In the beginning of this article, the topic of autonomy was dissected. He directly reasons against Beauchamp and Childress’ definition of autonomy. Ackerman describes the two conditions in which a person is fully autonomous, when: 1)”behavior is governed by plans of actions that have been deliberated through deliberation or reflection” and 2) the behavior “intentionally and voluntarily” stems from a person’s life plans.  And with these qualifications of an autonomous person, Ackerman thus argues that illness causes the affected person to not achieve these requirements. He posits that illness, both physical mental, causes a person to make biased decisions that do not reflect full autonomy.

However, I feel that this argument contains many flaws. One being that the question of autonomy is very prevalent for those who suffer from illness.In an example, a man ‘irresponsibly’ chooses to not have life-saving neurosurgery because of the “cosmetic affects” and “possibility of neurological damage.” The critique is that the illness caused irrational thought-processes to occur and the person makes a decision that they would have made without the illness.  I further contest that argument as another one of his reasonings to why illness dissolves autonomy, is that it makes a person decide that they hadn’t otherwise. He gives the example of the woman with continuous diagnoses of cancer refusing treatment after her last diagnosis. The claim was that “it was unlike her” to refuse treatment as she has not refused before. It was due to her depression that make this “new” decision for her, according to Ackerman. However, you can only judge who a person is by their reality, and their reality is being ill. To say that the woman would not have refused treatment if she were not depressed is too speculative to remove her status as an autonomous being. As a person potentially undergoing treatment, she has the right to decide if she should go through another round. Specifically this woman has suffered many bout of cancer, and has had treatment help her but only for her to become sick again. And due to her complications this time, her willingness may be decreasing . Not directly due to her newly-developed depression. Also you can’t judge a person’s choice simply on what she has agreed to before. In that case, what is the point of asking consent for treatment for a chronically ill-person?

To say that people who are suffering from something do not posses autonomy is also problematic, as this would lead to doctors or individuals close to the “ill person” to have more say in treatment (or lack thereof) for the individual. Ackerman continues to pose that noninterference is the not the best mode of action for doctors, and should not be acted on. He says that because an ill person lacks autonomy, the doctor must have a role in decision making. Because of the doctor’s expertise, his/her opinion should definitely be taken to account. However, they should only have a firm role in decision of treatment, if the person’s autonomy and abilities are greatly diminished or existent. As long a person’s decision to undergo treatment or not does not harm another, their choices should be respected. As blurring the lines of medical consent and status of autonomy can cause a slippery slope in how people and their illnesses are approached by medical professionals. This can cause exploitation and harm to those vulnerable populations that may not have the ability to directly/properly contest a doctor’s opinion/recommendation.

References:

Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001.

Paterick, Timothy J., Geoff V. Carson, Marjorie C. Allen, and Timothy E. Paterick. “Medical Informed Consent: General Considerations for Physicians.” Mayo Clinic Proceedings 83.3 (2008): 313-19.