"Autonomy, Paternalism, and the Moral Foundations of the Fiduciary Relationship" by Austin Horn
Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Philosophy

Supervisor

McLeod, Carolyn

Abstract

The fiduciary relationship is a legal relationship that describes those interactions in which one party is entrusted to exercise discretionary power on behalf of another’s interests. In recent years, the fiduciary relationship proven to be a powerful tool for providing clarity to complex bioethical issues. But the exciting promise of the fiduciary relationship for bioethical analysis is threatened by at least two conceptual problems: moral-legal equivocation and paternalism. Legal-moral equivocation refers to the problem of assuming that the normative demands of a legal relationship are also morally normative. The cogent use of the fiduciary relationship in bioethical analysis requires some justification as to why the fiduciary obligation is a moral obligation. Paternalism refers to the worry that the fiduciary relationship is paternalistic and thus an inappropriate model for the healthcare professional-patient relationship, with its ethos of promoting patient autonomy. Chapter 1 addresses the problem of equivocation by arguing that the fiduciary relationship is a moral relationship, fostering social harmony by enabling individuals to trust or depend on one another in those interactions where one undertakes to act on another’s behalf. Chapter 2 addresses the problem of paternalism, arguing that the fiduciary relationship is essentially autonomy promoting; adopting a relational theory of autonomy, I argue that fiduciary power is “relational capacity” that makes certain autonomous ends possible. In Chapter 3, I illustrate the practical utility of the fiduciary relationship by using it as a framework for conceptualizing and addressing the ethical issues in a controversial clinical trial, known as the SUPPORT trial.

Summary for Lay Audience

The fiduciary relationship is a legal relationship that describes those interactions in which one party is entrusted to exercise discretionary power on behalf of another’s interests. In recent years, the fiduciary relationship proven to be a powerful tool for providing clarity to complex bioethical issues. But the exciting promise of the fiduciary relationship for bioethical analysis is threatened by at least two conceptual problems: moral-legal equivocation and paternalism. Legal-moral equivocation refers to the problem of assuming that the normative demands of a legal relationship are also morally normative. The cogent use of the fiduciary relationship in bioethical analysis requires some justification as to why the fiduciary obligation is a moral obligation. Paternalism refers to the worry that the fiduciary relationship is paternalistic and thus an inappropriate model for the healthcare professional-patient relationship, with its ethos of promoting patient autonomy. Chapter 1 addresses the problem of equivocation by arguing that the fiduciary relationship is a moral relationship, fostering social harmony by enabling individuals to trust or depend on one another in those interactions where one undertakes to act on another’s behalf. Chapter 2 addresses the problem of paternalism, arguing that the fiduciary relationship is essentially autonomy promoting; adopting a relational theory of autonomy, I argue that fiduciary power is “relational capacity” that makes certain autonomous ends possible. In Chapter 3, I illustrate the practical utility of the fiduciary relationship by using it as a framework for conceptualizing and addressing the ethical issues in a controversial clinical trial, known as the SUPPORT trial.

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