1 - Autonomy

Summary

In the introduction I suggested that consent is predicated on autonomy. If one considers the role consent plays, which I will discuss in more detail in Chapter 4, the connection with autonomy seems apparent. It has not, however, gone unchallenged and I will address this later in the chapter. Starting with the etymological derivation of autonomy, which comes from the Greek and means self-rule, both senses of consent – as a waiver of a right and as a negotiated agreement – depend on the patient's autonomy, at least in the sense of autonomy as self-determination. Consent raises issues of liberty, power, control and responsibility; all of which are also relevant to the importance of autonomy. Because of this connection, it is essential to explore autonomy in some detail. This will allow the attributes of consent to be given more substance, which is a necessary part of determining the moral and legal duties that consent imposes on the healthcare professional. To explicate autonomy and its influence on consent I will explore the nature, value and limits of autonomy. I will then examine the nature of the connection between consent and autonomy.

The nature of autonomy

Various senses and conceptions of autonomy have been expounded. If there are real differences between these approaches to autonomy then the conception adopted may affect the obligations arising from the patient's right of consent. Rather than simply assert my own version of autonomy, recognising these competing conceptions makes it necessary to consider the different views.