• Principlism
• autonomy
• personal autonomy
• philosophical ethics

In their Principles of biomedical ethics, Tom L Beauchamp and James F Childress take ‘respect for autonomy’ to be one basic principle of contemporary biomedical ethics. There is widespread agreement that respect for autonomy is deeply rooted in modern common morality, but little agreement exists about its nature, scope or strength. This is why they emphasise right at the beginning that in principlism the principle of respect for autonomy is concerned with individuals' actions (p1031). Originally the term ‘autonomy’ referred to the self-rule or self-governance of independent (Greek) city states and later to states in general. Later, for example, in the philosophy of Kant, autonomy was ascribed to (human) persons meaning the self-ruling of practical rationality. In contemporary philosophy it is disputed what should be taken as the apt extension of ‘being autonomous’. There is disagreement in philosophy whether being autonomous qualifies actions of persons or their character, their personality or their lives. Therefore it is important that readers of the Principles are informed straight away about the extension of the principle of respect for autonomy in principlism. Furthermore, we need some argument why in principlism the principle of respect for autonomy refers to actions and not to the structure of a person's life.

In this paper I discuss Tom L Beauchamp's arguments for the conclusion that in biomedical ethics we should refer to action-autonomy but not to personal autonomy when we use the principle of respect for autonomy in our ethical thinking. In the following, ‘action-autonomy’ is used to qualify actions and ‘personal autonomy’ is used to qualify the structure of a person's life; this distinction is not meant to imply that action-autonomy isn't a feature of a person's overall autonomy. The basic idea is that a person's autonomy can express herself both in action-autonomy and in …