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UBC Theses and Dissertations

Autonomy and the infertility patient : exploring the limits of the criteria that identify autonomous decision making with regards to the female infertility patient Paton, Alexis Hannahson Collins


Autonomous decision making is the cornerstone of bioethics, as it respects every person's right to make decisions for themselves based on their own values and beliefs. Maintaining autonomy in medicine is especially important due to the long standing history of paternalism in medicine. Today best practice in medicine demands that competent patients be allowed to make autonomous decisions about their treatment. The criteria that we use to classify an individual as autonomous are crucial in medicine, where the validity of a patient's informed consent to receive treatment rests on whether they are recognized as autonomous. One area in which the classification of autonomy is most perplexing is that of infertility. The known causes of infertility are few, the number of effective diagnostic tests are limited and less than 50% of couples end up with a child. The uncertainty and limited prognosis mean that choices should be driven by personal preferences rather than paternalism. Due to the nature of infertility, the intricacies of its diagnosis and treatment as well as the heavy influence of social norms about femininity, infertile women may lose their identity as autonomous individuals, despite seeming to be autonomous in all other respects. While the traditional criteria for autonomy successfully identify those female infertility patients who are not autonomous, they give us no direction as to how to tackle the larger issue of societal influence on infertility patients. I will argue that a change in the theory used by medical professionals is necessary in order to address the concern of social influence on patient decision making. Instead we must replace the use of traditional autonomy by the medical institution as the paradigm with the theory of relational autonomy, since relational autonomy is the only theory that can properly account for societal influence on patients.

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