If desires and character are themselves determined by prior causes beyond the agent's control, the distinction between 'internal' and 'external' determination becomes merely verbal.

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Determined(describing whether your internal states themselves are forced by previous causes): Completely caused by prior events and conditions, so that given those exact circumstances, the outcome couldn't have been any different.
External determination(as used in debates about free will): When outside forces (other people, circumstances, or physical laws) control your actions instead of you choosing freely.
Prior causes(as contrasted with the agent's will): Events or conditions that happened before an action and might have influenced it, like someone's upbringing, genetics, or circumstances beyond their control.
agent(Economics terminology applied to medical ethics): The party in a principal-agent relationship who is instructed to produce the good or service on the principal's behalf — in the medical context, the doctor

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