Legitimate authority is the normative power to govern, where a normative power is the ability to change the normative situation of others. Correlatively, when one has the normative power to govern others, these others face a normative liability to be governed. So understood, physicians do not have legitimate authority over their patients, and patients do not have legitimate authority over their physicians. An authority is legitimate only when it is a free group agent constituted by its free members. On this conception, associations of physicians sometimes have legitimate authority over individual physicians, and physicians sometimes count as members subject to the legitimate authority of these associations. This might be so even when they have not consented to membership.
IntroductionDisagreement over the proper practice of medicine is an enduring feature of contemporary health care: patients might disagree with their physicians about the suitability of resuscitation in end-of-life care; individual physicians might reject the guidance of medical associations over the off-label use of atypical antipsychotics; or employers might challenge a legal requirement to provide their employees insurance coverage for contraception. Sometimes the question of who should decide in the face of such dissension is posed as a question of who has legitimate authority over whom. As we shall see, this only sometimes is the most perspicuous way to understand the challenge of resolving disagreements in medicine.