Ought-onomy and African Health Care: Beyond the Universal Claims of Autonomy in Bioethics

Abstract

Autonomy has been labelled as one of the key principles of biomedical ethics on the premise that it has the capacity to impel universally. Although the conceptual ideals of autonomy immediately seem to conflict with other values, it is adopted in health care to address issues in different socio-cultural contexts. The principles which conflict with autonomy tend to be treated in most cases as secondary, assigning autonomy an overarching value in health care. Consequently, there is a general tendency toward autonomy fetishism in health care. The implication is that a patient should not choose to act otherwise than autonomously, and that this autonomy must be respected in health care contexts generally.

The ideals of autonomy, however, are derived from particular socio-cultural backgrounds, which does not necessarily mean that they are suitable in other contexts. On what grounds then does autonomy assume such central value that it is espoused as a universal principle in health care? This thesis examines the legitimacy of autonomy as a universal principle in health care. Through conceptual analyses of the notion, it critiques the basis on which autonomy claims universal validity as a principle of practices. Furthermore, using a particular African socio-cultural context as an example, it shows that the applicability of autonomy as a principle of practice is limited only to some parts of world. Hence, it cannot be adopted as a general principle of practice in health care.

This thesis proffers ought-onomy as an alternative principle, which subsumes autonomy and equivalent values in other socio-cultural contexts, and thus is the appropriate mediating principle to be adopted in universal health care. Ought-onomy derives partly from the Kantian ought, but differs from it in the sense that it appeals to the reality of the human condition. It qualifies as a principle as its conception is universalizable and its application practicable across socio-cultural boundaries. It is also in a sense a mediating principle as it only finds expression through other values that it subsumes, such as autonomy and communalism.