The neurocognitive basis of compromised autonomy after traumatic brain injury: clinical and ethical considerations

It is widely accepted, based on the principle of respect for autonomy, that there are ethical constraints on the range of tactics that persons may use to influence the decisions and behaviors of others. However, accurate ascriptions of autonomy to either persons or acts may vary considerably, depending on properties of the person, the situation, or both. Traumatic brain injury affects cognitive domains that are critical for the effective exercise of autonomy, and so offers a context for further examination of this variability. Analysis of the neuropathology of traumatic brain injury and its neurocognitive consequences provides a foundation for understanding cases in which autonomy is compromised even though legal competency may be preserved. Respecting autonomy in these cases is not always straightforward; it may entail both special ethical obligations and consideration of tactics that would not be morally permissible under other circumstances.