Onora O’Neill on autonomy and trust 

A century ago, medicine was straightforwardly paternalistic.

Problem: Fear that weaker party has heightened risks.

Proposed solution: An agreement between equals with patient autonomy as a precondition of client trust in professional judgment.

1947 Nuremberg Code stipulates that consent must be “voluntary, competent, informed, and comprehending.” (More elaborate than Mohr v. Williams, 1905)

IN PRACTICE, we have reduced the idea of autonomy into the simpler process of informed consent (giving consent a minimal interpretation).

Our legalistic emphasis focuses on minimal standards for what the professional must do, and simply assumes a corresponding liberty of the client to accept or refuse what is offered. Instead of an agreement between equals, we have “professional strangers” who receive consent.


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Last updated May 16, 2008