Chapter 4 of the sixth edition of Beauchamp and Childress's Principles of Biomedical Ethics contains a lengthy, complicated, and comprehensive discussion of autonomy. The chapter is titled "Respect for Autonomy". This post, due to time constraints, will focus on the the authors's evaluation of coercion as an unjust form of influence invalidating the voluntary nature of an act.
The authors state that coercion "occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another." Of interest to libertarians, the footnote to this definition lists Robert Nozick as one of two influences. This definition is wrong however. Harm cannot be added successfully to the definition of coercion. For example, it is harmful for my business if a similar business opens across the street and outcompetes my business for customers so revenue for my business decreases. But this is not an example of coercion, for the use of term coercion is limited to UNJUST forms of influence. Harm, as illustrated in my example, is not unjust. Later in the chapter the authors claim that coercion is "occasionally justified-infrequently in medicine, more often in public health, and even more often in law enforcement." Specific examples are not provided, so it is not possible for the LIBERTARIAN BIOETHICS BLOGger to critique this controversial statement. Finally, the authors classify "rewards, offers, and encouragement" as forms of manipulation rather than forms of coercion (labeling monetary rewards as coercion is a classic tactic utilized by statists to argue against offering money to patients as an inducement to participate in clinical trials). The authors define manipulation (without mentioning the negative connotations of the word) as "swaying people to do what the manipulator wants by means other than coercion or persuasion." The authors oppose coercion and manipulation but support persuasion. Logically, the authors must then believe that patients unjustly "manipulate" doctors by offering money to doctors as an inducement to provide healthcare. The absurdity of this idea is self-evident.
Disclosure, informed consent, and surrogate decision making are other important chapter 4 topics I shall discuss in a future blog post.
The authors state that coercion "occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another." Of interest to libertarians, the footnote to this definition lists Robert Nozick as one of two influences. This definition is wrong however. Harm cannot be added successfully to the definition of coercion. For example, it is harmful for my business if a similar business opens across the street and outcompetes my business for customers so revenue for my business decreases. But this is not an example of coercion, for the use of term coercion is limited to UNJUST forms of influence. Harm, as illustrated in my example, is not unjust. Later in the chapter the authors claim that coercion is "occasionally justified-infrequently in medicine, more often in public health, and even more often in law enforcement." Specific examples are not provided, so it is not possible for the LIBERTARIAN BIOETHICS BLOGger to critique this controversial statement. Finally, the authors classify "rewards, offers, and encouragement" as forms of manipulation rather than forms of coercion (labeling monetary rewards as coercion is a classic tactic utilized by statists to argue against offering money to patients as an inducement to participate in clinical trials). The authors define manipulation (without mentioning the negative connotations of the word) as "swaying people to do what the manipulator wants by means other than coercion or persuasion." The authors oppose coercion and manipulation but support persuasion. Logically, the authors must then believe that patients unjustly "manipulate" doctors by offering money to doctors as an inducement to provide healthcare. The absurdity of this idea is self-evident.
Disclosure, informed consent, and surrogate decision making are other important chapter 4 topics I shall discuss in a future blog post.
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