Hypothetical approval in prudence and medicine

We often assume that hypothetical approval - either in the form of preferences or consent - under ideal conditions adds to the legitimacy of an arrangement or act. I want to show that this assumption, reasonable as it may seem, will also give rise to ethical problems. I focus on three problem areas: prudence, euthanasia and coercive psychiatric treatment. If we are to count as prudentially or morally relevant those preferences you would have if you were informed and rational, we will run into difficulties in all these areas if your actual and rational preferences are at variance with each other. In the prudential sphere we may question the personal value of satisfying preferences that a person does not actually have. In this case our problem concerns the point of satisfying a rational preference in conflict with an actual one. In the cases of euthanasia and coercive care it concerns instead whether it would be morally right to do such a thing. I doubt there is a simple solution to our problem. In this paper at most I prepare the way for a solution or for wiser decisions in the hard cases, by pointing out what they will have to deal with. © Springer Science+Business Media, LLC 2006.