Freedom as Non-Domination Hunter July 2015


 Past Event:

Freedom as Non-Domination:

Political Threats to Informed Consent and Patient Autonomy.

Speaker: Dr David Hunter,

Associate Professor of Medical Ethics, Flinders University, Australia.

18.00, Tuesday the 21st of July 2015.

Old Staff Common Room [Map – .pdf].

Lanyon Building. Queen’s University Belfast.

The seminar is free but registration is encouraged, please email us at:

Seminar Flyer [.pdf]


Respect for autonomy has come to be taken as if not perhaps the only value in biomedical ethics certainly a very central and important one. Based on respect for autonomy informed consent is an essential element of medical practice and hence a number of threats to informed consent and autonomy typically ought to be avoided and negated. Threats include an absence of information, coercion and incompetence. In response to these we typically specify the sort of information that patients should have, that their decision is free from certain forms of coercion and their competency assured. In this paper drawing on recent work in political philosophy I will suggest a new threat to the validity of informed consent – what Philip Pettit refers to as domination. You are dominated not when someone interferes with you against your will, but instead when someone is in the position to arbitrarily interfere with you without significant consequence. I will further suggest that this is a more pervasive and insidious threat to informed consent than coercion, a lack of information and incompetence, since patients are naturally in a vulnerable position, medical organisations tend to be disempowering and there are significant power imbalances between medical professionals and patients. Furthermore, combatting domination in a medical setting might have negative consequences, undermining the care effect and organisational efficiency. As such I will suggest that rather than trying to remove domination entirely we instead recognise that patients are not free rational autonomous atomistic individuals choosing for themselves in accordance with their higher values in a vacuum and instead recognise that they are weak, vulnerable and in need of support in decision making. This is not to say that they should not be central decision makers regarding their own care, however it recognises that abandoning them to make medical decisions on their own fails to respect the position they are actually in.


David Hunter is a philosopher who presently teaches medical ethics in the School of Medicine at Flinders University in Adelaide, South Australia. He has previously taught at University of Birmingham, Keele University and the University of Ulster. His research interests are many and varied, but he focuses on areas where political philosophy is relevant to applied ethics, such as resource allocation, research ethics and ethical challenges raised by new technologies.