Autonomy, Paternalism, and the Moral Foundations of the Fiduciary Relationship

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.

Name thesis:degree_name

Ph D

Discipline thesis:degree_discipline

Philosophy

Grantor dc:publisher

The University of Western Ontario

Year dc:date.issued

2021

Author dc:creator

• Horn, Austin

Advisor dc:contributor.advisor

• McLeod, Carolyn

• Fiduciary Relationship
• Bioethics
• Healthcare Ethics
• Physician-Patient Relationship
• Research Ethics
• Clinical Trials

Language dc:language.iso

en_ca

Handle dc:identifier.uri

https://hdl.handle.net/20.500.14721/30843

OAI identifier oai:identifier

oai:uwo.scholaris.ca:20.500.14721/30843