Friday, April 10, 2009

Authenticity vs. Autonomy

Rosemary Flanigan
April 10, 2009

In his article in the newest Hastings Center Report, Dan Brudney dispels the notion that asking “What would the patient choose?” is asking about the patient’s autonomy or his/her best interests.

Imagine this scenario: you are the surrogate for a patient, Bill, who has lost decision-making capacity. He has no advance directive or anything equivalent. An important treatment decision needs to be made. When you are asked, “What would Bill choose to do?” you are being asked a hypothetical question.
Bill is not self-determining, so there is no question of choice here. And when you decide for him, you are making your decision in terms of the Bill you know, his values, and you try to give a response coherent with those values.

What is at stake here is his authenticity, not his autonomy (or self-determining capacity).

Dan says that clinicians will find little new in this article—and I think he’s correct. Physicians know that when they ask surrogates, “What would your loved one choose?” they are seeking a reply beyond a simple matter of choice; they are hoping for a reply which reflects the whole person of the patient, his authentic self.

The name of the foundational value matters little; that the decision reflects who Bill is matters a lot.

If any of you have read the article, tell me if the distinction was as meaningful to you as it was to me. THANKS.

Daniel Brudney
Hastings Center Report
March/April 2009

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