Relational Autonomy: Moving Beyond the Limits of Isolated Individualism

Abstract

Although clinicians may value respecting a patient' s or surrogate' s autonomy in decision-making, it is not always clear how to proceed in clinical practice. The confusion results, in part, from which conception of autonomy is used to guide ethical practice. Reliance on an individualistic conception such as the "in-control agent" model prioritizes self-sufficiency in decision-making and highlights a decisionmaker' s capacity to have reason transcend one' s emotional experience. An alternative model of autonomy, relational autonomy, highlights the social context within which all individuals exist and acknowledges the emotional and embodied aspects of decision-makers. These 2 conceptions of autonomy lead to different interpretations of several aspects of ethical decision-making. The in-control agent model believes patients or surrogates should avoid both the influence of others and emotional persuasion in decision-making. As a result, providers have a limited role to play and are expected to provide medical expertise but not interfere with the individual' s decisionmaking process. In contrast, a relational autonomy approach acknowledges the central role of others in decision-making, including clinicians, who have a responsibility to engage patients' and surrogates' emotional experiences and offer clear guidance when patients are confronting serious illness. In the pediatric setting, in which decision-making is complicated by having a surrogate decisionmaker in addition to a patient, these conceptions of autonomy also may influence expectations about the role that adolescents can play in decision-making. Pediatrics 2014;133:S16-S23

Responsibility: From its conceptual foundations to its practical application in intensive care units

“…In our opinion this relational component of autonomy is just the same as the aforementioned concept of responsible autonomy being aligned with the so-called "alternative model of autonomy", i.e., relational autonomy. This concept highlights the social and interpersonal extend within all individuals exist and acknowledges the emotional and embodied aspects of decision-makers (41)(42)(43)(44). A relational autonomy approach takes full consideration to the central role of 'others', including their narratives (45), in the decision-making process, highlighting the complex dimension and framework of end of life decisions and including physicians and health professionals' role and their responsibility.…”

Ovarian Tissue Cryopreservation / Transplantation for Social Reasons: Between (“Good”) Medicalization and Medical Treatment.

“…When the conception of autonomy is conceptualized as individual autonomy, it is captured through the 'in-control agent' [83,84] model, the model of autonomy that highlights the individual, a woman is considered self-suffi cient, capable of making sovereign decisions regardless of any infl uence of her environment. She is considered capable of self-reliance and rationality to the point of being resistant to societal emotional pressures [83,85].…”

“…She is considered capable of self-reliance and rationality to the point of being resistant to societal emotional pressures [83,85]. According to this model of autonomy, a childbearing age woman has the authenticity to be herself.…”

Autonomy and Severe Mental Illness: The Relationship between Social Network and Functioning

“…In light of these findings, autonomy as a capacity should not solely be understood in terms of internal cognitive factors, but also take into consideration the social surrounding of the individual. From this perspective, autonomy might be seen as relational [15,16].…”