{"id":{"repo_id":"uwo","oai_identifier":"oai:uwo.scholaris.ca:20.500.14721/30843"},"canonical_url":"https://search.dev.ndltd.org/etd/uwo/oai:uwo.scholaris.ca:20.500.14721/30843","repository":{"repo_id":"uwo","name":"Western University","base_url":"https://uwo.scholaris.ca/server/oai/request"},"display":{"title":"Autonomy, Paternalism, and the Moral Foundations of the Fiduciary Relationship","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.","abstract_html":"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.","abstract_has_math":false,"creators":["Horn, Austin"],"institution":"The University of Western Ontario","degree_name":"Ph D","degree_level":null,"degree_discipline":"Philosophy","degree_department":null,"school":null,"contributors":[],"advisors":["McLeod, Carolyn"],"committee_chairs":[],"committee_members":[],"year":2021,"date_issued":"2021-01-08","date_published":"2021-01-08","updated_at":"2026-07-27T21:56:18Z","subjects":["Fiduciary Relationship","Bioethics","Healthcare Ethics","Physician-Patient Relationship","Research Ethics","Clinical Trials"],"languages":["en_ca"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/20.500.14721/30843","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["McLeod, Carolyn"]},{"key":"dc:creator","label":"Author","values":["Horn, Austin"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-07-10T18:46:15Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-07-10T18:46:15Z"]},{"key":"dc:date.issued","label":"Date","values":["2021-01-08"]},{"key":"dc:publisher","label":"Institution","values":["The University of Western Ontario"]},{"key":"dc:type","label":"Dc Type","values":["thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Philosophy"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph D"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Fiduciary Relationship","Bioethics","Healthcare Ethics","Physician-Patient Relationship","Research Ethics","Clinical Trials"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en_ca"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/20.500.14721/30843"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). Western University Open Repository. https://doi.org/10.71858/123456."]},{"key":"dc:description.abstract","label":"Abstract","values":["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."]},{"key":"dc:title","label":"Title","values":["Autonomy, Paternalism, and the Moral Foundations of the Fiduciary Relationship"]}]}],"canonical_facts":{"dc:contributor.advisor":["McLeod, Carolyn"],"dc:creator":["Horn, Austin"],"dc:date.accessioned":["2025-07-10T18:46:15Z"],"dc:date.available":["2025-07-10T18:46:15Z"],"dc:date.issued":["2021-01-08"],"dc:description":["The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). 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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. 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