Respecting Personal Autonomy in Bioethics

Abstract

This chapter unpacks the dominant, though thin and procedural, conception of the principle of respect for personal autonomy in the context of a medical and legal decision to allow a fourteen-year-old Jehovah’s Witness boy to refuse a blood transfusion needed to extend his life. It argues that thicker conceptions of autonomy, closely connected with relational autonomy, can enable us to see more clearly aspects of respect for autonomy too often neglected or downplayed. These help us understand better the interpretive complexity of this principle by directing attention beyond a potential beneficiary’s immediate decision in the moment to the broader context of relations that in part shape such decisions and to the temporal extensions of the self. As valuable as these indicators are, they should not be converted into necessary conditions of autonomous choices and actions for which respect is due. This would set the bar too high for autonomy, and it would deprive ordinary decision-makers of the protection and support needed for their autonomous choices and actions.