Precedent autonomy and subsequent consent

Ethical Theory Moral Pract. 2004 Jun;7(3):267-91. doi: 10.1023/b:etta.0000042908.13784.00.


Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her "precedent autonomy" by giving her what she used to want? There is a similar problem with "subsequent consent": How can we justify interfering with someone's autonomy on the grounds that she will later consent to the interference, if she refuses now? Both problems arise on the assumption that, to respect one's autonomy, any preferences we respect must be among that person's current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone's wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy, we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference.

MeSH terms

  • Advance Directive Adherence / ethics*
  • Humans
  • Informed Consent / ethics*
  • Living Wills / ethics*
  • Mental Competency
  • Paternalism / ethics
  • Personal Autonomy*
  • Philosophy, Medical*
  • Time Factors