Theoretical Medicine and Bioethics

, Volume 32, Issue 4, pp 217-227

First online:

Agency and authenticity: Which value grounds patient choice?

  • Daniel BrudneyAffiliated withDepartment of Philosophy, The University of Chicago Email author 
  • , John LantosAffiliated withUniversity of Missouri at Kansas City and Children’s Mercy Bioethics Center

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In current American medical practice, autonomy is assumed to be more valuable than human life: if a patient autonomously refuses lifesaving treatment, the doctors are supposed to let him die. In this paper we discuss two values that might be at stake in such clinical contexts. Usually, we hear only of autonomy and best interests. However, here, autonomy is ambiguous between two concepts—concepts that are tied to different values and to different philosophical traditions. In some cases, the two values (that of agency and that of authenticity) entail different outcomes. We argue that the comparative value of these values needs to be assessed.


Agency Authenticity Autonomy Best interests Kant Mill