Abstract

Like many, I find the idea of relying on patient preference predictors in life-or-death cases ethically troubling. As part of his stimulating discussion, Sharadin1 diagnoses such unease as a worry that using PPPs disrespects patients’ autonomy, by treating their most intimate and significant desires as if they were caused by their demographic traits. I agree entirely with Sharadin’s ‘debunking’ response to this concern: we can use statistical correlations to predict others’ preferences without thereby assuming any causal claim. However, I suspect that, for at least some of us, our unease about PPPs stems from a different kind of ‘autonomy’ concern. In this commentary, then, I will explore this concern, and show how it relates to Sharadin’s work. Very many of our preferences are caused, ultimately, by facts which are outside our control, such as our demographic features. However, I suggest that we can still act autonomously on the basis of such preferences, when they are preferences which we endorse. Imagine, for example, that Jane has grown up in a church-growing environment, which has shaped many of her preferences, …