Autonomy and Trust in Bioethics

A very good piece of criticism of some modern trends in bioethics from a distinguished moral philosopher. O'Neill highlights the inadequacies of the emphasis on individual autonomy that characterizes much writing on bioethics, particularly biomedical ethics. O'Neill points out multiple shortcomings of this approach, pointing multiple ways in which individual autonomy fails to provide a solid foundation for many aspects of bioethics. O'Neill argues as well that the emphasis on individual autonomy has contributed in subtle but important ways to erosion of trust in institutions. O'Neill argues for what she terms 'principled autonomy,' a Kantian argument that stresses duties along with rights. This is a fairly demanding position, as O'Neill intends, requiring a real commitment to performance, both at the institutional and individual levels, of crucial ethical duties. In this context, O'Neill discusses the variety of ways in which trust has been eroded and how some efforts to improve trustworthiness, such as increased auditing, professional oversight, and efforts at openness, may have inadvertantly had opposite effects. She then reaches to standards stemming from her concepts of principled autonomy to suggest alternatives, including a reasonable proposal to improve media treatment of biotechnology issues.