Abstract

According to Gawande, Lazaroff “chose badly.” Gawande suggests that physicians may be permitted to intervene in choices of this kind. What makes the temptation to intervene paternalistically in this and similar cases especially strong is that the patient’s choice contradicts his professed values. Paternalism appears less problematic in such cases because, in contradicting his values, the patient seems to sidestep his own autonomy. This chapter addresses the dangers of overextending this interpretation. I argue that it is not so easy to judge when a person is not genuinely exercising autonomy, and that choosing contrary to one’s own values does not necessarily amount to sidestepping one’s autonomy. The key insight is to recognize the importance of the attitude of caring as an integral part of some expressions of autonomy. This will allow us to develop an alternative picture of minimal autonomy, according to which it is possible to choose against one’s values while genuinely exercising autonomy. For practical purposes, in medicine and elsewhere, this means that, in cases like Lazaroff’s, those tempted toward paternalism must exercise particular caution before they deem a choice to be disen- gaged from autonomy: even if a choice contradicts the person’s own values, it might be rooted in caring, and then, despite initial appearances to the contrary, it may still command the highest level of protection against paternalism.