Health Care Analysis 9 (3):299-319 (2001)

Abstract
Contemporary American medical ethics was born during a period of social ferment, a key theme of which was the espousal of individual rights. Driven by complex cultural forces united in the effort to protect individuality and self-determined choices, an extrapolation from case law to rights of patients was accomplished under the philosophical auspices of ‘autonomy’. Autonomy has a complex history; arising in the modern period as the idea of self-governance, it received its most ambitious philosophical elaboration in Kant's moral philosophy. In examining the Kantian construction, it is evident that neither his universal moral imperative nor his rigorous application of self-legislated ethical action can sustain our own notions of moral agency in a pragmatic, pluralistic society. But the Kantian position is useful in highlighting that self-governance is not equivalent to ‘autonomy’, and this distinction defines the limits of autonomy in the clinical setting. A critique of Engelhardt's idea of ‘principle of permission’ is used to illustrate autonomy's eclipse as a governing principle for medical ethics
Keywords autonomy  Kant  medical ethics  pragmatism  self-governance
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DOI 10.1023/A:1012901831835
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The History of Autonomy in Medicine From Antiquity to Principlism.Toni C. Saad - 2018 - Medicine, Health Care and Philosophy 21 (1):125-137.
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Immanuel Kant, His Philosophy and Medicine.Urban Wiesing - 2008 - Medicine, Health Care and Philosophy 11 (2):221-236.
Facilitating Patient Participation by Embracing Patients' Preferences—A Discussion.Ann Catrine Eldh - 2019 - Journal of Evaluation in Clinical Practice 25 (6):1070-1073.

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