The Need for Authenticity-Based Autonomy in Medical Ethics

Abstract

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of "authenticity", the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity-as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires.

Resolved and unresolved bioethical authenticity problems

“…During the twentieth century, informed consent practices have been incorporated in healthcare in large parts of the Western world with the aim of respecting and promoting patient autonomy (Jonsen 2000;Faden and Beauchamp 1986). In recent years, various bioethicists have raised the possibility of incorporating authenticity in autonomy-based practices in healthcare (Ahlin Marceta 2018a, b;Sjöstrand and Juth 2014;Villafranca 2019;White 2018;Zürcher et al 2019). It is not entirely clear how the notion of authenticity should be conceptualized, although the term is usually understood to mean "genuine," "real," "true to oneself," or similar.…”

Ethical issues in human cloning

“…Cloning weakens the authenticity and autonomy of the product concerning his/her accomplishments and dispositions. The engineered person's abilities, talents, and outputs are no longer his or her own (White, 2018). All that he/she accomplish are as a result of the genetic modification.…”

“…According to Dr. Ryuzo Yanagimachi, a University of Hawaii researcher who first cloned these animals, the fat mice seem fine until an age that would be equivalent of 30 for a person, when their weight starts to soar. Yanagimachi also opines that cloned mice tend to have developmental abnormalities, taking the longest to reach a milestone like eye-opening and ear twitching (White, 2018).…”

A non-ideal authenticity-based conceptualization of personal autonomy

“…In one of the most recent contributions to authenticity theory in biomedical ethics, White (2018) argues in favor of using the notion of authenticity as a frame of reference in assessments of the validity of patients’ healthcare decisions. More specifically, it should be used in accounts of autonomy as a means to protect high-stake choices from being overridden.…”