Autonomy in the medico-legal courtroom: a principle fit for purpose?

This article examines the way that the principle of autonomy is handled in (mostly English) law. The law pays loud lip-service to autonomy, saying that it is the governing principle in many areas. This is particularly true for cases involving bioethics. The courts are rarely philosophically explicit about which account of autonomy is favoured, but three accounts (Millian self-determination, Kantian deontology, and relational autonomy-in which the social nexus of the subject is explicitly recognised) can be identified. Despite the law's traditional rhetorical insistence that autonomy rules absolutely, that rule is, in practice, unworkable. Other principles, such as beneficence and dignity, have to be drafted in to help. Much of the philosophical work that autonomy should do in the law is delegated to the notion of capacity, but that notion too is insufficiently examined by the courts, and is problematic.