Re-envisioning autonomy: From consent and cognitive capacity to embodied, relational, and authentic selfhood

Re-envisioning autonomy: From consent and cognitive capacity to embodied, relational, and authentic selfhood
Editorial
Jonathan Lewis
Clinical Ethics, 24 February 2025
Excerpt
… In medical ethics, autonomy at its most basic level has tended to be conceptualized in terms of a patient’s ability to understand, deliberate, and decide. Prevailing legal and ethical paradigms have long held that a patient’s expressed preferences—assuming they satisfy the requisite threshold of mental capacity—ought to be respected unequivocally. This model underpins practices such as advance directives, a framework critiqued by Brock for its narrow focus on cognitive capacity. Empirical findings reported by Toomey et al. suggest that lay judgments about decision-making do not align neatly with this capacity-centric model. Their research indicates that when tasked with deciding for another, individuals are inclined to privilege a person’s treatment preference even when the person fails to satisfy the traditional cognitive requirements for capacity so long as the preference reflects the person’s “true self.” According to Strohminger, Knobe, and Newman, the true self consists of those stable, core attributes—values, traits, and dispositions—that consistently define who a person is across time and circumstance. Their research demonstrates that individuals tend to regard actions as more authentic when they are consistent with these enduring, core attributes (rather than reflecting transient states or external pressures). If we, like most theorists of autonomy, consider authenticity to be a key component of the nature of autonomy, then Toomey et al.’s studies could suggest that a decision may not be genuinely autonomous if it does not resonate with these enduring aspects of the self. In other words, and in the context of medical decision-making, a patient’s choice might satisfy the formal criteria for cognitive capacity but still be considered non-autonomous if it deviates from what is widely recognized as the individual’s deep-seated values, interests, and dispositions (see, e.g., Hawkins and Toomey et al.)…