Another Understanding of Autonomy in Biomedical Ethics : Focused on Relational Autonomy

Informed consent focuses on personal rationality and only accepts the choices of an individual. Thus, if the family of an incompetent patient makes decisions on behalf of the patient, those decisions are not regarded as autonomous. This article argues that a new approach is needed, one that strengthens patient autonomy and reflects the fact that in countries such as South Korea, a patient’s family memberscan act as proxy decision-makers for patients. This article proposes a new concept—relational autonomy—as an alternative to the flawed concept of liberal autonomy. Relational autonomy, which is an umbrella term focusing on social relationships and interdependent networks of relational selves, considers emotional aspects, interactions in relationships, and the attribute of patient dependency in medical practice. In relational autonomy, the self is not something that is fixed, but rather changes continuously. On this view, the self is a relational and innately social self with mutual relationships that continually develop and transform. A patient’s self is different from the rational self of a physically and mentally healthy person in that a patient must rely on others and is no longer fully independent. In order for a patient to have real autonomy, the concept of relational autonomy requires that certain social conditions, including improvements at the political and legal levels, are met.