Philosophical underpinnings of respect for autonomy in bioethics

Abstract

Bioethics is, at heart, a practical philosophy. Bioethics is the discipline that deals with ethical and social issues that arise in the context of medical care or biomedical research. The field of bioethics is relatively new, and has gained traction over the last century as the need for such training and ethics review boards became increasingly clear, especially in response to instances of patient vulnerability and medical exploitation.1,2 Tom Beauchamp and James Childress are chiefly responsible for streamlining bioethical methodology in their seminal work, Principles of Biomedical Ethics, originally published in 1977. In it the authors codify a system – a compilation of philosophical, medical, ethical and legal input – to legitimize and solidify a concrete and objective means of practicing bioethics. Beauchamp and Childress propose four moral principles as pillars that ought to dictate the nature of professional-patient interactions in healthcare or research: respect for autonomy, nonmaleficence, beneficence and justice. The principle of respect for autonomy is a directive that we ought to respect the decisions that people make when they have the capacity to do so. Nonmaleficence is the obligation to do no harm to others, and beneficence in a moral obligation to do good for others. The principle of justice in the context of bioethics refers to the idea that there ought to be equality in health care and fairness in distribution and access across gender, race and socioeconomic status. The theories and mechanisms described in Principles of Biomedical Ethics have been refined over six editions, and are largely responsible for the translation of bioethics from ivory-tower philosophy into pragmatic and solution-oriented ethics.