Autonomy And Trust In Bioethics

Argues against the conceptions of individual autonomy which are widely relied on in bioethics.

Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated with issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on medicine, science and technology. The study appeals to a wide range of readers in ethics, bioethics and related disciplines.

Personal autonomy is often lauded as a key value in contemporary Western bioethics, and the claim that there is an important relationship between autonomy and rationality is often treated as an uncontroversial claim in this sphere. Yet, there is also considerable disagreement about how we should cash out the relationship between rationality and autonomy. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether ". . . the reasons for making the choice are rational, irrational, unknown or even non-existent". In this book, I bring recent philosophical work on the nature of rationality to bear on the question of how we should understand autonomy in contemporary bioethics. In doing so, I develop a new framework for thinking about the concept, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in personal autonomy. Furthermore, the account outlined here allows for a deeper understanding of different form of controlling influence, and the relationship between our freedom to act, and our capacity to decide autonomously. I contrast my rationalist with other prominent accounts of autonomy in bioethics, and outline the revisionary implications it has for various practical questions in bioethics in which autonomy is a salient concern, including questions about the nature of informed consent and decision-making capacity.

A study of the importance of self-trust for women's autonomy in reproductive health. The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy.

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including self-conception, self-worth, memory, and the imagination.

Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics, first published in 2007, Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law.

Patient autonomy is a much discussed and debated subject in medical ethics, as well as in healthcare practice, medical law, and healthcare policy. This book provides a detailed and nuanced analysis of both the concept of autonomy and the principle of respect for autonomy, in an accessible style. The unique feature of this book is that it combines empirical research into hospital practice with thorough philosophical analyses. As such, it is an example of a new movement in applied ethics, that of 'empirical ethics'. The key themes are informed consent and medical decision making, personal well-being, competence, paternalism and decision making for incompetent patients. Much attention is also devoted to autonomy in non-decision making situations - patient control over small everyday aspects of care, authenticity and existential aspects of illness, autonomy and the 'ethics of care', and the relationship between autonomy and trust in the physician-patient relationship. This book will be of interest to those working or studying in the field of medical ethics and applied ethics but also to healthcare professionals and health policy makers.

The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy—which was inspired by other rights-based movements of the 1960s—was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine. Tauber examines the historical and philosophical competition between facts (scientific objectivity) and values (patient care) in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a "topology" of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care.