Reconceptualizing Autonomy for Bioethics

Abstract

Autonomy plays a central role in bioethics, but there is no consensus as to how we should understand this concept. This paper critically considers three different conceptions of autonomy: the default conception prevalent in bioethics literature; a broader procedural account of autonomy drawing on moral philosophical approaches; and a substantive, perfectionist account. Building on Rebecca Walker's critique of the default conception of autonomy, we will argue that a substantive, perfectionist approach both fulfils Walker's criteria for a conception of autonomy in bioethics and lends itself to application in practical scenarios. In so doing, we draw on scenarios from genomic medicine to show that a substantive, perfectionist approach not only offers a more conceptually adequate understanding of autonomy in more complex cases, but also lends itself to practical application by helping health professionals identify how they can maximize people's capacity to exercise their autonomy.

From Expectations to Experiences: Consumer Autonomy and Choice in Personal Genomic Testing

“…This first question can be addressed by initially looking to how autonomy is being construed in the bioethics literature more generally. Scholars have recently argued that we should move away from the so-called "default account" of autonomy (Dive and Newson 2018). Under the default framing, autonomy focuses more narrowly on the informed consent process and its requirements for information, understanding, and freedom from coercion as the mechanism to achieve an autonomous decision (Hildt 2009;Dive and Newson 2018).…”

“…Scholars have recently argued that we should move away from the so-called "default account" of autonomy (Dive and Newson 2018). Under the default framing, autonomy focuses more narrowly on the informed consent process and its requirements for information, understanding, and freedom from coercion as the mechanism to achieve an autonomous decision (Hildt 2009;Dive and Newson 2018). This leads to a negative framing of autonomy; one that requires third parties to refrain from certain actions to promote individual autonomy.…”

“…A broader ("substantive") notion of autonomy, which incorporates elements such as the importance of critical reflection, making authentic decisions, and sensitivity to social context and relationships is increasingly recognized as both important and practicable in bioethics (Dive and Newson 2018). Crucially, this notion of autonomy pays attention not only to the ways in which autonomy is exercised, but the content of a decision too.…”

“…For example, aspects of PGT such as the consent process, maintaining control over data, or the utility of results will have implications for whether it can be said to promote or detract from autonomy. There are also more general debates occurring in bioethics regarding how autonomy should be construed, including how a "substantive" account of autonomy can be defended and used in bioethics debates (Dive and Newson 2018). And while they are beyond the scope of this paper to discuss in-depth, it is important to note that autonomy is also relevant to wider ethical and political debates over concepts such as choice and individualism and how they manifest in neoliberal societies like Australia.…”

Can self-validating neuroenhancement be autonomous?

“…While the understanding of autonomy has not gone without criticism (see, e.g., Dive and Newson 2018;Manson and O'Neill 2007), 7 it nevertheless continues to play a central role in contemporary bioethics. 8 Whether Kelly's self-validating neuroenhancement meets its criteria of free, intentional, and knowing choice can also be of interest even to those who understand autonomy in different terms.…”