The Principle of Autonomy and the Ethics of Advance Directives

Advance directives are conceptualised as a means of increasing "patient autonomy", as they enforce individuals' power of choice over a post-competence dying process. There is, however, controversy over their moral force. Rebecca Dresser and John Robertson offer a conceptual argument grounded in epistemological considerations concerning personhood which challenges their authority. Roland Dworkin defends forcefully "precedent autonomy" in planning post-competence medical care. This paper examines the above opposing theses and assesses their main arguments. Limitations are detected in both. Regarding the former, its conceptualisation of the notion of personhood is found to be problematic, and regarding the latter, its conception of individual autonomy is found to be too narrow. An alternative route is explored by reconstructing Kant's conception of moral autonomy. It provides a framework for moral reasoning, from which certain contemporary understandings of autonomy as a right, as a reflective capacity of the individual, as responsibility and integrity can be properly assessed and justified. Normative conclusions follow regarding the extension of personal autonomy in advance medical choice.