For example, there are concerns about what authority the ‘self’ in a self-governor has: is a young child capable of autonomy, or is she too ignorant and irrational meaningfully to self-govern? Is being autonomous an absolute matter, meaning either one is or is not autonomous, or is it graded or context-specific, meaning one can be more or less autonomous? Is there a special normative concern due to something, such as an adult human being, simply by virtue of her capacity for autonomy? If so, does it apply also to someone with the potential to become autonomous? Consideration of such matters has dominated ethical debates on doctor-patient interactions, leading to more practically focused normative questions. Whether it is good that people govern themselves, or to what extent they should do so, are many-layered questions. This does not tell us that she should be self-governing. ![]() Rather we ask whether autonomy exists in any situation: is a person directing her action? If yes, she is being autonomous, if no, she is not. In this basic sense, it is not so much a normative concept as an empirical question: we do not know ex ante that (or how much) autonomy is good. 10 But what does autonomy mean and what is its importance within a regulated social and healthcare system?Īt its most simple, autonomy denotes self-government. 9 Normative concerns regarding an excessively paternalistic medical profession, supported by an excessively deferential judiciary, gradually led to a radical change in practice, as explored below. While it has, in many respects, attained a supreme status, 8 there is considerable variation in how the concept is understood. 7 Within medical ethics and healthcare law it has become deceptively familiar. Autonomy: Government within a Shared SystemĪutonomy is a familiar concept within legal, moral, and political philosophy. Legal change is not needed provided that judges, policy-makers, and practitioners understand the import of their actions and the bearing of existing principle. Our analysis exposes troublesome issues, but we argue that positive changes can be effected within the existing system. We map these concerns by exploring developments in medical jurisprudence and the Mental Capacity Act 2005. We also suggest that the proper demands of respecting an individual patient’s values, whether or not the patient is able to act autonomously, 6 may not be fully acknowledged. Our primary criticism is that there may be an excessive commitment to ostensible rather than substantive protection of autonomy. Although we are content with the general direction of medical law in this area, we discuss causes for concern with the current situation. This enables us to critique the existing legal picture. We therefore give an account of what respecting autonomy means and how it contrasts with the protection of other related and important concepts. 5 Whilst this is not intrinsically problematic, it creates problems in applying principles such as autonomy, which are often bound to ideas of rationality. 4 In this paper, we argue that in response to these issues, there has been a failure by the courts properly to distinguish political concepts of liberty and moral concepts of autonomy.Įnglish medical law demands non-prejudicial deference to patients’ reasons for giving or refusing consent to treatment, creating a practical system of moral value-pluralism. ![]() ![]() 3 Furthermore, there are distinct understandings of, and justifications for, different conceptions of autonomy. ![]() 2 Competing concerns for greater welfare and individual freedom, complicated by an overarching commitment to value-pluralism, make this a tricky area of policy-development. 1 Although we have seen a welcome move away from a system governed by largely unchecked paternalism, there is not universal agreement on the direction in which medical law should advance. A central tenet to much ethical argument within medical law is patient autonomy.
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