The Patient's Duties to others: Limitations to the Principle of Autonomy in Healthcare Decision Making

• Author: Rachel O'Sullivan
• Position: BCL (International) IV, University College Cork
• Pages: 7-21

[2015] COLR

7

THE PATIENT’S DUTIES TO OTHERS: LIMITATIONS TO THE PRINCIPLE OF

AUTONOMY IN HEALTHCARE DECISION MAKING

Rachel O’Sullivan*

A INTRODUCTION

While autonomy may be accepted as the primary governing principle in medical law and

ethics, the limitations on adherence to this pre-eminent principle are subject to debate. A

fundamental yet unresolved question involves an assessment of the restrictions placed on

autonomous medical choices by reference to duties to others. Such third-party constraints

may arise by virtue of distinct duties owing to identifiable individuals such as those arising

by virtue of a familial relationship. Alternately, restrictions may be placed on one’s medical

autonomy by reference to the interests of society as a whole. While Irish law does not provide

a defined answer to this complex ethical and legal discussion, it is submitted that while one

may morally conclude that such duties to others ought to limit autonomous healthcare

choices, their application through the law poses substantial difficulties. In seeking to

implement moral duties on a legal plane difficult questions arise as to the extent the law

ought to intervene in private decision making processes, or rather more fundamentally when a

decision transcends the private realm to acquire a public characterisation. Legalisation thus

threatens an erosion of autonomy with the re-emergence of medical, or perhaps more

accurately, moral paternalism.

B AUTONOMY AS AN ETHICAL PRINCIPLE

The right to self-determination is firmly embedded in Irish law.

1

However, this legal

recognition is influenced and dependent on its presence as a fundamental ethical principle.

*BCL (International) IV, University College Cork.

1

It has a co nstitutional and common law basis as recognised in Re a Ward of Court (refusal of medical

treatment) (No. 2) [1996] 2 IR79 (SC) (Re a Ward of Court). Furthermore, it is also protected under Article 8 of

the European Convention onHuman Rights.