According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

Derek Parfit has notably argued that while a moral theory should not be directly self-defeating, there is nothing necessarily wrong with a moral theory that is only indirectly self-defeating. Here I resist this line of argument. I argue instead that indirectly self-defeating moral theories are indeed problematic. Parfit tries to sidestep the oddities of indirectly self-defeating theories by focusing on the choice of dispositions rather than actions. But the very considerations that can make it impossible to achieve a theory's aims (...) if we try to do what the theory recommends can also make it impossible to achieve a theory's aims if we instead try to adopt the dispositions the theory recommends. What makes a theory indirectly self-defeating has little to do with the object of choice, but with the nature of choosing itself. (shrink)