Principle of Respect for Autonomy

Principles that support autonomy can be directed at the everyday relationships and encounters between persons; at the constitution, laws, and regulations of a nation-state; and at the policies of institutions such as hospitals, insurance companies, schools, and corporations. What ought to be done to respect autonomy will not be the same at all these levels and will be a function of a broad social ideology.

The minimal content for a principle of respect for autonomy is that persons ought to have independence, that is, be free from coercion and other similar interferences. John Stuart Mill made this the main principle in On Liberty (1947): No one should interfere with the liberty of action of another except to prevent harm to others. This obligation not to coerce others is defensible as an obligation binding on individuals, private organizations, and governments. Mill defended his principle of liberty, not because he believed that there is a fundamental right to autonomy nor that autonomy is valuable in itself, but because the recognition of liberty is supported by the principle of utility. This principle is that an action or policy is right to the extent that it promotes the greater happiness for the greater number. However, securing negative liberty does not establish autonomy as fundamental in moral theory. Other philosophers have gone further than Mill in their defense of autonomy.

The most widely quoted principle of respect for autonomy is one of Immanuel Kant's versions of the categorical imperative: "Treat others and oneself, never merely as a means, but always at the same time as an end in himself" (p. 101). This is frequently expressed as treating others as persons, and its distinctive Kantian claim is that others should be treated as rational beings who have their own ends. A further explanation of this principle is that persons should be seen as having interests in two senses. First, interests in those things that are a benefit to nearly everyone, for example, being free of pain, not being killed, being saved from dying. A physician can treat a patient without that person's consent and still protect these interests. Second, autonomous persons "take an interest" in things, that is, have preferences, projects, and plans. Acting only with concern to serve interests in the first sense, as is sometimes alleged against uses of the principle of utility, is not sufficient for respecting another's autonomy; we must also discover and take into account the individual's values and objectives (Benn). For example, a physician may believe that a surgical procedure is an effective treatment to relieve the pain of a patient's ulcer, but the patient may have a greater aversion to the risks of surgery than the physician does, and would prefer a restricted diet and medication. To not solicit, or to ignore, the patient's preferences in this matter would not respect his or her autonomy.

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