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Philosophy in the Contemporary World

Volume 10, Issue 1, Spring/Summer 2003

Fiduciary Ethics

Alfred I. Tauber
Pages 75-80

Autonomy Gone Mad

Medicine’s fundamental moral philosophy is the responsibility of caring for the ill, yet beneficence is not under the province of the law. Indeed, fiduciary responsibilities of doctors are limited. Instead, American law is preoccupied with protecting patient rights under the precept of patient autonomy, and contemporary medical ethics is dominated by these concerns. The extrapolation of autonomy rights from the political and judicial culture to medicine is, under ordinary circumstance, non-problematic. However, in instances of conflict, the dominance of autonomy reveals a hierarchy of values determining patient care. To illustrate the moral calculus of balancing competing principles, the ethical issues of involuntary treatment of psychotic patients are considered, and alternatives to the moral reasoning currently guiding the care of these individuals are offered to better solve the dilemma of respecting patient autonomy while still fulfilling the claims of physician responsibility.

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