Paternalism and Partial Autonomy
Journal of Medical Ethics. 1984 Dec; 10(4): 173-178.
Medical paternalism, and the related concepts of consent and respect for persons, are considered within three traditional frameworks: the result-oriented ethics of utilitarianism, action-oriented ethics based on respect for human autonomy, and consent theory's idea of the inherent opacity--or selective and incomplete nature--of consent. An alternative model is proposed, based on the assumption that only consideration of the determinate cognitive and volitional capacities and incapacities of particular patients at particular times provides a framework for working out boundaries of permissible medical paternalism. Different contextual resolutions will be required, therefore, according to whether the patient's capacity for autonomy is impaired temporarily, impaired for a long time or permanently, lost permanently, or never existing. (KIE abstract)