Bioethics 24 (2):87-95 (2010)

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural arbitrariness’ in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others.
Keywords reasonableness  surrogate decision‐making  respectful treatment  competence assessment  autonomy  non‐competent  consent
Categories (categorize this paper)
DOI 10.1111/j.1467-8519.2008.00672.x
Edit this record
Mark as duplicate
Export citation
Find it on Scholar
Request removal from index
Revision history

Download options

PhilArchive copy

Upload a copy of this paper     Check publisher's policy     Papers currently archived: 72,564
External links

Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library

References found in this work BETA

No references found.

Add more references

Citations of this work BETA

The Role of Vulnerability in Kantian Ethics.Paul Formosa - 2014 - In Catriona Mackenzie, Wendy Rogers & Susan Dodds (eds.), Vulnerability: New Essays in Ethics and Feminist Philosophy. New York: Oxford University Press. pp. 88-109.
Commentary: The Problematic Proxy and the Patient’s Best Interests.David Campbell - 2014 - Cambridge Quarterly of Healthcare Ethics 23 (2):232-234.

Add more citations

Similar books and articles

Dementia and Dignity: Towards a New Method of Surrogate Decision Making.Elysa R. Koppelman - 2002 - Journal of Medicine and Philosophy 27 (1):65 – 85.
Shared Decision-Making and Patient Autonomy.Lars Sandman & Christian Munthe - 2009 - Theoretical Medicine and Bioethics 30 (4):289-310.
Patient Competence and Surrogate Decision Making.Dan Brock - 2007 - In Rosamond Rhodes, Leslie Francis & Anita Silvers (eds.), The Blackwell Guide to Medical Ethics. Blackwell. pp. 128--140.
Physician-Patient Relations: No More Models.Greg Clarke, Robert T. Hall & Greg Rosencrance - 2004 - American Journal of Bioethics 4 (2):16 – 19.
An Economic Theory of Patient Decision-Making.Douglas O. Stewart & Joseph P. DeMarco - 2005 - Journal of Bioethical Inquiry 2 (3):153-164.


Added to PP index

Total views
36 ( #320,137 of 2,533,564 )

Recent downloads (6 months)
1 ( #390,861 of 2,533,564 )

How can I increase my downloads?


My notes