Abstract
Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when (decision-competent) anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine.
Highlights
“I wasn’t really bothered about dying, as long as I died thin.” The citation is an excerpt from an interview conducted with a person who talks about her anorexia nervosa (Tan et al 2006, p. 274)
Bioethicists have reason to engage in authenticity-related problems just as they have previously engaged in problems relating to decision-making capacity, voluntariness, and so on
Authenticity issues relate to a number of different problems; some are related to decision-making, others rather concern personhood or being in some condition
Summary
“I wasn’t really bothered about dying, as long as I died thin.” The citation is an excerpt from an interview conducted with a person who talks about her anorexia nervosa (Tan et al 2006, p. 274). The person reports that being thin was more important to her than being alive. Namely Ahlin Marceta (2019), has been developed with the purpose of providing real guidance in such problems in practical biomedical settings. I argue that while that theory may be fruitful in cases related. J. Ahlin Marceta to decision-making, there are at least six authenticity-related problems that the theory from Ahlin Marceta (2019) cannot solve. Thereafter, I present the theory from Ahlin Marceta (2019) and discuss three cases in which the theory manages to provide normative guidance. The remainder of the article is devoted to six cases in which the theory fails to provide normative guidance.
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