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Health Care Analysis

, Volume 15, Issue 3, pp 235–255 | Cite as

Varied and Principled Understandings of Autonomy in English Law: Justifiable Inconsistency or Blinkered Moralism?

  • John Coggon
Original Article

Abstract

Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find.

Keywords

Autonomy Ideal desire autonomy Best desire autonomy Current desire autonomy English medical law 

Notes

Acknowledgements

Author owes enormous thanks to Professor Søren Holm for his comments on drafts of this paper, and to the generosity of Cardiff Law School for funding this research. This paper was chosen as winner of the 2006 Mark S. Ehrenreich Prize for Healthcare Ethics Research, awarded at the 8th World Congress of Bioethics by the Pacific Center for Health Policy and Ethics, University of Southern California.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Centre for Social Ethics and Policy, School of LawUniversity of ManchesterManchesterUK

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