Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in the late stages of Alzheimer’s disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called ‘marginal agents,’ which include young children and patients in the middle stages of Alzheimer’s disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of ‘pre-forms’ of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions – namely, they express the value of autonomy. As I will argue, autonomy is a value worthy of protection and promotion – even in its non-reflexive forms. Against this background, it becomes clear why we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients.

患者通常被授予自主权，包括同意或拒绝治疗的权利。如果患者满足某些条件，这些权利通常归于患者。例如，患者在做出治疗决定之前必须充分理解提供给他们的信息。一方面，有一大群符合这些条件的患者。另一方面，有一群人显然不符合这些条件，包括昏迷患者或阿尔茨海默病晚期患者。然后还有一群患者，他们属于这两者之间的范围。在这个范围的低端是所谓的“边际代理人”，其中包括年幼的儿童和处于阿尔茨海默病中期的患者。他们也不符合自治的典型要求，这就是为什么他们通常被授予较少的自主权。然而，他们中的一些人能够“预先形成”自主性，表达对他们来说重要的东西。这些预制形式不同于纯粹的欲望，反映了自主性的身份/真实性条件。它们与自主的态度、选择和行动有一些共同点——即，它们表达了自主权的价值。正如我将要论证的那样，自治是一种值得保护和促进的价值——即使是在其非反身形式下也是如此。在这种背景下，为什么我们对边缘代理人有自主责任，更准确地说是积极的、自主的责任，以及为什么我们应该像对有能力的病人的自主责任一样重视他们。