Value-freedom & patient autonomy

A longstanding debate in philosophy of medicine-whether disease concepts are value-free (naturalism) or value-laden (normativism)-intersects with broader discussions about patient autonomy and the move away from paternalistic practices. An important argument supporting naturalism is the idea that value-freedom is necessary to protect patient autonomy. This paper challenges that view, arguing that autonomy does not require value-freedom. We first demonstrate that prominent theories of personal autonomy do not demand value-freedom but rather a responsible way of dealing with normative judgements. Drawing on parallels to debates on values in science, we distill three strategies for managing non-epistemic values responsibly: transparency, value diversity, and prioritization of appropriate values. Applying these strategies to medicine, we illustrate how value-ladenness can align with patient autonomy when managed appropriately.