Paternalism and partial autonomy

Abstract

A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy.

KIE: Medical paternalism, and the related concepts of consent and respect for persons, are considered within three traditional frameworks: the result-oriented ethics of utilitarianism, action-oriented ethics based on respect for human autonomy, and consent theory's idea of the inherent opacity--or selective and incomplete nature--of consent. An alternative model is proposed, based on the assumption that only consideration of the determinate cognitive and volitional capacities and incapacities of particular patients at particular times provides a framework for working out boundaries of permissible medical paternalism. Different contextual resolutions will be required, therefore, according to whether the patient's capacity for autonomy is impaired temporarily, impaired for a long time or permanently, lost permanently, or never existing.