11.04.2024

Respect for autonomy or the principle of autonomy

Respect for a person's autonomous choices runs deep in common morality, like any principle, but there is no agreement on its nature, scope or power.

The word autonomy, derived from the Greek terms autos (self) and nomos (rule, government or law), originally referred to the self-government of independent city-states^[1]. The term came to be extended to individuals, but the exact meaning of the notion is disputed. Personal autonomy encompasses, at the very least, self-government free from the interference and control of others, as well as from certain limitations, such as inadequate understanding that might lead to wrong choices. The autonomous individual acts freely in accordance with a self-elected plan, analogous to the way an independent government administers its territories and sets its policies. In contrast, a person with diminished autonomy is in a sense controlled by others or incapable of deliberating or acting on his or her own desires and plans. For example, mental incapacity limits a person's autonomy from the inside, while coercive measures involving institutionalization limit a person's autonomy from the outside.

Virtually all theories of autonomy consider two essential conditions of autonomy: freedom (independence from control or influence) and volition (the capacity for purposeful action)^[2].

Respecting autonomous will means recognizing the right of others to their opinions, the right to make choices and take actions based on their personal values and beliefs. It is more than non-interference in the personal affairs of others, because it includes, in certain contexts, building or maintaining capacities for autonomous choice by removing fears and other issues that destroy or disrupt autonomous action. Disrespect for autonomy involves attitudes and actions that ignore, insult or demean the right of others to act autonomously^[3].

Contemporary interpretations of the notion of respect for autonomy are influenced in a major way by the thinking of two philosophers: Immanuel Kant and John Stuart Mill. Kant argued that respect for autonomy derives from the recognition that all persons have an unconditional, intrinsic value, each having the capacity to determine his or her own destiny^[4]. To violate a person's autonomy is to treat that person only as a means to the ends of others, without regard to that person's own ends. Mill argued that society should allow individuals to develop their own beliefs, so long as they do not interfere with other people's liberty or cause others undue harm; but he also insisted that we sometimes have an obligation to persuade others when they hold false or inappropriate views^[5]. Mill's position envisages both the absence of interference and the enhancement of the expression of autonomy, while Kant's position presupposes a moral imperative of respectful treatment of persons, justified by the very quality of the person as a human being^[6]. In different ways, both advocate the principle of respect for autonomy.

The principle of autonomy, as it is understood in Europe and the USA, appears to most theorists to be binding and universally valid, regardless of the cultural context in which it is applied. But the opposite can also be demonstrated^[7].

The principle of autonomy can be described as involving a negative and a positive obligation^[8]. As a negative obligation: autonomous actions should not be subject to constraints from others. As a positive obligation: this principle requires both respectful treatment in disclosing information and actions that favor autonomous decision-making. Respect for autonomy obliges, for example, health and research professionals involving human subjects to disclose information in order to ensure understanding and to facilitate appropriate decision-making. The temptation for health and research professionals is to encourage or perpetuate patient dependency rather than to promote patient autonomy. But respecting patients' autonomy requires professionals to help patients to overcome their sense of dependence on themselves, and to help subjects to realize the limits of their control. These positive obligations derive in part from the special fiduciary duties of health and research professionals to their patients and subjects.

These negative and positive aspects of respect for autonomy form the basis of several specific moral rules (and other principles, such as the principle of beneficence and non-harm, can be justified by these rules).

An article by Veronica Dobozi (vdobozi@stoica-asociatii.ro), Partner, STOICA & ASSOCIATES.

[1] Tom L. Beauchamp, James F. Childress, Principles of biomedical ethics, Oxford University Press, 2009, p. 99.

[2] T. Beauchamp, J. Childress, op. cit., p 100.

[3] Jacob Dahl Rendtorff, Basic ethical principles in European bioethics and biolaw: Autonomy, dignity, integrity and vulnerability - Towards a foundation of bioethcis and biolaw, Medicine, Healtf Care and Philosophy, October 2002, vol. 5, no. 3, pp. 335-244.

[4] Valentin Mureșan, Principiism, available at http://www.ub-filosofie.ro/~muresan/licenta_etica_aplicata/2_principiismul.pdf, retrieved on 04.12.2018.

[5] John Suart Mill, Utilitarianism, available at http://socio-umane.lispanciu.com/wp-content/pdf/pdf%20opere%20filosofice/J.S.%20Mill-Utilitarismul.pdf, retrieved on 12.12.2018.

[6] V. Mureșan, op. cit., p. 8.

[7] Ruiping Fan, Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy, Bioethics, vol. 11, no. 3-4, available at https://doi.org/10.1111/1467-8519.00070

[8] T. Beauchamp, J. Childress, op. cit., p 104.