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Personal Autonomy and Informed Consent: Conceptual and Normative Analyses
Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.ORCID iD: 0000-0003-1456-4352
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: urn:nbn:se:kth:diva-212300ISBN: 978-91-7729-495-5 (print)OAI: oai:DiVA.org:kth-212300DiVA, id: diva2:1134058
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
List of papers
1. The impossibility of reliably determining the authenticity of desires: implications for informed consent
Open this publication in new window or tab >>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
Authenticity, Autonomy, Informed consent, Decision-making, Healthcare
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-208635 (URN)10.1007/s11019-017-9783-0 (DOI)000425299900006 ()2-s2.0-85020429439 (Scopus ID)
Funder
Swedish Research Council, 2014–4024
Note

QC 20170612

Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2018-03-14Bibliographically approved
2. Toward an Agent-Centered Theory of Voluntariness
Open this publication in new window or tab >>Toward an Agent-Centered Theory of Voluntariness
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The concept of voluntariness is central to informed consent and personal autonomy, yet it has been underexplored by bioethicists. There are various theories intended to explain voluntary choice and action. None is fully agent-centered, in the sense that the conceptualization of voluntariness takes into account the agent’s views of her decisions and actions. An agent-centered theory of voluntariness would promote analytical precision, and foster autonomy in healthcare and research practices. According to the most influential bioethical theory of voluntariness, here called the Voluntariness as Control theory, an action is non-voluntary if the agent is controlled by external influences. The theory is critically discussed from an agent-centered perspective, and a new conceptualization of voluntariness is proposed.

Keywords
voluntariness, autonomy, informed consent, agent-centered, bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-212299 (URN)
Funder
Swedish Research Council, 2014-4024Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4024
Note

QC 20170821

Available from: 2017-08-17 Created: 2017-08-17 Last updated: 2017-08-21Bibliographically approved

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