The history of autonomy in medicine from antiquity to principlism

• Published in: Medicine, health care, and philosophy Vol. 21; no. 1; pp. 125 - 137
• Main Author: Saad, Toni C.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2018; Springer Nature B.V
• Subjects: American culture; Bioethics; Education; Ethics; Ethics, Medical - history; History of ideas; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Individualism; Medical Law; Medical philosophy; Morality; Paternalism; Patients rights; Personal Autonomy; Philosophy; Philosophy of Biology; Philosophy of Medicine; Postwar history; Review Article; Rousseau, Jean-Jacques (1712-1778); Theory of Medicine/Bioethics; Bioethics; Autonomy; Principlism; Rousseau; Kant
• ISSN: 1386-7423; 1572-8633
• DOI: 10.1007/s11019-017-9781-2

Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.