Autonomy and its limitations in artificial reproduction.
We have examined the concept of autonomy and some of its limitations. The choice between comprehensive and paternalistically modified information giving is not necessarily easy and the competence of a patient to comprehend and give informed consent in medically complex issues may be limited. In extreme cases, such as mentally defective persons, the consent-giver is unarguably incompetent to directly exercise autonomy and a substitute consent-giver or decision-maker is required. In most circumstances decision-making should be devolved to patients as much as possible, notwithstanding the faulty heuristics frequently displayed. This is not only because autonomy is an important principle in its own right but because an internally inconsistent decision is still likely to be closer to an individual's theoretical ideal decision than a decision based on a substitute decision-maker's values. We can see from the examples discussed that there are many instances where principles, guidelines, rules or laws propounded for the benefit of one party may restrain autonomy, beneficence and justice done to another. We would not wish to see anarchy occur in any branch of medicine but is there evidence that restricting the autonomy of the parties involved will necessarily prevent that? We argue that restraint on the autonomy of individuals in reproductive medicine should be kept to a minimum and that society is strongest where individuals have the greatest freedom to follow their personal beliefs.
Bromham
D R
DR
Lilford
R J
RJ
D026683:Advisory Committees; D026686:Beneficence; D002651:Child Advocacy; D032882:Comprehension; D030881:Disclosure; D004992:Ethics, Medical; D005260:Female; D005333:Fetus; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D033261:Maternal-Fetal Relations; D008962:Models, Theoretical; D018587:Oocyte Donation; D010290:Parents; D026706:Paternalism; D010344:Patient Advocacy; D026684:Personal Autonomy; D010820:Physicians; D012747:Sexual Partners; D012926:Social Control, Formal; D012945:Social Values; D013094:Spermatozoa; D013533:Gestational Carriers