What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions

  • Aya Enzo
  • Taketoshi Okita
  • Atsushi Asai
Scientific Contribution


The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities.


Chronic conditions Self-management Respect for autonomy Personal autonomy Respect for persons Kant 



This study was supported by JSPS KAKENHI, Grant Number 16K16681.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.


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© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medical Ethics, Graduate School of MedicineTohoku UniversitySendaiJapan

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