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Written by Scott Y.H. Kim, this academic article concentrates on bioethics and the particular ethical philosophies that are prominent within the provision of healthcare. The article was written for the philosophy, psychiatry and psychology journal published by John Hopkins University Press in 2013. Through this article, Kim expands on the notion of autonomy and its application within medicine. The presence of autonomy in healthcare stems from the principlism theory, most famously advocated for by Beauchamp and Childress. This dominant approach to bioethics highlights 4 principles that facilitate a means for resolving any bioethical concern; autonomy; non-maleficence; beneficence and justice. Although it is acknowledged that all four are of equal value, autonomy holds significant importance. Flowing from Beauchamp and Childress theory of principlism, autonomy is widely regarded as an individuals right to make their own independent decisions concerning their life and how to live it. Scott Y.H. Kim recognises that the principle of autonomy plays a significant role in the application of bioethics however, throughout this article he considers whether the concept is too individualistic. The basis of his argument centres on the traditional understanding of autonomy and whether it is too restrictive/confined; neglecting to acknowledge the wider context in which the principle is applied. Instead, Kim promotes autonomy understood in broader terms, known as relational autonomy. This takes account for a wider community in which an individual develops, not just consideration for their own individual decisions. He suggests that the relational character of autonomy is intrinsic to its very nature.
Autonomy has been deep-rooted within society for some time. We (as a community) give this freedom such high regard because the decisions we make and the values which we hold close are inherently important to us. It is a means through which we can achieve our goals and values. Despite the longstanding acceptance of the significance of autonomy (particularly within the provision of healthcare), there has been an ongoing dispute regarding how it should be understood. Kim aims to thwart the traditional understanding of the principle, suggesting that relational autonomy should prevail; placing greater emphasis on ones wider relationships within society. He begins by critiquing the narrowly defined autonomy and why it is problematic. Following this he discusses why this understanding of the principle risks autonomy being abused, particularly in a healthcare setting. Finally, Kim finishes by laying down relational autonomy and why this understanding is favourable.
Firstly, Kim explains that those who have long advocated for the principle of autonomy are sceptical of its application in medicine, owing to it being understood in an isolated manner. In particular, Kant, famous for his support of autonomy, has recognised that it ought not to be considered as a detached principle but instead it should be viewed as the source of all morality . Kim interprets Kants theory as viewing society as an end that cannot be achieved through absolute autonomy i.e. individuals having total free will to pursue whichever endeavours they desire. That is not to say that their wishes should be restricted but rather that individuals must be aware that they are existing within a community that involves mutual relationships and respect for one another. However, his perception of Kantian autonomy as a theory of human relationships is slightly erroneous; Kim has to some extent misconstrued Kants understanding of autonomy. While recognising that every individual has the right to be respected as well as having a corresponding duty to respect others, Kants theory is predominantly focused on the moral law which an individual prescribes himself. We are governed by our own moral law and from this law arises a responsibility to pursue behaviours which are universally favourable . On the other hand, relational autonomy is centred on the basis that an individuals personhood develops in a social environment consisting of relationships and social determinants. Flowing from this, an individuals values and decisions can be influenced by/defined in terms of these social norms and relationships. Kant does not disregard this &&.. we as human beings have an obligation but what differentiates his theory from one of relational autonomy is that he recognises that obligation arises from being governed by ones own moral law, not simply because we live in a society and must have respect for others. On the sliding scale of autonomy, Kants theory lies in the middle, with isolated autonomy at one end and relational autonomy at the other. Kim has failed to recognise this distinction, ultimately causing this particular argument in favour of relational autonomy to be flawed.
Furthermore, Kims argument is poorly elucidated in the context of healthcare. He introduces the argument by referencing bioethics and the problematic application of the isolated interpretation of autonomy within it. However, he fails to expand on why autonomy understood in relational terms is favourable in a healthcare setting. Kims failure to support his stance with practical examples within medicine weakens his argument in favour of the application of relational autonomy in healthcare.
Where relational autonomy fits into the provision of healthcare and why it is favourable (as opposed to the narrow definition) in a healthcare setting.
We impose a moral law on ourselves and from this law emerges a responsibility to act in a particular way.
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