Bioethics refers to ethical implications of biological research, especially in medicinal applications. Bioethics relates morality to medical investigation and practice. It deals with ethics when dealing with a diverse multicultural population in the provision of healthcare. According to Childress and Beauchamp (2001), these values address a broad range of issues such as life boundaries, surrogacy, organ donation and the refusal of medical services due to religious reasons. The origin of bioethics can be traced back to Hippocrates, a Greek philosopher in the 4th century who directed doctors to help patients and harm none of them (Ells, 2001). Bioethics enable us to solve conflicts arising in the provision of healthcare due to patient's beliefs and religion. Currently, bioethics' mandate is expanding to biotechnology to address issues such as cloning, gene altering, and life extension. There are four essential principles of bioethics: respect for autonomy, justice, beneficence, and nonmaleficence (Childress & Beauchamp, 2001). The nonmaleficence principle states that no patient should be harmed intentionally due to physician's negligence. The Principle of Beneficence states that the doctor's main aim should be to assist patients. The principle of justice explains how risks and benefits in medical care should be equitable distributed. The principle of respect for autonomy demands respect for patients' right to make their informed decisions.
This paper tackles the principle of autonomy, which is very vital for the provision of medical services. This is because it is crucial to respect the right of the patient in choosing their treatment options. The physician should recognize the intellectual ability of a patient to make an autonomous decision. The patient should be well informed of all possible decisions, their benefits, and their consequences. The physician should not, in any way, influence the decision of the patient. In cases where this principle does not apply such as in fetuses, children, patients in coma and the mentally ill, the human life must be adequately protected. This paper presents a review of Wardropes (2015) article entitled Autonomy as Ideology: Towards an Autonomy Worthy of Respect in the context of the autonomy principle and healthcare.
Wardrope tackles the criticism that autonomy in bioethics is an ideology. The article aims to establish the meaning of "autonomy worthy of respect." This meaning is sought by answering three central questions; what is autonomy, what is involved in the manifestation of respect for autonomy and the worthiness of terms in autonomy. Critics argue that respect for freedom has reached an ideological status in healthcare provision. According to Ells (2001), ideologies distort human perception in a solution of ethical problems. Diverse interpretations of respect and autonomy have caused very complex and different meanings of "respect for autonomy." This article also addresses three main issues that put respect for autonomy into disrepute. These are an emphasis on decision-making competence, dealing on a solitary issue and focusing on an individual patient and neglecting his decision's ramification on the society.
It is difficult to pin out precisely what problematic conception prevailing in autonomy is. It lacks a distinct definition which all the critics can agree on. The flexibility of autonomy specifications and its practical application usually consider a limited set of positions. According to Calhoun (1988), moral philosophy reveals its face not in morality topics where it can talk but in topics where it does talk. Autonomy is best witnessed when handling practical applications. According to Doctrine of Informed Consent, an individual is presumed autonomous if there is no vivid evidence of coercion and inability to utilize the available information in decision-making (Holmes & Purdy, 1992). Respect for autonomy removes barriers to people's capability in making informed decisions on what is best for their lives.
The first implicit premise of autonomy is competence. Individuals should be able to consider all relevant information before making decisions and should communicate the decision in the absence of coercion. However, the analyses of bioethical autonomy tend to be expansive. Christman (2004) stated that such reviews usually accompany competence and authenticity issues. Most bioethicists agree on competence. However, authenticity is a controversial matter. It is agreeable to most bioethicists that authenticity is subject to agent's reasoning capability and their social values. Authenticity enables the patient to make a decision based on his wishes, values, and desires and bears authority for his actions (MacKenzie, 2008). Supplementing the patient's values with relational factors' and recognizing different social phenomena may boost or undermine the patient's decision (Kukla, 2005). Using relational autonomy to competent individuals without overly coercing them may influence the patient's decision based on values that are not his own. Focusing on the competence of autonomy and neglecting authenticity brings about conflicts between medical practitioners and patients.
The most important argument in respect for autonomy is to permit and enable patients to seek their vision for their own good. When dealing with individual cases focus changes to a person to the autonomous decision by the individual. A specific act is autonomous if it is sourced in considerations of a well-informed source (Kukla, 2005). Kukla draws attention to how long-term interaction between doctors and patients (in long term conditions especially pregnancy and chronic diseases) exert physician's influence on the patient. The patient's autonomy is affected by this series of meetings with the doctor. Construction and management of these relationships should determine all options that are practically possible not necessarily the physician's preference. The complex relationship between agents and their communities can also limit or enhance autonomy capability of the agent. It is not enough to look at how an individual makes decisions; it is vital to check on factors influencing the process of decision making.
Bioethical problems create conflicts. These conflicts require solutions. The concentration of conflict solution is ethically wrong. Instead, effort should be put to avoid these conflicts. Holmes and Purdy (1992) encourage the creation of a strategy of preventive ethics involving changes to medical education and altering social healthcare plans to minimize future conflicts. However, she does not explain vividly what these preventive ethics should be. Using preventive medicine analogy, these preventive ethics can be classified as "public values." Public ethics dwell on how social features are influencing individuals autonomy. Focus on how to minimize the society's influence on patient's autonomy is totally neglected in public ethics. Sherwin (2011) explains public standards using various levels of the human organization. What she tells about the penchant to focus the analysis of bioethics at intervals is ineffective as all the reasonable available options at each human organization level are restricted by the choices that are made at other levels.
For effective utilization of the principle of respect for autonomy, dialogue is important between the care provider and the patient. For autonomy, competence alone is too shallow to adequately define autonomy. Authenticity should be incorporated in the definition of autonomy. The author defines authenticity as the ability to determine what is right for an individual and being able to live up to the established standards. He thus describes autonomy as the ability to be coherent and live with the conception of the good. Respect for autonomy involves an open conversation between two parties. Both parties should be open to criticism and corrections. Respect for autonomy enables physicians to treat agent's autonomous capacity, not decision, with the respect it deserves. The agent should be viewed as a human being with a capability to make decisions.
The author tackles well the bioethical principle of respect for autonomy. He explains well how it is important for physicians to respect this fundamental principle when dealing with patients. Patients' right to all relevant information is duly stated. The need to offer guidance without coercion is clearly stated. The author has adequately answered all the questions raised at the beginning of the article. The definitions of autonomy need for autonomy and respect for autonomy have been explained. The author insists on the need for competence and authenticity as the basis of respect for autonomy.
The principle of respect for autonomy is the foundation of all principles of bioethics. It enables the agent to make a decision based on information given by a medical practitioner as well as his will. In most cases, the patients decision is influenced by several non-medical reasons. Our neighbor had an accident which left him paralyzed for life. Due to social discrimination, he went for euthanasia. His decision was based on social factors which were not related to medical reasons. The decision made by the paralyzed man was influenced by social circles and factors. It is, therefore, important to reduce the social influence that undermines autonomy in bioethics.
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Childress, J. F., & Beauchamp, T. L. (2001). Principles of biomedical ethics. Oxford University Press, USA.
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Wardrope, A. (2015). Autonomy as Ideology: Towards an Autonomy Worthy of Respect. The New Bioethics, 21(1), 56-70. http://dx.doi.org/10.1179/2050287715z.00000000057
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