J Med Ethics doi:10.1136/medethics-2011-100207
  • Feature article

Forced to be free? Increasing patient autonomy by constraining it

Open Access
  1. Neil Levy
  1. Correspondence to Associate Professor Neil Levy, Florey Neuroscience Institutes, Royal Parade, The University of Melbourne, Parkville, Victoria 3010, Australia; nllevy{at}
  1. Contributors NL is the sole author of this paper and conducted all research leading up to it.

  • Received 30 August 2011
  • Revised 18 October 2011
  • Accepted 16 December 2011
  • Published Online First 8 February 2012


It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted.


  • Oxford Centre for Neuroethics, Suite 8, Littlegate House, 16/17 St Ebbes St, OX1 1PT, UK.

  • Funding Australian Research Council.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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