Personal Autonomy and Informed Consent Conceptual and Normative Analyses

Sammanfattning: This licentiate thesis is comprised of a “kappa” and two articles. The kappa includes an account of personal autonomy and informed consent, an explanation of how the concepts and articles relate to each other, and a summary in Swedish.Article 1 treats one problem with the argument that a patient’s consent to treatment is valid only if it is authentic, i.e., if it is “genuine,” “truly her own,” “not out of character,” or similar. As interventions with a patient’s life and liberties must be justified, the argument presupposes that the authenticity of desires can be reliably determined. If the status of a desire in terms of authenticity cannot be reliably determined, discarding the desire-holder’s treatment decision on the basis that it is inauthentic is morally unjustified. In the article, I argue that no theory of authenticity that is present in the relevant literature can render reliably observable consequences. Therefore, the concept of authenticity, as it is understood in those theories, should not be part of informed consent practices.Article 2 discusses the problem of what it is to consent or refuse voluntarily. In it, I argue that voluntariness should be more narrowly understood than what is common. My main point is that a conceptualization of voluntariness should be agent-centered, i.e., take into account the agent’s view of her actions. Among other things, I argue that an action is non-voluntary only if the agent thinks of it as such when being coerced. This notion, which at first look may seem uncontroversial, entails the counterintuitive conclusion that an action can be voluntary although the agent has been manipulated or coerced into doing it. In defense of the notion, I argue that if the agent’s point of view is not considered accordingly, describing her actions as non-voluntary can be alien to how she leads her life. There are other moral concepts available to describe what is wrong with manipulation and coercion, i.e., to make sense of the counterintuitive conclusion. Voluntariness should be reserved to fewer cases than what is commonly assumed.