The core idea of personal autonomy is to have personal rule of the self while remaining free from controlling interference by others. The autonomous person acts in accordance with a freely self-chosen and informed plan. A person of diminished autonomy, by contrast, is in at least some respects controlled by others or is incapable of deliberating or acting on the basis of his or her own plans. For example, institutionalized persons, such as prisoners or the mentally retarded, may have diminished autonomy.
In public health, the concept of autonomous decision making is related to informed consent. Virtually all medical and research codes of ethics
There is growing international appreciation of the importance of ethical review of research involving human subjects. Ethical review committees carry the primary responsibility for ensuring that research is scientifically sound, and that informed consent is obtained from research subjects in ways that respect their autonomy and ensure an appropriate balance of risks and benefits.
While informed consent can be obtained in more advanced societies in ways that can be assessed by ethical review committees in terms of subjects being well informed and the consent being understood and responded to by the subject without coercion or intimidation, the situation may be different in developing countries. The informed consent process could be very different in a cultural situation in which the subject is illiterate and the process of seeking consent involves obtaining overall permission from community leadership in addition to individual consent from research subjects. In such situations the challenge is to respect local culture and its processes, while at the same time respecting the autonomous rights of each research subject.
JOHN H. BRYANT
Beauchamp, T. L., and Childress, J. F. (1989). Principles of Biomedical Ethics, 3rd edition. New York: Oxford University Press.
Council of International Organizations for Medical Science (2000). Biomedical Research Ethics: Updating International Guidelines. Geneva: Author.