Health Hats the Podcast by Danny van Leeuwen

Welcome to Health Hats, the Podcast, learning on the journey towards best health. We will learn what it takes to adjust to life’s realities in the awesome circus of health care. Follow Health Hats, the Podcast on your favorite player. I am Danny van Leeuwen, a patient-caregiver activist, a patient with Multiple Sclerosis, care partner to my grandmother, mother, and son’s end-of-life journeys, a registered nurse, a person with health technology experience, and a leader in healthcare administration. I wear many hats. My guests and I muse about making health choices and decisions, communicating health information, sharing what works, and supporting each other. This brief PodBuffet episode offers a clip from Kenneth Goodman, biomedical ethicist entitled Bioethics: Autonomy. For Me on Behalf of Me. We talk about celebrating autonomy at any age. 


Kenneth W. Goodman, PhD, FACMI, FACE, is founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy and co-director of the university’s Ethics Programs.



Celebrate autonomy at any age 06:23

Kenneth Goodman: That’s a great question. We have come over thousands of years, I guess, but certainly in our moral frameworks, our legal systems, and now what we do in the world of bioethics, to recognize and celebrate self-determination. Autonomy, if you will, or Autonomics, to be self-governing, is something that free entities enjoy simply by having free will and a brain. The challenge, of course, is that you don’t get that from the get-go. As a child, through all the stages you mentioned, see a creature who very, very slowly manages to acquire more autonomy simply by the root faculty of human development. Kids need guidance. They are not self-governing. Parents and guardians govern them. That’s as it should be. We’ve learned, and this matters a lot in practical ethics, that as you achieve autonomy at different times, depending on the biology of it, especially if you worked in a Children’s Hospital, you will see 15, 16, 14-year-olds and even younger, have extraordinary insight about their maladies. And you’ve seen 35-year olds who can’t pour water out of a boot. So, it’s a part of individual variation. Then you have our cultures. Our cultures have several other and different criteria. We want to be able to point to a number. In some cultures, it could be 13 and others, and it could be 16; sometimes, it’s 18 unless it’s 21.  That suggests how very tricky it is to get this right. You’re not going to have a social system or a culture that’s going to get it right for every individual, which is why, in a lot of cases, we muddle through. But the law is sometimes not very nimble about this, because when you have a 15-year-old who’s got her bolts in tight, the law still wants to say that there needs to be a parent, and yet we also know of adults who really could use some grownup assistance themselves. How do we take the privilege, the right, the brute cognitive sack of self-governance or autonomy and apply it? Well, decisions involving reproduction, involving a medical procedure, involving life and death can be so challenging. It’s one reason I have a job, but it’s also one of the reasons that, or one of the sources of why my job is so interesting. We want to get it right and being virtuous doesn’t help you get it right. We need to do a critical analysis. A lot of evidence and data are brought to bear to make the right decision.

I podcast to make a ruckus. Making a ruckus means sharing stories of learning on the journey towards best health. I’m trying to move the needle of health care a couple of degrees towards more self-confidence, more participation, more collaboration, more dignity and more inclusion. Wait a minute. I should tell you the truth. I’m a selfish person at heart. I’m a storytelling, patient/caregiver activist, living at peak capacity. I couldn’t say that before my diagnosis. I podcast mostly for myself. My show notes are comprehensive with a full transcript and many resources.  Find the recent podcasts here