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Who cares?
  1. Nikola Biller-Andorno
  1. Correspondence to Professor Nikola Biller-Andorno, Director, Institute of Biomedical Ethics, University of Zurich, Pestalozzistr 24, 8032 Zurich, Switzerland; biller-andorno{at}

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Liberalism is a big word in bioethics. It smacks of freedom—the freedom of patients from unwanted therapeutic interventions, the freedom of physicians to practice according to what they consider the state of the art, the freedom of society from unwanted regulation, everyone's freedom to form and pursue an individual idea of a good life.

So far so good. Yet sometimes ‘liberal’ positions are strikingly simplistic: using enhancers is ok as long as competent individuals consent to it; selling your organs is ok if that is what you want, and women wearing a burka and having their hymen repaired after premarital intercourse are just expressing their autonomy.

You do not have to be a sociologist to sense a part of the picture might be missing here. Usually we consider people from a certain age as competent to make decisions, unless there are good reasons to doubt that. Still, this does not mean there is nothing else to consider.

Autonomy is an ideal that is constantly being compromised in everyday life. We do not have quite the information we would need to make a …

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  • Competing interests None.

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

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