• Ethics

Mirko Garasic's book investigates the principle of autonomy and, in an oblique way, joins the chorus of voices disenchanted with the tyranny of autonomy. I say oblique because he does not simply reorder the four famous principles of bioethics by trying to knock respect for autonomy from its pedestal, but employs a number of practical cases to demonstrate what I, not he, might call the abuse or misuse of autonomy. Apart from its rarefied formulations by Kant and, to a lesser extent Mill, autonomy has distinct social and political dimensions that shape its outsized role in bioethical deliberations. This is not a new argument but Garasic puts the case much more bluntly: the bioethical and medical community respect autonomy when it enhances their power, and disrespect autonomy when it diminishes their power. These claims appear early on but are most pronounced in the last two chapters of the book devoted to the dilemmas of force-feeding hunger strikers.

In a compelling fourth chapter, Garasic juxtaposes the Dax case (where medical authorities disrespected his autonomy not only to save his live but because he was, presumably, a compatriot) and the case of …