Written by Rev. Professor Douglas Milne
Principal of the Presbyterian Theological College, Melbourne
No principle has had greater influence in the practice of bioethics and clinical medicine than that of autonomy. First promoted in the internationally claimed text-book, The Principles of Biomedical Ethics, by Beauchamp and Childers (1979) autonomy has established itself as a leading, if not the leading, principle in biomedical theory and practice.
Autonomy comes from the two Greek words ‘self’ and ‘law’ and refers to a law of choice and behaviour that a person imposes on herself. In Western philosophy autonomy appears as a significant concept especially in the writings of Immanuel Kant, JS Mill and Isaiah Berlin. But in bioethics autonomy stands basically for the right of the individual to choose and refuse in receiving health care.
By itself, or in receiving undue prominence, autonomy produces adverse results and hastens procedures or promotes rights that otherwise might be judged unethical. Examples of this can be found in abortion, reproductive technologies and assisted suicide.
In abortion autonomy is granted to the mother but not to the fetus, and is now firmly entrenched in our law codes. Autonomy was clearly central for those who did not ascribe moral significance to the early embryo and fetus. (The Oxford Handbook of Bioethics, [OUP, 2009], p. 74)
In assisted reproductive technologies autonomy appears in the belief that everyone has the right to do what a person chooses to do with his or her own
gametes. As a result, ARTs (assisted reproductive technologies) are available
to unmarried people and homosexual people, as well as the infertile. The practice of donor sperm and eggs rests on the same foundation.
In the case of euthanasia autonomy has morphed from the earlier right to refuse life-sustaining treatments to the right to die. On this basis, euthanasia has already been decriminalized in some American states.
Autonomy appeals directly to the general acceptance in our Western cultures of the individual person’s right to live out their life in freedom from outside interference. By itself, without other moral restraints, autonomy can become a cause of harm to individuals, third parties and society as a whole, as the above cases have shown.
What is required is a corrective principle like justice or love to counterbalance the negative effects of an excessive attachment to the autonomy of the individual. Justice and love are moral principles that remind us of our responsibilities to one another.
In Christian ethics the individual is always a social self whose true interests are met in the service of others. This means there will be times and occasions when individual freedom should be controlled and curbed by considering the long-term interests of others.
In the above examples, this would mean that the moral rights of the defenceless foetus would be upheld in the abortion debate, that the interests of marriage and the family would prevail in policies surrounding ARTs, and that the ill effects of a culture of suicide on all members of society would trump the push for legalized euthanasia.