Apple’s Steve Jobs, during his bout with islet cell tumor (or gasteroenteropancreatic neuroendocrine tumor [GEP-NET]), despite his intelligence and his access to the best advice and care anywhere in the world, made poor choices ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924574/#__ffn_sectitle ) which shortened his life.
As with Jobs, we have a right to irreversibly screw up our lives. This is one consequence of, even we’ll informed, autonomy.
However, Jobs made these choices, uncoerced, and as he had lived his life: forcing his will and his vision to achieve goals via what others had warned him were unwise choices during exceedingly difficult situations.
The question is how does such autonomy affect everyone else (family, friends, caregivers, neighbors, coworkers, citizens, the medical system, etc.), and how much of a burden does one person’s autonomy affect these other people (eg, Jobs used a scarce resource, an urgent liver transplantation, once it was found that his neoplasm had metastasized to that organ)?
We all have cognitive biases, fears, hopeful/magical thinking, and difficulties understanding all the nuances behind the statistics of applicable studies (let alone if these were well designed studies which produced useful results).
My hope is for us to work toward a definition of autonomy to mean: uncoerced (from external and internal sources), values-driven, well informed, evidence based personal choices and actions.
Charles Tadros, M.D.
July 14, 2022
Saint Louis, Missouri