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Authenticity in Bioethics: Bridging the Gap between Theory and Practice

Jesper Ahlin Marceta has analysed whether it is possible to reliably determine that a patient expresses inauthentic wishes and if a healthcare decision should be overridden for paternalist reasons if it can be determined as inauthentic.
Hopefully, the results can benefit patients suffering from medical conditions that affect their decision-making processes.

Jesper Ahlin Marceta (Photo:

What is the topic of your Doctoral Thesis?

The topic of my thesis concerns personal autonomy, which is a moral concept. Being autonomous is to be governed by one’s own powers and not by any other influence. It is usually viewed as a valuable condition to be in. In my thesis, I have analyzed the concept of authenticity, which is sometimes treated as an element of autonomy, and how it may be practically relevant in biomedicine. In this context, being authentic means being genuine, real, true to oneself, or similar. Among other things, the notion has been discussed by psychiatrists and philosophers in cases where there is a suspicion that a patient’s healthcare decisions are non-autonomous for authenticity-related reasons. One paradigm example is a person suffering from anorexia nervosa who states that she would rather die than gain weight. Both theorists and practitioners have asked whether such wishes can be judged to be inauthentic.

Why did you choose this topic?

Autonomy is an important moral concept in liberal societies in general, and in biomedical contexts in particular. With a background in practical philosophy, I found the paradigm example with the anorexia nervosa patient intriguing; can it be reliably determined whether a patient expresses inauthentic wishes? Should a healthcare decision be overridden for paternalist reasons if it is inauthentic? What is the relationship between the notions of authenticity and, for instance, decision-making competence? Can theoretical ideals of authenticity be made practically useful in this context?

What are the most important results?

As far as I know, my thesis is the first comprehensive analysis of authenticity in this context and philosophical tradition. The dominating view among bioethicists in this tradition have been that although authenticity may be important, it is an element of the decision-making process of patients that is unavailable for critical scrutiny. My thesis challenges this view. I argue that under certain conditions, and given the truth or reasonableness of one particular theory of authenticity, the authenticity of a patient’s decisions can be reliably determined. I incorporate this proposition into a conceptualization of personal autonomy which makes the complete account practically useful in healthcare.

Did you come across something unexpected during your thesis research?

Yes, to the best of my knowledge there have not been any real attempts to make the theoretical notion of authenticity practically useful before. Researchers with various theoretical backgrounds have noted that the notion of authenticity is difficult to put into practice, but they have all settled with noting this difficulty and not explored it in greater detail. Why, more precisely, is it difficult to observe authenticity in others? What could be done about it?

Who will benefit from your results?

Hopefully, this can help some people suffering from medical conditions that affect their decision-making processes.

What kind the impact may it have on surrounding society?

In addition to its immediate practical usefulness in healthcare, I hope that my thesis is a valuable contribution to the philosophical conversation on personal autonomy. By extension, the arguments in it could spill over to the wider discussion of how personal autonomy can be furthered in society at large. It may be the case that the notion of authenticity can be applied in research in, for instance, psychology, economics, and sociology, to explain or even predict individual decision-making. Perhaps there are political means available that could further personal autonomy in ways that we have not yet realized.

What will you do next?

I am fully funded until June 2020 and will continue doing research at KTH until then.

Jesper Ahlin Marceta defended the doctoral thesis Authenticity in Bioethics: Bridging the Gap between Theory and Practice in June 2019 in the subject Philosophy.

Belongs to: School of Architecture and the Built Environment (ABE)
Last changed: Jul 08, 2019