The Pre-eminence of Autonomy in Bioethics
Upon reading case books on medical ethics or simply news reports in the media, one cannot escape noticing that the medical professions are currently involved in practices that some few decades ago would have been unthinkable, not only because of the level of technology involved, but because of the then prevailing moral evaluation of the practices. One reads of Dr. Kevorkian and his death machine; of a sixty-one-year-old woman having a baby conceived with another woman’s ovum in a petri dish; of embryos created solely for experimental purposes; of vital organs taken from living anencephalic infants; of millions of abortions yearly. Clearly a revolution of some kind, beyond the merely technological, has taken place.
KeywordsMoral Truth Common Morality Autonomous Choice Active Euthanasia Voluntary Euthanasia
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- 1.An exhaustive bibliography of articles challenging the primacy of autonomy will not be offered here. But see, for instance, Douglas N. Husak, ‘Paternalism and Autonomy’, Philosophy and Public Affairs 10 (1980) 27–46; Mark S. Komrad, ‘A Defence of Medical Paternalism: Maximising Patients’ Autonomy’, Journal of Medical Ethics 9 (1983) 38–44; Harry Yeide, Jr., ‘The Many Faces of Autonomy’, The Journal of Clinical Ethics 3 (1983) 269–74; Onora O’Neill, ‘Paternalism and Partial Autonomy’, Journal of Medical Ethics 10 (1984) 173–8; Daniel Callahan, ‘Autonomy: A Moral Good, Not a Moral Obsession’, The Hastings Center Report (October 1984) 40–2. Especially valuable is Edmund D. Pellegrino, M. D. and David C. Thomasma, Ph.D., For the Patient’s Good: The Restoration of Beneficence in Health Care (New York OUP, 1988; hereafter FPG.). For a very challenging criticism from the clinical perspective see Stephen Wear, ‘The Irreducibly Clinical Character of Bioethics’, The Journal of Medicine and Philosophy 16 (1991) 53–70.Google Scholar
- 2.Edmund Pellegrino has done some of the most interesting work on the role of autonomy in medical ethics. He was pioneering in his description of disease as a state of reduced autonomy (‘Humanistic Base for Professional Ethics in Medicine’, New York State Journal of Medicine 77 (1977) 1456–62). In FPG, he situates autonomy within a system of ethics that holds beneficence to be the pre-eminent value.Google Scholar
- 3.Bruce L. Miller, ‘Autonomy and the Refusal of Lifesaving Treatment’, The Hastings Center Report (August 1981) 22–9, at p. 24.Google Scholar
- 5.A good history of the emergence of the value of autonomy is to be found in Ruth R. Faden and Tom L. Beauchamp, A History and Theory of Informed Consent (New York: OUP, 1986) and J. Katz, The Silent World of Doctor and Patient (New York: The Free Press, 1984). See also FPG.Google Scholar
- 6.Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (New York: OUP, 1994, 4th edition; hereafter PBE(4)), p. 274.Google Scholar
- 11.Leon R. Kass, Towards a More Natural Science: Biology and Human Affairs, (New York: The Free Press, 1985).Google Scholar
- 17.Paul Ramsey, The Patient as Person (New Haven: Yale University Press, 1970).Google Scholar
- 18.H. Tristram Engelhardt, Jr., The Foundations of Bioethics (New York: OUP, 1986).Google Scholar