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Communities Need More Than Autonomy

1994; Wiley; Volume: 24; Issue: 3 Linguagem: Inglês

10.2307/3563398

1552-146X

Thomas H. Murray,

Ethics in medical practice

The past twenty-five years have witnessed the transmutation of autonomy from a battle cry of the oppressed to a rallying cry for those who elevate certain kinds of moral commitments--those chosen voluntarily and competently--over all other moral concerns and values. The business contract becomes the supreme model of a sound moral relationship; informed consent, the esseential moral content of the physician-patient relationship. Loyalty, integrity, solidarity, and other such moral concepts, when they do not disappear completely, are shoved aside as little more than interesting curiosities or idiosyncratic preoccupations. When the contract becomes the paradigm of a moral relationship, and the market the regnant model of a just community, much of what makes us human, and our communities livable, is excluded. The concept of autonomy, like all other products of culture, has a history and a context that help to account for its appeal and shed light on its limitations. In the development of bioethics, autonomy emerged as a powerful protest against evil or thoughtless researchers and paternalistic physicians. It found deep ideological resonances within American popular, legal, and political culture: our celebration of the individual, our anger at infringements by others, our constitutionalized protections of personal liberty, and our faith in markets as fair and efficient methods for distributing social goods from bathtubs to--babies? Autonomy was an exceptionally apt tool with which to confront the problems bioethics faced at its birth. But it is not the all-purpose solution that some of its enthusiasts claim. Autonomy sometimes appears to be regarded as a kind of universal moral solvent, at least for some bioethics theorists. That the parties to an encounter come together voluntarily and with full understanding and consent casts a favorable moral glow on the encounter. It does not, however, tell us the whole moral story about that interaction. Nor does it assure us that the sum total of such encounters will provide the cultural support needed for a vibrant and just community, one in which love, loyalty, peace, and other vitally important human values flourish. A near-exclusive emphasis on autonomy is attractive in part because it permits us to avoid many unpleasant and complex realities--the strains of living in communities in which others not only have different interests, but may be ornery and unreasonable besides; the gnawing difficulties and deep satisfactions of enduring family relationships; the confusing, embarrassing, and sometimes ugly particulars of the human psyche. When autonomy is the answer, the question is largely limited to asking whether the person decided freely. Autonomy counsels us not to ask if the decision was wise, or even good in the short run for the person making it. For many decisions, that is sound counsel. …