How a "right to die" may become a "coercive option".

ABSTRACT It is accepted that treatment of previously competent, now incompetent patients can be limited if that is what the patient would desire, if she were now competent. Expressed past preferences or an advance directive are often taken to constitute sufficient evidence of what a patient would now desire. I distinguish between desires and rational desires. I argue that for a desire to be an expression of a person's autonomy, it must be or satisfy that person's rational desires. A person (...) rationally desires a course of action if that person desires it while being in possession of all available relevant facts, without committing relevant error of logic, and “vividly imagining” what its consequences would be like for her. I argue that some competent, expressed desires obstruct autonomy. I show that several psychological mechanisms operate to prevent a person rationally evaluating what future life in a disabled state would be like. Rational evaluation is difficult. However, treatment limitation, if it is to respect autonomy, must be in accord with a patient's rational desires, and not merely her expressed desires. I illustrate the implications of these arguments for the use of advance directives and for the treatment of competent patients. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 20 Heft: 1 Seiten: 5-28.

To respect the autonomous choices of persons is an important moral principle. There is, however, little agreement about its nature and its normative importance. This is due to the fact that the concept of autonomy as well as the moral relevance of autonomy are contested. It is argued in this paper that the debate about autonomy is at its core a debate about the reasons for respecting decisions. Decisions of persons are to be respected as their decisions, and they have (...) to be respected as determining the deontic properties of situations. This, however, can only be understood against the background of persons having rights over themselves. Their decisions determine the deontic properties as exercises of their rights. Thus, respect for the autonomous choice of persons turns out to be respect for their rights. (shrink)

Harry Frankfurt has claimed that some of our desires are ‘internal’, i.e., our own in a special sense. I defend the idea that a desire's being internal matters in a normative, reasons-involving sense, and offer an explanation for this fact. The explanation is Kantian in spirit. We have reason to respect the desires of persons in so far as respecting them is a way to respect the persons who have them (in some cases, ourselves). But if desires matter normatively in (...) so far as they belong to persons, then it matters whether they really do belong to the persons who have them. Thus Kantian considerations explain why identification (or internality) is a normatively relevant category. This account is superior to others, and does not lead to reasons bootstrapping or a self-centred conception of deliberation. (shrink)