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Issues and Concepts

Autonomy

(See also Principle of Respect for Autonomy.) From the Greek autonomia, meaning "self-rule." The concept became central in the influential moral philosophy of Immanuel Kant (18th Century). In Kant’s ethics, autonomy was considered the ability to know what morality requires of us, and functioned not as freedom to pursue ends, but as the power of the agent to act on objective and universally valid rules of conduct (i.e., the different formulations of the categorical imperative), which the will imposes on its self through pure reason. In contemporary thought, autonomy is most often equated with self-determination and individuals are said to be autonomous when their actions are truly their own. Thus, patient autonomy refers to the capability and right of patients to control the course of their own medical treatment and participate in the treatment decision-making process. Today, case law and the courts define the legal limits of patient autonomy, usually framed under the rubric of informed consent:

No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law [Union Pacific R. Co. vs. Botsford, 141 U.S. 250 (1891)].

Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits assault, for which he is liable in damages [Schloendorff vs. Society of New York Hospital, 105 N.W. 92 (1914)].

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