| Abstract [eng] |
The principle of respect for autonomy has taken a central role in guiding ethical decision-making in Western culture and contexts. It affirms the right of rational individuals to make independent and informed choices. However, despite its dominance, limitations regarding its prioritised nature, individualistic framework, and lack of cultural considerations need to be acknowledged. This thesis aims to critically examine the principle of respect for autonomy, exploring its limitations and reflecting on its prominence within Western bioethics. It advocates for a broader, more inclusive, and context-sensitive understanding of autonomy that incorporates relational and cultural perspectives. The thesis has four main objectives: (1) tracing the historical development of autonomy and its entrenchment in principlism, (2) assessing its limitations, particularly regarding informed consent, vulnerability, and paternalism, (3) exploring an alternative, contextual, and relational understanding of autonomy as put forward in the ethics of care, and (4) establishing the need for a reformulation on the understanding of autonomy based on alternative perspectives to better reflect ethical pluralism and human interdependence. The findings reveal that autonomy’s dominant individualistic interpretation presents significant challenges. Prioritising autonomy above other ethical considerations can marginalise vulnerable populations, overlook relational decision-making, and rigidly reject paternalism, even when protective. Informed consent, a key mechanism for safeguarding autonomy, is deeply rooted in Western ideals of rational self-determination, often failing to accommodate cultural diversity, interdependence, and different forms of consent that may be valued in non-Western contexts. The thesis concludes that a more inclusive understanding of autonomy is needed. By incorporating insights from care ethics and non-Western traditions, it advocates for a relational understanding of autonomy that recognises human interdependence, vulnerability, and social responsibility. Practical recommendations include fostering interdisciplinary collaboration to explore the integration of principlism and care ethics, revising informed consent processes to incorporate relational and cultural dimensions, and developing flexible, context-sensitive ethical decision-making models that respect both individual autonomy and collective well-being. Ultimately, this thesis contributes to the ongoing discourse on balancing autonomy with ethical pluralism and social responsibility in bioethics and healthcare. |
