The Moral Significance of Non-Autonomous Refusals of Medical Treatment Open Access

Jenkins, Brian Scott (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/z890rt51p?locale=en
Published

Abstract

In contemporary medical ethics, the theoretical justification for informed consent has been extended to treatment refusal decisions. This has rendered a theoretical framework in which compulsory treatment of non-autonomous patients (those lacking decisionmaking capacity) is justified solely by reference to their lack of decision-making capacity. The result is that an active refusal by a non-autonomous patient may be automatically overridden by the consent of a surrogate decision maker. The primary objective of this thesis is to make the case that the nature of an active refusal is such that lack of decision-making capacity should not automatically negate one's right to refuse medical treatment. I will argue that a refusal contains a moral significance, the source of which is one's negative liberty rights, that is independent of a patient's decision-making capacity. Therefore, if a non-autonomous patient is to be treated against his or her expressed wishes, the treatment must be justified on grounds in addition to his or her lack of decision-making capacity. The secondary objective of this thesis is to propose a principle that balances the moral significance of a non-autonomous patient's refusal with the obligation to protect him from the consequences of his decisions. I will argue that a harm principle accomplishes this task and is the appropriate threshold for determining whether overriding the patient's expressed refusal is justified.

Table of Contents

Table of Contents CHAPTER 1 ................................................................................................................................... 1 Informed Consent, Decision-Making Capacity, and Refusal ....................................................... 2 The Structure of Autonomy ......................................................................................................... 7 Decision-Making Capacity .......................................................................................................... 8 Relationship Between Agency and Liberty ................................................................................. 9 The Five Dimensions of Autonomy ........................................................................................... 15 Structure of Autonomy Along the Five Dimensions.................................................................. 18 Can Forced Treatment Be Justified? .......................................................................................... 19 CHAPTER 2 ................................................................................................................................. 21 Autonomy and Informed Consent .............................................................................................. 21 What is Informed Consent? ....................................................................................................... 26 Autonomous Refusal of Treatment ............................................................................................ 31 Decision-Making Capacity and Surrogate Decision Making ..................................................... 37 Does Consent of a Surrogate Nullify a Patient's Active Refusal? ............................................. 41 Capacity and the Consequences of Refusal ............................................................................... 47 Should We Respect All Refusals? ............................................................................................. 50 CHAPTER 3 ................................................................................................................................. 52 Isaiah Berlin and Two Concepts of Liberty ............................................................................... 54 Negative Liberty ........................................................................................................................ 55 Positive Liberty .......................................................................................................................... 56 The Relationship Between Positive and Negative Liberty ........................................................ 57 Medical Decision-Making Capacity as Positive Liberty ........................................................... 58 Objections to Berlin's Distinction ............................................................................................. 60 Christman's Content-Neutral Conception of Positive Liberty ................................................... 61 Richard Fallon's Concept of Ascriptive Autonomy................................................................... 70 CHAPTER 4 ................................................................................................................................. 73 Paternalism ................................................................................................................................ 73 Person-Mediating Maxim versus Act-Mediating Maxim .......................................................... 74 Paternalism in the Case of Non-Autonomous Active Refusal ................................................... 75 Harm Principle ........................................................................................................................... 80 The Case of Ryan ....................................................................................................................... 87 Conclusion ................................................................................................................................ 91 BIBLIOGRAPHY .......................................................................................................................... 93

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
School
Department
Degree
Submission
Language
  • English
Research field
Keyword
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files