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Journal of Medicine and Philosophy Advance Access published online on December 24, 2008
Journal of Medicine and Philosophy, doi:10.1093/jmp/jhn033
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© The Author 2008. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Medical Ethics Needs a New View of Autonomy

Rebecca L. Walker

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Address correspondence to: Rebecca L. Walker, PhD, #7240, Department of Social Medicine/University of North Carolina at Chapel Hill/Chapel Hill, NC 27599-7240, USA. E-mail: rlwalker{at}med.unc.edu


  Abstract

The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of "respect for autonomy" are in order.

Keywords: concept of autonomy, medical ethics, principles, respect, self-rule


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