Document Type


Publication Date



This article considers the problem of line-drawing between autonomy-preserving and autonomy-negating influence in clinical relationships. The author’s purpose is not to propose particular boundaries, either with respect to reproductive decisions by HIV-infected women or for other clinical choices. Rather, he attempts to shed some light on what drives our disputes about whether one or another influence method is compatible with autonomous choice.

The author argues that such disagreements reflect underlying conflicts between normative commitments, and that resolving these conflicts is essential to settling controversies over whether particular influences unduly interfere with autonomous choice. Alternative understandings of the prerequisites for autonomous choice are informed by differing normative visions. Although the ideal of a unified conception of autonomy has broad appeal, in practice we live with multiple understandings. Typically, this presents few problems; each governs within its own sphere of clinical or other activity. Indeed, it may be that illusory belief in autonomy as a unified concept, analytically separable from competing normative visions, facilitates the tranquil coexistence of contrary ideas about the scope of personal responsibility.

Yet at times, differing understandings of autonomous choice collide. The counseling of HIV-infected women about their reproductive options represents an example. When this happens, underlying normative commitments should be candidly explored, with an eye toward the clarification of differences and the discovery of possibilities for accommodation. The author concludes by briefly considering how such exploration might proceed with respect to clinical counseling and reproductive choices by HIV-infected women. Unless we probe beneath the notion of autonomy to its normative foundations, our arguments about autonomy-negating influence are likely to be bitter and fruitless, especially in such painful contexts as the AIDS epidemic.

Publication Citation

6 Health Matrix 229-304 (1996)