THE FAILINGS OF INDIVIDUAL AUTONOMY

The claims of individual autonomy, in particular of patient autonomy and reproductive autonomy, have been endlessly rehearsed in bioethics in recent decades. By themselves, I have argued, conceptions of individual autonomy cannot provide a sufficient and convincing starting point for bioethics, or even for medical ethics. They may encourage ethically questionable forms of individualism and self-expression and may heighten rather than reduce public mistrust in medicine, science and biotechnology. At most individual autonomy, understood merely as an inflated term for informed consent requirements, can play a minor part within a wider account of ethical standards.

Even when individual autonomy is coupled with other ethical standards, problems persist. Most often it is combined with a Millian principle of avoiding harm. This is unsatisfactory. If we assume a full Utilitarian account of maximising happiness, we subordinate and marginalise individual autonomy itself; if we do not, the line between harmful and non-harmful action and policies will often be blurred. The supposed triumph of individual autonomy over other principles in bioethics is, I conclude, an unsustainable illusion.

The difficult and serious tasks remain. We need to identify more convincing patterns of ethical reasoning, and more convincing ways of choosing policies and action for medical practice and for dealing with advances in the life sciences and in biotechnology. In this chapter I shall argue that a different and older view of autonomy supports a more convincing approach to ethics, and also to bioethics.