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The impossibility of reliably determining the authenticity of desires: implications for informed consent
2017 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633Article in journal (Refereed) Published
Abstract [en]

It is sometimes argued that autonomous decision-making requires that the decision-maker’s desires are authentic, i.e., “genuine,” “truly her own,” “not out of character,” or similar. In this article, it is argued that a method to reliably determine the authenticity (or inauthenticity) of a desire cannot be developed. A taxonomy of characteristics displayed by different theories of authenticity is introduced and applied to evaluate such theories categorically, in contrast to the prior approach of treating them individually. The conclusion is drawn that, in practice, the authenticity of desires cannot be reliably determined. It is suggested that authenticity should therefore not be employed in informed consent practices in healthcare.

Place, publisher, year, edition, pages
Springer, 2017.
Keywords [en]
Authenticity, Autonomy, Informed consent, Decision-making, Healthcare
National Category
Ethics
Research subject
Philosophy
Identifiers
URN: urn:nbn:se:kth:diva-208635DOI: 10.1007/s11019-017-9783-0ISI: 000425299900006Scopus ID: 2-s2.0-85020429439OAI: oai:DiVA.org:kth-208635DiVA, id: diva2:1107450
Funder
Swedish Research Council, 2014–4024
Note

QC 20170612

Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2019-02-18Bibliographically approved
In thesis
1. Personal Autonomy and Informed Consent: Conceptual and Normative Analyses
Open this publication in new window or tab >>Personal Autonomy and Informed Consent: Conceptual and Normative Analyses
2017 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

This licentiate thesis is comprised of a “kappa” and two articles. The kappa includes an account of personal autonomy and informed consent, an explanation of how the concepts and articles relate to each other, and a summary in Swedish.

Article 1 treats one problem with the argument that a patient’s consent to treatment is valid only if it is authentic, i.e., if it is “genuine,” “truly her own,” “not out of character,” or similar. As interventions with a patient’s life and liberties must be justified, the argument presupposes that the authenticity of desires can be reliably determined. If the status of a desire in terms of authenticity cannot be reliably determined, discarding the desire-holder’s treatment decision on the basis that it is inauthentic is morally unjustified. In the article, I argue that no theory of authenticity that is present in the relevant literature can render reliably observable consequences. Therefore, the concept of authenticity, as it is understood in those theories, should not be part of informed consent practices.

Article 2 discusses the problem of what it is to consent or refuse voluntarily. In it, I argue that voluntariness should be more narrowly understood than what is common. My main point is that a conceptualization of voluntariness should be agent-centered, i.e., take into account the agent’s view of her actions. Among other things, I argue that an action is non-voluntary only if the agent thinks of it as such when being coerced. This notion, which at first look may seem uncontroversial, entails the counterintuitive conclusion that an action can be voluntary although the agent has been manipulated or coerced into doing it. In defense of the notion, I argue that if the agent’s point of view is not considered accordingly, describing her actions as non-voluntary can be alien to how she leads her life. There are other moral concepts available to describe what is wrong with manipulation and coercion, i.e., to make sense of the counterintuitive conclusion. Voluntariness should be reserved to fewer cases than what is commonly assumed.

Place, publisher, year, edition, pages
Kungliga Tekniska högskolan, 2017. p. 65
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-212300 (URN)978-91-7729-495-5 (ISBN)
Presentation
2017-10-20, 16:04 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2014-4024Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4024
Note

QC 20170821

Available from: 2017-08-21 Created: 2017-08-17 Last updated: 2017-08-21Bibliographically approved
2. Authenticity in Bioethics: Bridging the Gap between Theory and Practice
Open this publication in new window or tab >>Authenticity in Bioethics: Bridging the Gap between Theory and Practice
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this doctoral thesis is to bridge the gap between theoretical ideals of authenticity and practical authenticity-related problems in healthcare. In this context, authenticity means being "genuine," "real," "true to oneself," or similar, and is assumed to be closely connected to the autonomy of persons. The thesis includes an introduction and four articles related to authenticity. The first article collects various theories intended to explain the distinction between authenticity and inauthenticity in a taxonomy that enables oversight and analysis. It is argued that (in-)authenticity is difficult to observe in others. The second article offers a solution to this difficulty in one theory of authenticity. It is proposed that under certain circumstances, it is morally justified to judge that the desires underlying a person's decisions are inauthentic. The third article incorporates this proposition into an already established theory of personal autonomy. It is argued that the resulting conceptualization of autonomy is fruitful for action-guidance in authenticity-related problems in healthcare. The fourth article collects nine cases of possible authenticity-related problems in healthcare. The theory developed in the third article is applied to the problems, when this is allowed by the case-description, to provide guidance with regard to them. It is argued that there is not one universal authenticity-related problem but many different problems, and that there is thus likely not one universal solution to such problems but various particular solutions.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2019. p. 147
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831 ; 62
Keywords
Authenticity, autonomy, decision-making, healthcare, paternalism, informed consent, bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-244301 (URN)978-91-7873-124-4 (ISBN)
Public defence
2019-06-10, Kollegiesalen, Brinellvägen 8, Stockholm, 13:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2014–4024Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–4024
Available from: 2019-03-21 Created: 2019-02-18 Last updated: 2019-03-21Bibliographically approved

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