Article Text

Download PDFPDF
Formal and effective autonomy in healthcare
  1. A P Schwab
  1. Correspondence to:
 Abraham P Schwab
 Department of Philosophy, Brooklyn College, 2900 Bedford Ave, Brooklyn, NY 11210, USA; ASchwab{at}


This essay lays the groundwork for a novel conception of autonomy that may be called “effective autonomy”—a conception designed to be genuinely action guiding in bioethics. As empirical psychology research on the heuristics and biases approach shows, decision making commonly fails to correspond to people’s desires because of the biases arising from bounded cognition. People who are classified as autonomous on contemporary philosophical accounts may fail to be effectively autonomous because their decisions are uncoupled from their autonomous desires. Accordingly, continuing attempts to value patient autonomy must go beyond existing philosophical conceptions of autonomy to consider the background conditions of human decision making.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • i Berg et al12 provide (or attempt to provide) “a comprehensive introduction to the theory and practice of informed consent” for practicing clinicians and, yet, they never mention the psychology of decision making.

  • Competing interests: None.