Abstract
For decades, the greater part of efforts to improve regulatory frameworks for research ethics has focused on informed consent procedures; their design, codification and regulation. Why is informed consent thought to be so important? Since the publication of the Belmont Report in 1979, the standard response has been that obtaining informed consent is a way of treating individuals as autonomous agents. Despite its political success, the philosophical validity of this Belmont view cannot be taken for granted. If the Belmont view is to be based on a conception of autonomy that generates moral justification, it will either have to be reinterpreted along Kantian lines or coupled with a something like Mill’s conception of individuality. The Kantian interpretation would be a radical reinterpretation of the Belmont view, while the Millian justification is incompatible with the liberal requirement that justification for public policy should be neutral between controversial conceptions of the good. This consequence might be avoided by replacing Mill’s conception of individuality with a procedural conception of autonomy, but I argue that the resulting view would in fact fail to support a non-Kantian, autonomy-based justification of informed consent. These difficulties suggest that insofar as informed consent is justified by respect for persons and considerations of autonomy, as the Belmont report maintained, the justification should be along the lines of Kantian autonomy and not individual autonomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allison, H.: 1990, Kant’s Theory of Freedom. Cambridge University Press
Appiah, K.A.: 2005, The Ethics of Identity. Princeton University Press
Benson, P.: 2005, ‘Feminist Intuitions and the Normative Substance of Autonomy’ in: J.S. Taylor (ed.), Personal Autonomy: New Essays on Personal Autonomy and Its Role in Contemporary Moral Philosophy, pp. 124–142. Cambridge University Press
Buss S. (2005). Valuing Autonomy and Respecting Persons: Manipulation, Seduction, and the Basis of Moral Constraints Ethics 115: 195–235
Christman, J. (ed.): 1989, The Inner Citadel: Essays on Individual Autonomy. Oxford University Press
Christman J. (2004). Relational Autonomy, Liberal Individualism, and the Social Constitution of Selves Philosophical Studies 117: 143–164
Christman J.: 2005, ‚Autonomy, Self-Knowledge, and Liberal Legitimacy’, in: John Christman and Joel Anderson (eds.), Autonomy and the Challenges to Liberalism: New Essays, pp. 330–358. Cambridge University Press
Double R. (1992). Two Types of Autonomy accounts Canadian Journal of Philosophy 22: 65–80
Dworkin, G.: 1988, The Theory and Practice of Autonomy. Cambridge University Press
Hill, T.: 1992, ‚The Kantian Conception of Autonomy’. Dignity and Practical Reason in Kant’s Moral Theory, pp. 76–96. Cornell University Press
Kant, I.: 1997/1785, Groundwork of the Metaphysics of Morals, edited and translated by M. Gregor. Cambridge University Press
Kristinsson S. (2000). The Limits of Neutrality: Toward a Weakly Substantive Account of Autonomy Canadian Journal of Philosophy 30: 257–286
Kymlicka, W.: 1995, Multicultural Citizenship. Oxford University Press
Larmore, C.: 1996, The Morals of Modernity. Cambridge University Press
Larmore C. (1999). The Moral Basis of Political Liberalism Journal of Philosophy 96: 599–625
MacIntyre, A.: 1981, After Virtue. University of Notre Dame Press
Mill, J.S.: 1989/1859, ‘On Liberty’, in: S. Collini (ed.), On Liberty and Other Writings, pp. 1–115. Cambridge University Press
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: 1979, ‚The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research’. Department of Health, Education, and Welfare. http://ohsr.od.nih.gov/guidelines/belmont.html#goc1
Noggle R. (1997). The Public Conception of Autonomy and Critical Self-Reflection Southern Journal of Philosophy 25: 495–515
O’Neill, O.: 2002, Autonomy and Trust in Bioethics. Cambridge University Press
O’Neill O. (2003). Some Limits of Informed Consent Journal of Medical Ethics 29: 4–7
Paris J., Graham N., Schreiber M., Goodwin M. (2006). Has the Emphasis on Autonomy Gone Too Far? Insights from Dostoevsky on Paternal Decision-Making in the NICU Cambridge Quarterly of Healthcare Ethics 15: 147–151
Rawls, J.: 1993, Political Liberalism. Columbia
Sandel, M.: 1982, Liberalism and the Limits of Justice. Cambridge University Press
Sher, G.: 1997, Beyond Neutrality: Perfectionism and Politics. Cambridge University Press
Taylor, J.S. (ed.): 2005, Personal Autonomy: New Essays on Personal Autonomy and Its Role in Contemporary Moral Philosophy. Cambridge University Press
Wood, A.: 1999, Kant’s Ethical Thought. Cambridge University Press
Acknowledgements
I am grateful to Vilhjálmur árnason for helpful written comments, and to my audience at the VIII Annual Swedish Symposium on Biomedicine, Ethics and Society for their input. I also thank the University of Akureyri for a sabbatical during which this research was carried out, and the Philosophy Department at Lund University for providing research accommodation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kristinsson, S. Autonomy and informed consent: A mistaken association?. Med Health Care and Philos 10, 253–264 (2007). https://doi.org/10.1007/s11019-007-9048-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-007-9048-4