title: The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine.
abstract: The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care (and the unit of value) is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics.
authors.affiliation: a The University of Central Florida.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Beever
authors.affiliation: b University of Oregon.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Morar
mesh_terms: D001921:Brain; D003210:Concept Formation; D026689:Ethical Analysis; D028663:Ethical Theory; D019513:Feminism; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007398:Interpersonal Relations; D028681:Moral Obligations; D009765:Obesity / Q000382:microbiology; D010361:Patients / Q000523:psychology; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics; D015430:Weight Gain
keywords: autonomy, relational autonomy, individual, biological constitution, microbial ecology