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The notion of free will and its ethical relevance for decision-making capacity


Zürcher, Tobias; Elger, Bernice; Trachsel, Manuel (2019). The notion of free will and its ethical relevance for decision-making capacity. BMC Medical Ethics, 20:31.

Abstract

Background: Obtaining informed consent from patients is a moral and legal duty and, thus, a key legitimation for
medical treatment. The pivotal prerequisite for valid informed consent is decision-making capacity of the patient.
Related to the question of whether and when consent should be morally and legally valid, there has been a longlasting
philosophical debate about freedom of will and the connection of freedom and responsibility.
Main text: The scholarly discussion on decision-making capacity and its clinical evaluation does not sufficiently take
into account this fundamental debate. It is contended that the notion of free will must be reflected when evaluating
decision-making capacity. Namely, it should be included as a part of the appreciation-criterion for decision-making
capacity. The argumentation is mainly drawn on the compatibilism of Harry Frankfurt.
Conclusions: A solution is proposed which at the same time takes the notion of free will seriously and enriches the
traditional understanding of decision-making capacity, strengthening its justificatory force while remaining clinically
applicable.
Keywords: Informed consent, Decision-making capacity, Competence, Ethics, Free will, Autonomy, Authenticity,
Compatibilism, Harry Frankfurt

Abstract

Background: Obtaining informed consent from patients is a moral and legal duty and, thus, a key legitimation for
medical treatment. The pivotal prerequisite for valid informed consent is decision-making capacity of the patient.
Related to the question of whether and when consent should be morally and legally valid, there has been a longlasting
philosophical debate about freedom of will and the connection of freedom and responsibility.
Main text: The scholarly discussion on decision-making capacity and its clinical evaluation does not sufficiently take
into account this fundamental debate. It is contended that the notion of free will must be reflected when evaluating
decision-making capacity. Namely, it should be included as a part of the appreciation-criterion for decision-making
capacity. The argumentation is mainly drawn on the compatibilism of Harry Frankfurt.
Conclusions: A solution is proposed which at the same time takes the notion of free will seriously and enriches the
traditional understanding of decision-making capacity, strengthening its justificatory force while remaining clinically
applicable.
Keywords: Informed consent, Decision-making capacity, Competence, Ethics, Free will, Autonomy, Authenticity,
Compatibilism, Harry Frankfurt

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Issues, Ethics and Legal Aspects
Social Sciences & Humanities > Health (social science)
Health Sciences > Health Policy
Language:English
Date:8 May 2019
Deposited On:15 Nov 2019 15:22
Last Modified:22 Apr 2020 21:32
Publisher:BioMed Central
ISSN:1472-6939
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s12910-019-0371-0
PubMed ID:31068168

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