By Onora O'Neill

Onora O'Neill means that the conceptions of person autonomy (so largely depended on in bioethics) are philosophically and ethically insufficient; they undermine instead of help relationships in response to belief. Her arguments are illustrated with concerns raised through such practices because the use of genetic details by means of the police, examine utilizing human tissues, new reproductive applied sciences, and media practices for reporting on medication, technological know-how and expertise. The research appeals to a variety of readers in ethics, bioethics and similar disciplines.

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How are the principles to be justified? How are conflicts between them to be handled? Is not a principle of justice a different type of principle from the others, relevant to medical policies and systems rather than to clinical decisions and doctor–patient relationships? How is the move from principle to action in particular cases to be made? Within a fairly short time the principle of autonomy had gained great support, and also attracted a lot of criticism. In the  edition of their textbook, Beauchamp and Childress recognised that the principle of autonomy was sometimes being seen as more important in medical ethics even than the principle of beneficence: Whether respect for the autonomy of patients should have priority over professional beneficence has become a central problem in biomedical ethics.

As we warm to his conclusions it is easy to forget that they can be established only if he can show how the picture of self-mastery and of developing one’s own character and individuality – his version of individual autonomy – fits within the naturalistic account of human action that he propounds.  Others doubt whether the enterprise works, or could work. Similar approaches to individual or personal autonomy have been proposed and adopted by many late-twentieth-century writers. Like Mill, they think a naturalistic account of human action can be given, and specifically that all action has beliefs and desires among its causes.

Patients are typically asked to choose from a smallish menu – often a menu of one item – that others have composed and described in simplified terms. This may suit us well when ill, but it is a far cry from any demanding exercise of individual autonomy. It is probably a considerable relief to many patients that they are not asked to muster much in the way of individual autonomy. When we are ill or injured we often lack the skills or energy for demanding cognitive tasks. Our highest priority is to get help from others and in particular from others with relevant skills and knowledge.

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