model

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients' true wishes, meaningfully engaging patients' significant others, balancing interests among patients and significant others, and determining clinicians' obligations to change patients' unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate patients' competence (apart from decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman's procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman's account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician-patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care.

Addressing the Challenges of Cross-Cultural Communication

Cross-cultural communication has many challenges due to the complexity of culture, communication, and language. Improving cross-cultural communication in health care is critical to reducing disparities and improving health equity. Specifically, improving cross-cultural communication must be prioritized to overcome systemic barriers and to eliminate disparities that stem from stigma and biases. Communication must be improved, ideally via a cultural humility framework. Unconscious bias and communication training must be intentional. Culture is an attribute and should be celebrated and incorporated into health practice at all levels to prioritize health equity.

Postpartum Maternal Tethering: A Bioethics of Early Motherhood

This article proposes a new way of conceptualizing the ethical relationship between postpartum mothers and their newborn babies. I suggest that the intertwinement of mother and baby - and the tensions that this intertwinement produces - do not disappear with birth, but rather persist throughout the postpartum period in the form of postpartum maternal tethering. I draw upon three years of ethnographic fieldwork and training in the US and China to argue that the dependency associated with postpartum maternal tethering makes it extremely difficult for postpartum mothers to act autonomously, even in the relational sense. I then examine how breaches in the postpartum maternal tether can open up new possibilities for thinking about the bioethics of vulnerability, dependency and care, by denaturalizing and de-sanctifying the mother-baby relationship and diversifying newborn care.