Is a partially informed choice less autonomous?: a probabilistic account for autonomous choice and information

Abstract

Abstract The standard account for the role of information in patients’ consent decisions was provided by Faden and Beauchamp. According to this account, in order to make a substantially autonomous choice, a patient needs to receive and understand all the information material to the choice. But the scope of material information is controversial, and it is difficult to determine whether a choice based on partial information is substantially autonomous or not. In order to solve the problem, this paper tries to use “autonomy-undermining ignorance” to capture Faden and Beauchamp’s view of how ignorance undermines autonomous decision-making. It is believed that autonomy-undermining ignorance is key to understanding the relationship between autonomous choices and information in the clinical context. A probabilistic account of this relationship is presented. According to this account, one’s choice can be regarded as substantially autonomous as long as one minimizes the risk of autonomy-undermining ignorance (provided that other conditions of autonomous choice are satisfied). In order to do this, one needs to receive and understand as much accessible information as possible that is likely to be material to a particular choice. This means that sometimes one’s choice based on partial information can also be regarded as substantially autonomous. The practical implication of the probabilistic account is that it allows patients to reasonably choose the information needed for autonomous decision-making in light of a specific situation, rather than invariably requiring them to receive and understand sufficient information to make a consent decision in the clinical context.