Introduction: the limits of consent and conscience in medicine.

Abstract

In recent years a concern with the value of personal autonomy has come to dominate discussions in medical ethics. This emphasis on autonomy has naturally led to discussions of what criteria must be met for a person to be autonomous, or to be autonomous with respect to her decisions, her actions, or those of her desires that motivate her to make or to perform the decisions or the actions that she makes or does. It has also led to discussions of whether autonomy is valuable in itself, instrumentally valuable, or whether its value is a combination of the two: that a person’s autonomy is valuable to her not merely as a means to securing something else that she finds valuable, but is valuable as its possession is part of what makes her life go well. Questions that concern the value of autonomy are necessarily linked to the prior question of the precise nature of autonomy. There are two main approaches to answering this question within the Western philosophical tradition. The first is Kantian, the proponents of which hold (loosely) that a person is autonomous to the extent that her will conforms to the moral law. This approach to autonomy is thoroughly impersonal. By contrast, proponents of accounts of personal autonomy hold that a person is autonomous to the degree that her decisions (desires, actions) flow from her individual self in some specifiable way. On this latter account of autonomy, a person is autonomous with respect to (for example) a first order desire that moves her to act if it meets certain specified conditions for it to be considered hers, such that she could be expected to be answerable for it (rather than merely being hers as an animal’s desire could be its), or else being an alien force within her. In the first paper in this Special Issue, ‘‘The Limits of Traditional Approaches to Informed Consent for