Abstract
It is necessary to have a conception of autonomy that can plausibly explain the interaction between patients and family members or patients and significant others in order to craft effective principles for surrogate decision-making concerning life-sustaining treatment. In this article the author contrasts two possible conceptions of autonomy―family autonomy and relational autonomy―that are thought to explain the relationships between patients and family members or patients and significant others. In doing so, the author aims to determine the best conception of autonomy for surrogate decision-making. In article 18 of the newly enacted Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, family members are authorized to make surrogate decisions. However, the law does not provide any criteria for surrogate decision-making or limit the surrogates’ authority. The author applies the aforementioned conceptions of autonomy to article 18 and examines the possible outcomes. It is concluded that that relational autonomy is the best conception of autonomy in the context of surrogate decision-making concerning end-of-life decisions. This conception allows due regard to be given to the role of family members and significant others. Moreover, additional support is provided for the relational concept of autonomy by the significant level of equal liberty that this concept ensures.
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