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Kious BM. J Med Ethics 2016;42: 769–775

The title of this EXTENDED ESSAY is at the heart of this discourse; on one hand respect for a person's autonomy but on the other hand this has to be balanced with the extent a person can decide that which is good. The commentator recounts the care of a person who elected not to take insulin, despite suffering from recurrent abscesses and peripheral neuropathy. It was unacceptable to force this medication into her as she had rejected this choice. The essayist, who works in a department of psychiatry, had respected this person's autonomy. The concept of 'agent-constitution of the good' or 'agent-constitution' for short, is then examined. Agent-constitution encapsulates the person's desires, goals, preferences and values. Such an approach may seem appealing as it is both links respect for autonomy and an action based on a decision that would appear to be well-informed, voluntary and rational. But could such be based on a false premise. Peoples' choices may be mistaken or distorted as their desires, preferences and values could be distorted. But then if it is a private decision for that person, could this be permissible? It is asserted a decision is only private if its effects are relatively less important for others, than its effects on the agent (person). The waters are muddied further when competing priorities are considered.