Dr Katrine Del Villar1
1ACHLR, QUT, Brisbane, Australia
Biography:
Dr Katrine Del Villar is a member of the Australian Centre for Health Law Research at QUT, where she researches voluntary assisted dying and mental health law. She is an investigator on End-of-Life Law for Clinicians, embedding end-of-life legal training in general practices and residential aged care facilities.
Abstract:
Autonomy is a fundamental, perhaps the preeminent, ethical principle in modern western society. It is the primary ethical consideration underpinning legal principles concerning many healthcare decisions, including consent to or refusal of medical treatment. Despite the high value placed on autonomy in medical decision-making, most scholars accept that it is not, or should not be, absolute.
This paper seeks to analyse and critically evaluate the most commonly postulated limits on autonomy from a survey of the extant philosophical and ethical literature. It groups suggested limits into three categories. First, it explores ‘others-regarding’ limits such as preventing harm to others; acting in furtherance of the common good; and ensuring a just allocation of societal resources. Others-regarding limitations on autonomy are generally well accepted. Second, it explores possible limits on autonomy for ‘self-regarding reasons’, such as to correct false beliefs; to avoid serious harm to self; or to preserve a person’s future autonomy. These postulated restrictions are more contentious. From this analysis we seek to derive a synthesis – proposing a suggested scheme of acceptable limits on autonomy in the context of healthcare decisions.
The findings of this analysis will be useful to inform healthcare policy and law reform. They will particularly be useful in evaluating whether existing legal exceptions demonstrate appropriate respect for autonomy, in contexts such as overriding refusals of medical treatment by mature minors, the operation of advance directives, or involuntary treatment laws.
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