Two rival understandings of autonomy, paternalism, and bioethical principlism

Aaron E. Hinkley

pp. 85-95

in: Tristram Engelhardt (ed), Bioethics critically reconsidered, Berlin, Springer, 2012

Abstract

Beauchamp and Childress' Principles of Biomedical Ethics is built around an opposition to medical paternalism, as well as around a crucial and fatal ambiguity regarding their primary principle of autonomy (Beauchamp and Childress, 1979). On the one hand, Beauchamp and Childress invoke Kant's views of autonomy to explain the force of their principle of autonomy. On the other hand, they regard their principle of autonomy to be directed to respecting what Kant would recognize as heteronomous choices, that is, immoral choices. Their principle of autonomy and the bioethics it endorses are framed in terms of the ethos criticized by Griffin Trotter (Chapter 3, this volume), the ethos of doing things "my very own way", which lies at the heart of the culture that produced bioethics (Trotter, 2011). Given their endorsement of heteronomous individualism, Beauchamp and Childress mean for physicians to respect patients' choices, even when decisions are made on the basis of inclinations, not rational decision-making. Their respect of heteronomous, autonomous choices sets their principle of autonomy at tension with the principles of beneficence, non-maleficence, and justice, which concern the non-liberty-directed best interests of the patient.

Cited authors

Kant Immanuel

Trotter Griffin