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

AuthorRachel O'Sullivan
PositionBCL (International) IV, University College Cork
Pages7-21
[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 IR 79 (SC) (Re a Ward of Court). Furthermore, it is also protected under Article 8 of
the European Convention on Human Rights.

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