Respect for Autonomous Risky Decisions and People with IDD: Prioritizing Healthcare Provider Trustworthiness
Bibliographic record
Abstract
Autonomy is a primary guiding healthcare ethics principle in Western liberal societies. Generally speaking, the principle means that we ought to respect individuals’ decisions in relation to themselves, even when such decisions are risky from some perspectives. The principle of autonomy may be of particular importance when thinking about marginalized populations whose ability to make autonomous decisions, and to have such decisions respected (by enabling the autonomous decision to occur through positive or negative means), was largely, historically non-existent. One of these populations is people with intellectual and developmental disabilities (IDD). When it comes to a person with IDD making an autonomous risky decision, a clinician may respect their decision because of the typical weight and priority given to the principle of autonomy. However, this paper argues that a person with IDD’s autonomous risky decision related to care provision should only be respected insofar as the clinician has demonstrated trustworthiness in an effort to obtain trust. In other words, I argue that unless a clinician has demonstrated that they are trustworthy, then a risky autonomous decision related to care provision should not be immediately respected when working with a person with IDD. The reason that a risky autonomous decision should not be respected unless there is demonstrated trustworthiness is because of how trustworthiness may influence decision-making insofar as trust is gained. If a person with IDD makes a risky decision without finding their provider to be trustworthy, then their decision may be unnecessarily motivated by lack of trust. There are good reasons that a person with IDD may not find their clinicians to be trustworthy, hence the rationale for ensuring the intentional demonstration of trustworthiness before respect for autonomous risky decision-making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.039 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.015 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.001 | 0.010 |
| Research integrity | 0.003 | 0.007 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".