Bioethics and Radical Autonomy

2017 October 26 http://www.thepublicdiscourse.com/2017/10/20061/ The Witherspoon Institute Radical Autonomy: A Dangerous Metaphysical Myth by Philip Hawley, Jr.

This is a paper that John E recommends to anyone. Here are little bits; I would copy-paste the whole paper but it is copyrighted.

When the moral stakes are highest, we degrade patients by treating them as though they were simply bundles of self-interest. corrupting power of bioethics’ all-purpose catchphrase—Respect for Autonomy—and the flotsam of deception that churns in its wake. morphed from an instrumental means of protecting patient rights to a seemingly unrestrained end in itself.

The Birth of an Ever-Expanding Principle

In 1978, the Belmont Report Respect for Persons, Beneficence, and Justice. eminent philosophers, medical researchers, social scientists, and jurists recognized the problem created by Roe v. Wade (which introduced the peculiar and still-undefined concept of “potential life”), but its members chose to look the other way. In so doing, they prevented any conception of human nature from exerting its proper influence on autonomy’s role in bioethics.

A Tectonic Shift—From Protecting Persons to Protecting Freedoms

The Belmont Report was soon eclipsed by Tom Beauchamp and James Childress’s Principles of Biomedical Ethics Respect for Autonomy, Beneficence, Non-Maleficence, and Justice—collectively known as “principlism” and widely regarded as a mainstay of modern biomedical ethics.

Beauchamp and Childress discarded Belmont’s “Respect for Persons” and replaced it with “Respect for Autonomy.” Physicians are thus instructed to render their respect to a principle rather than to persons. Physicians enthusiastically embraced principlism. medicine’s steady retreat from ethics based on older, “rigid” moral philosophies. In place of traditional Judeo-Christian morality, modern medicine adopted . . . well, nothing. This was one of the early criticisms of principlism—that it had no moral foundation on which to stand—but our postmodern secular society had little interest in this (mostly whispered) concern. (Postmodernism supplants Christian principles and modernism, it frees anyone to make up his own values, and it allows anyone to blithely contradict anyone else's values. It is as if everyone is allowed to place their stake in a parallel universe. Postmodernism values feelings above objective truth.)

Deciding Who Counts

Autonomy’s radical expression exerts a harmful effect on modern culture the weak and vulnerable must rely on the goodwill of the strong and powerful. the principle of autonomy to strip human embryos of their human nature even as they affirm that such embryos deserve our “profound respect”:

One interpretation of such “profound respect” for the embryonic source of stem cells is respect for the “cellular dignity” of these embryos as symbolizing the personal autonomy society already honors in adults.

Rebelling Against Our Nature

feelings replace (rather than complement) intellect. We are told that we must accept a declaration like, “Even though I was born in a boy’s body, I feel like a girl. I have the right to make my body conform to my feelings.” This is one of the most tragic failures of modern medicine. many of my medical colleagues have acquiesced to the growing social norm that feelings about gender are reality. autonomy is the ethical principle almost universally invoked by those undergoing a sex “transition.”

we invoke this idea of truth when treating anorexic teenagers whose bodies “do not conform” to what they feel. We do this because we care about them and want to help them. But pre-adolescent children and young teenagers who feel that their bodies do not conform to their preferred gender are told to embrace and even celebrate this intuition.

When the moral stakes are highest, we degrade patients by treating them as though they were simply bundles of self-interest.

Autonomy Has Become a Dangerous Metaphysical Myth

The radical form of autonomy that has overtaken our culture is a metaphysical myth, and a dangerous one at that. emphasizes human will over human nature and creates hierarchical tiers of moral status, betrays a breathtaking arrogance.

cultural tsunami, and for our protection moral philosophers have placed a leaky water pail in our hand. Physicians have been indoctrinated to believe that we must not introduce our personal moral judgment when caring for our patients

Philip Hawley, Jr., MD, is a hospice physician and former Assistant Professor of Clinical Pediatrics at University of Southern California Keck School of Medicine. His novel, STIGMA, was published by HarperCollins.