The history of autonomy in medicine from antiquity to principlism
Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.
KeywordsAutonomy Principlism Kant Rousseau Bioethics
The author would like to thank Dr Trevor Stammers for overseeing this work as part of the MA programme in bioethics at St Mary’s University, Twickenham.
- Annas, G. J., and M.A. Grodin, eds. 1992. The Nazi doctors and the Nuremberg code: Human rights in human experimentation. New York: Oxford University Press.Google Scholar
- Anscombe, G.E.M. 2000. Intention, 2nd edn. Cambridge, MA: Harvard University Press. (Originally published 1957).Google Scholar
- Beauchamp, T.L., and J.F. Childress. 2013. Principles of biomedical ethics, 7th edn. New York: Oxford University Press, USA.Google Scholar
- Berendzen, J.C. 2009. Max Horkheimer. Stanford Encyclopaedia of Philosophy. http://plato.stanford.edu/entries/horkheimer. Accessed 13 Jan 2016.
- Christman, J. 2015. Autonomy in moral and political philosophy. https://plato.stanford.edu/entries/autonomy-moral/. Accessed 28 Feb 2017.
- Engelhardt, H.T. 1996. The Foundations of bioethics, 2nd edn. Oxford: Oxford University Press.Google Scholar
- Evans, J. H. 2002. Playing god?: Human genetic engineering and the rationalization of public bioethical debate. Chicago: University of Chicago Press.Google Scholar
- Faden, R.R., T.L. Beauchamp, and N.M.P. King. 1986. A history and theory of informed consent. New York: Oxford University Press.Google Scholar
- Finnis, J.M. 1984. Fundamentals of ethics. Oxford: Oxford University Press.Google Scholar
- Gaus, G., S.D. Courtland, and D. Schmidtz. 2014 Liberalism. https://plato.stanford.edu/entries/liberalism/. Accessed 2 Mar 2017.
- Gomez-Lobo, A., and J. Keown. 2015. Bioethics and the human Goods: an introduction to natural law bioethics. Washington, DC: Georgetown University Press.Google Scholar
- Horkheimer, M., T.W. Adorno, and J. Cumming. 1997. Dialectic of enlightenment. New York: Verso Books.Google Scholar
- Kant, I. 2005. Groundwork for the metaphysics of morals. Trans. Thomas K. Abbott. Ed. Lara Denis. Peterborough, ON: Broadview Press.Google Scholar
- Miles, S.H. 2004. The Hippocratic Oath and the ethics of medicine. New York, NY: Oxford University Press.Google Scholar
- Outram, D. 2013. Enlightenment, 3rd edn. Cambridge: Cambridge University Press.Google Scholar
- Ramsey, P., M.A. Farley, A.R. Jonsen, M.R. Wood, and W.F. May. 2002. The patient as person: Explorations in medical ethics, 2nd edn. New Haven: Yale University Press.Google Scholar
- Rawls, J. 1999. A theory of justice. Cambridge, MA: Belknap Press of Harvard University Press.Google Scholar
- Stirk, P.M. 1992. Max Horkeimer: A new interpretation. Exeter: Harvester Wheatsheaf.Google Scholar
- United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1978. The Belmont report: Ethical principles and guidelines for the commission for the protection of human subjects of biomedical and behavioral research. https://videocast.nih.gov/pdf/ohrp_appendix_belmont_report_vol_2.pdf. Accessed 7 July 2016.