Autonomy is an issue. Is it morally wrong for a doctor to deceive their patient about the true nature of a treatment, which the patient would otherwise refuse, even if it means improving that patient’s prognosis? Consider the case:
An adult male presenting with aplastic anaemia requires a bone marrow transplant. Without the transplant he will almost certainly die, but with the transplant, he has a good chance of recovery. The patient is a long-time committed Jehovah’s Witness and will not accept any treatments that contain blood; he tells his doctor that he would rather die than act against his faith. The doctor knows that bone marrow will always contain some blood, but instead of telling the truth, he assures his patient that bone marrow contains no blood whatsoever. The transplant proceeds.
In this paper, I will argue that the doctor’s actions were morally wrong. To establish my argument, I will first discuss how the doctor harmed his patient in disregarding his autonomy. Then, I will explore the counterpoint that perhaps his actions could be justified, before dismissing the self-refuting logic. Finally, I will return to the claim that the doctor acted against his patient’s intrinsic and instrumental values while not bringing about any greater good in the process; therefore, from a utilitarian perspective, the doctor was morally wrong.
I will begin with the presumptions that autonomy is intrinsically valuable and to inhibit autonomy is wrong. Autonomy is intrinsically valuable, according to Richards, because it is a central characteristic of personhood, and if personhood is seen as intrinsically valuable, then autonomy must be seen as intrinsically valuable as well (to debate whether or not personhood has intrinsic value would be reductionist, so for the purposes of this paper, I will presume that it does). I will add that the notion of respect for autonomy fosters social equality; when people feel that their own choices are being respected, they are more likely to be respectful of others’ choices. Moreover, utilitarianism is concerned with maximising good; and, by definition, intrinsic values are good in and of themselves. If it is true that autonomy is intrinsically valuable, and such values ought to be maximised, then autonomy ought to be maximised.
Beauchamp’s theory of autonomy requires that individuals have intentionality (i.e. foresight), understanding (i.e. comprehension), and voluntariness (i.e. willingness) when making decisions, if they are to give ‘informed consent’. The only situation where it is acceptable to not obtain informed consent from an individual (on issues solely regarding their own wellbeing) is if the individual in question lacks the capacity to meet those requirements (e.g. children, people with mentally illness, people who are unconscious, etc.). However, the default is to assume an individual does have capacity and the burden of proof (morally as well as legally) rests on whoever is responsible for restricting the autonomy of that individual. In this case, the patient had the capacity to make medical decisions for himself, in the absence of any indication to the contrary, so the doctor ought to have obtained his informed consent. Because the patient was misinformed, he was unable to act on autonomy. And because he was unjustifiably misinformed as a result of the doctor’s actions, the doctor was responsible for his inability to act on autonomy. Autonomy is good and ought to be maximised. Therefore, the doctor’s actions were wrong.
Or were they? An act which restricts an individual’s autonomy with the intent to help (or prevent harm to) that individual, is ‘paternalistic’. By Dworkin’s analysis of paternalism, the doctor was acting paternalistically: he obstructed his patient’s autonomy, without his patient’s consent, in efforts to improve his patient’s welfare. Paternalism, without reasonable justification, is wrong because it limits autonomy. But what if the doctor was justified in acting paternalistically? Perhaps, if autonomy is good, then it would be morally wrong not to maximise a person’s lifetime potential for autonomy. A classical utilitarian approach to maximising autonomy will emphasise that what really matters is how much autonomy I am able to exercise over my whole life, rather than how much autonomy I am able to exercise at one point in time. Maybe, by restricting his autonomy temporarily, the doctor gave his patient future in which he has greater opportunity to be autonomous. Lifelong autonomy. More autonomy over a lifetime. Lifetime sum of autonomy.
While there seems to be a valid argument for overriding an individual’s present right to autonomy in order to protect their future right to autonomy, it adheres to a self-refuting idea of autonomy. What is the point of being recognised as an autonomous person if, when it really matters (e.g. in life or death situations), some authority is going to restrict my right to be autonomous? I would not actually be autonomous then. Furthermore, if we were to accept this counterpoint, we would also have to accept that autonomy is an empty value.
In this paper, I have argued that it was morally wrong for a doctor to intentionally deceive their patient even if it means improving that patient’s prognosis.
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Utilitarian Argument against the Deceptive Doctor: Issues of Autonomy.
(2022, December 27). Edubirdie. Retrieved April 25, 2024, from https://edubirdie.com/examples/utilitarian-argument-against-the-deceptive-doctor-issues-of-autonomy/
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Utilitarian Argument against the Deceptive Doctor: Issues of Autonomy [Internet]. Edubirdie.
2022 Dec 27 [cited 2024 Apr 25].
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