Study Guide for Second Test in Medical Ethics
Autonomy means ‘self-rule’ pg. 57. Some see a conflict between autonomy and
tradition, since autonomy is about making choices for oneself. However, you
could say that our traditions are part of who we are, so the question of whether
someone has autonomy isn’t as simple as just asking whether they have outside
influences. Everyone has influences. The question is about ‘undue’ influence and
ability to achieve goals.
Autonomy can be positive or negative, just like rights and liberties pg. 64 (know
the difference). Also, autonomy is a right, not a duty. (61) That means patients
have the right to make choices, but that doesn’t mean that they have to do so.
They can renounce that right and let doctors/nurses/etc make choices for them.
In order to be autonomous, three things must be in place, and autonomy is a
matter of degree pg. 59, mainly because of the third one (understanding).
With the exception of extreme cases (like slavery or torture) autonomy only has
prima facie value pg. 65. That doesn’t lessen it’s importance, though. It’s also
become more important recently, as concern for patient rights has increased.
Consent can be either explicit or implicit, i.e. either directly expressed or simply
implied in cases where we can infer consent based on other actions (e.g. social
contracts, previous agreements, etc.) pg. 65-66. It can also be tacit, meaning that
sometimes we consent by NOT protesting an action that we understand.
Consent is related to autonomy insofar as a person who does not have autonomy
cannot really consent (though he/she could still be forced into doing something).
Also, like autonomy, our ability to consent varies (since consent is really just us
using our autonomy to agree to things). Also, people change over time, so
consenting once does not mean you consent forever.
Competence is a question of whether “potential subjects are capable,
psychologically or legally, of adequate decision-making.” Pg. 69
Competence and autonomy are closely connected. If a person is competent, then
we must respect their autonomy (according to the principle of autonomy), but if
they are not competent, then we do not have to respect their autonomy. In fact,
they may not even HAVE full autonomy if they are not competent because they
lack understanding (see note 3 above) pg. 71. Unlike autonomy, one either is or is
not competent…it is about drawing a line for when autonomy must be respected
List of reasons for declaring someone incompetent, from most obvious to most
subtle is on pg. 73
10. The sliding scale strategy (pg. 74) says that the more dangerous/risky/important a
decision is, the more sure we should be that the person making the decision is
competent to exercise autonomy. Trivial decision would therefore be OK to leave
up to questionably competent people, but life/death decisions would not. The
problem with this is that there is no evidence that life/death decisions are