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Compulsory treatment: ask who the patient really is. A response to Mirko Garasic
  1. Charles Foster
  1. Correspondence to Dr Charles Foster, The Ethox Centre, Department of Public Health and Primary Care, University of Oxford, Badenoch Building, Old Road Campus, Oxford OX3 7LG, UK; Charles.Foster{at}

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It is wholly meaningless to say simply that one is ‘respecting autonomy’. Many questions have to be answered before the expression has any meaning. Those questions include: ‘Which account of autonomy are you using? Ideal desire? Best desire? Current desire? Relational autonomy? And so on’.1 ,2

Garasic's important contribution is to demonstrate that whether or not autonomy is being respected depends very much on what he calls the ‘bio-political’ context. There is some overlap (rather under-discussed in the book) between this contention and the contentions of the relational autonomists. He illustrates his thesis, (to my eye convincingly), by reference to five cases.

But I want to suggest that there is a more fundamental determinant of the meaning of respect for autonomy than ‘bio-political’ context. This is simply the identity of the person whose autonomy is being respected. One should ask in each case: ‘Who is the person in question?’3 That question encompasses the concerns of the various substantive accounts of autonomy, since it demands identification of the hat that the subject is wearing at the time that their autonomy is being considered. And it also acknowledges the ‘bio-political’ context, since we all modify our identities (or have them modified for us) according to the political milieux in …

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  • Competing interests I am the co-author with Mirko Garasic of one of the papers referred to by him in the book and in his precise of the book.

  • Provenance and peer review Commissioned; internally peer reviewed.

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