This paper argues that doctors ought to make all things considered value judgments about what is best for their patients. It illustrates some of the shortcomings of the model of doctor as 'fact-provider'. The 'fact-provider' model fails to take account of the fact that practising medicine necessarily involves making value judgments; that medical practice is a moral practice and requires that doctors reflect on what ought to be done, and that patients can make choices which fail to express their autonomy (...) and which are based on mistaken judgments of value. If doctors are properly to respect patient autonomy and to function as moral agents, they must make evaluations of what their patients ought to do, all things considered. This paper argues for 'rational, non-interventional paternalism'. This is a practice in which doctors form conceptions of what is best for their patients and argue rationally with them. It differs from old-style paternalism in that it is not committed to doing what is best. (shrink)

This dissertation provides a philosophical analysis of personal autonomy. Personal autonomy is defined as the condition of being self-directed. The conditions which make such self-direction possible are then explored. ;Self-direction requires that one's actions are motivated by authentic reasons for action. One makes some of one's desires authentic by critically reflecting upon and identifying with them. One identifies with a particular desire when one approves of it as a reason for action, thus desiring that it be an effective desire. Provided (...) that one's identification with a desire is decisive and one is not ambivalent with respect to it, identification is sufficient for the authenticity of one's desires. ;This capacity to adopt authentic reasons for action cannot be sufficient for the autonomy of one's desires or actions, though. For authenticity is a function solely of the psychological states of an individual; yet autonomy cannot be adequately explicated solely by reference to an agent's subjective states. I refer to those theories which make the autonomy of a person's desires solely a function of her psychological states as "internalist", and argue that such theories must be rejected. An "externalist" is one who denies that autonomy is wholly a function of the psychological states of the individual, and so holds that the autonomy of a desire is determined, at least in part, by facts which are independent of the subjective attitudes of the agent. ;I defend a form of externalism, which makes the autonomy of a desire depend upon the following conditions: the agent must approve of it as a reason for action; the agent must have the capacity to respond appropriately to whatever reasons there are for and against it; the agent must have been able to avoid falling into error concerning the object of the desire and the desire itself; the agent's approval of it is not caused solely by a restriction of her feasible options or coercion. ;I argue that this is a more plausible theory than other externalist positions, and it can meet the objections which have beset internalist theories. (shrink)