David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Journal of Medical Ethics 31 (3):127-130 (2005)
Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors
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Citations of this work BETA
A. Ravelingien, J. Braeckman, L. Crevits, D. De Ridder & E. Mortier (2009). 'Cosmetic Neurology' and the Moral Complicity Argument. Neuroethics 2 (3):151-162.
Antoine Carlioz, Joseph G. Wolyniak & Pierre Coz (2012). Is There Such a Thing as Latin Bioethics? Medicine, Health Care and Philosophy 15 (4):461-467.
Giles Birchley (2013). Doctor? Who? Nurses, Patient's Best Interests and Treatment Withdrawal: When No Doctor is Available, Should Nurses Withdraw Treatment From Patients? Nursing Philosophy 14 (2):96-108.
Dr Phil Lara Huber (2006). Patientenautonomie als nichtidealisierte „natürliche Autonomie“. Ethik in der Medizin 18 (2):133-147.
Yin-Yang Lee & Julia L. Lin (2009). Trust but Verify: The Interactive Effects of Trust and Autonomy Preferences on Health Outcomes. [REVIEW] Health Care Analysis 17 (3):244-260.
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