Abstract
For the last few decades, the principle of respecting patients’ autonomy has been of major importance in medical ethics, notably in terms of the requirement of gaining patients’ informed consent for any treatment to be considered legitimate. However, there is still an ongoing debate about its exact understanding and implications. It is not only a matter of dispute how to analyze the concept of personal autonomy in general, but also whether and to what degree resulting specific conceptions of autonomy are suitable for being used in medical ethics in particular. Moreover, the authenticity criterion comprised in conceptions of autonomy raises questions about how it relates to conceptions of the self. This makes it necessary to include the latter in the medical ethics debate as well. In this introduction, we sketch the respective theoretical landscape and provide an overview of the contributions to the volume.
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Notes
- 1.
Cf., for example, Eyal (2012) and Article 5, “Autonomy and individual responsibility,” of the Universal Declaration on Bioethics and Human Rights: “The autonomy of persons to make decisions, while taking responsibility for those decisions and respecting the autonomy of others, is to be respected. For persons who are not capable of exercising autonomy, special measures are to be taken to protect their rights and interests” (UNESCO 2005, 77).
- 2.
- 3.
See, for example Maclean (2009).
- 4.
- 5.
Beauchamp and Childress (2013), 104.
- 6.
Cf. Beauchamp and Childress (2013), 106. It should be noted that Beauchamp and Childress address such issues partially in the context of their three other principles, i.e. nonmaleficence, beneficence, and justice. However, this already characterizes these issues as external to a person’s autonomy, while relational accounts of autonomy typically aim at depicting social relations as internal characteristics of autonomy. Hence, Beauchamp and Childress essentially still presuppose an individualistic conception of autonomy.
- 7.
- 8.
As one reviewer of this volume helpfully remarked, it should be noted that some hard cases nowadays pose a flip sided challenge. In these cases, the patient explicitly wants to continue treatment, e.g. due to the patient’s advance directive including that “everything be done,” while physicians and other caregivers would prefer to cease treatment due to it being clearly futile. This indeed raises the familiar issue discussed in this volume, i.e. whether the patient’s wish that “everything be done” may be considered sufficiently autonomous. However, given the assumed futility of further treatment, the more pressing ethical questions presumably concern matters of justice in access to specific and likely expensive health care while assuming that health care resources are scarce and need to be distributed effectively, efficiently, and fairly—questions that go beyond the scope of this volume.
- 9.
In this regard, the doctrine of double effect may also play an important role. See McIntyre (2014).
- 10.
Article 8, “Respect for human vulnerability and personal integrity,” of the Universal Declaration on Bioethics and Human Rights pays special attention to such individuals and groups: “In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected” (UNESCO 2005, 77). Still, no specific guidelines are mentioned that define the manner in which such persons have to be protected, especially when it comes to the relation between vulnerability and autonomy.
- 11.
Another example of such vulnerable positions would be embryos created in IVF (in vitro fertilization).
- 12.
For a discussion of some practical implications of such cases, see Mitrović (2015).
- 13.
For an instructive overview of different cultural perspectives on medical ethics and bioethics more generally, see Have and Gordijn (2013), section III.
- 14.
- 15.
See UNESCO (2005).
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Kühler, M., Mitrović, V. (2020). Introduction. In: Kühler, M., Mitrović, V.L. (eds) Theories of the Self and Autonomy in Medical Ethics. The International Library of Bioethics, vol 83. Springer, Cham. https://doi.org/10.1007/978-3-030-56703-3_1
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