title: Patient autonomy, assessment of competence and surrogate decision-making: a call for reasonableness in deciding for others.
abstract: In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of 'structural arbitrariness' in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Norway. kristine.baroe@isf.uib.no
authors.forename: Kristine
authors.initials: K
authors.lastname: Baerøe
mesh_terms: D003657:Decision Making / Q000941:ethics*; D006801:Humans; D016743:Mental Competency; D026684:Personal Autonomy; D020458:Third-Party Consent / Q000941:ethics*