Paternalism v. autonomy

Lepping et al ¹ rightly point out that autonomy is only one of several important ethical values, which, in the patient–doctor relationship, needs to be weighed against other values such as beneficence and justice. However, they do not seem to be aware of the factors which reduce our autonomy and how limited it therefore is in the first place. These factors include manipulation (think of the Brexit campaign), oppressive socialisation, coercion (e.g. through legislation), overconformity (which in the medical context may mean uncritical acceptance by patients of the suggestions of paternalistic doctors), inner necessity (the strong feeling that we have to do what we want to do – Martin Luther's ‘Here I stand. I can do no other’) and luck (we often think we are responsible for outcomes which are simply lucky occurrences). ^2,3 As a consequence, our autonomy is much more limited than we think it is. For this reason, we need to consider how best to increase our autonomy, and the autonomy of patients, so that it can at least compete with other important values.