Cambridge Quarterly of Healthcare Ethics


Response to “Advance Directives and Voluntary Slavery” by Christopher Tollefsen (CQ Vol 7, No 4)

(Slavery, Commitment, and Choice: Do Advance Directives Reflect Autonomy?)

Thomas  May a1
a1 Clinical Ethics Center at Memorial Medical Center, Springfield, Illinois, and the Department of Medical Humanities, Southern Illinois University School of Medicine, Springfield


In an interesting response to an article I published in CQ that questions the ability of advance directives to reflect autonomy, Christopher Tollefsen raises a number of issues that deserve greater attention. Tollefsen offers several examples to illustrate how the critique of advance directives I offer would also threaten other choices that most people would consider autonomous. Importantly, I largely agree that the examples Tollefsen offers should be captured as autonomous. Where I disagree, however, is whether these examples reflect the particular type of second order decision strategy that I categorize advance directives as, and so whether the critique of advance directives I offer, if accepted, would commit us to an unreasonably narrow conception of autonomy.