Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Autonomy and informed consent are two interrelated concepts given much prominence in
contemporary biomedical discourse. The word autonomy, from the Greek autos (self) and
nomos (rule), originally referred to the self-governance of independent Hellenic states,
but was extended to individuals during the time of the Enlightenment, most notably
through the work of Immanuel Kant and John Stuart Mill. In healthcare, the autonomy
model is grounded in the idea of the dignity of persons and the claim people have on each
other to privacy, self-direction, the establishment of their own values and life plans based
on information and reasoning, and the freedom to act on the results of their
contemplation. Autonomy thus finds expression in the ethical and legal requirement of
informed consent. Feminists and multiculturalists have however argued that since
autonomy rests on the Enlightenment ideals of rationality, objectivity and independence,
unconstrained by emotional and spiritual qualities, it serves to isolate the individual and
thus fails to rectify the dehumanisation and depersonalisation of modern scientific
medical practice. It only serves to exacerbate the problematic power-differential between
doctor and patient. Medicine is a unique profession since it operates in a space where
religion, morality, metaphysics, science and culture come together. It is a privileged
space because health care providers assume responsibility for the care of their patients
outside the usual moral space defined by equality and autonomy. Patients necessarily
relinquish some of their autonomy and power to experts and autonomy thus cannot
account for the moral calling that epitomizes and defines medicine. Recognition of the
dependence of patients need not be viewed negatively as a lack of autonomy or
incompetence, but could rather reinforce the understanding of our shared human
vulnerability and that we are all ultimately patients. There is however no need to abandon
the concept of autonomy altogether. A world without autonomy is unconceivable. When
we recognise how the concept functions in the modern world as a social construct, we can
harness its positive properties to create a new form of identity. We can utilise the
possibility of self-stylization embedded in autonomy to fashion ourselves into responsible
moral agents that are responsive not only to ourselves, but also to others, whether in our
own species or in that of another. Responsible agency depends on mature deliberators
that are mindful of the necessary diversity of the moral life and the complex nature of the moral subject. I thus argue that the development of modern individualism should not be
rejected altogether, since we cannot return to some pre-modern sense of community, or
transcend it altogether in some postmodern deconstruction of the self. We also do not
need to search for a different word to supplant the concept of autonomy in moral life.
What we rather need is a different attitude of being in the world; an attitude that strives
for holism, not only of the self, but also of the moral community. We can only be whole
if we acknowledge and embrace our interdependence as social and moral beings, as
Homo moralis. / AFRIKAANSE OPSOMMING: Outonomie en ingeligte toestemming is twee nou verwante konsepte wat beide
prominensie in moderne bioetiese diskoers verwerf het. Die woord outonomie, van die
Grieks autos (self) en nomos (reël), het oorspronklik verwys na die selfbestuur van
onafhanklike Griekse state, maar is in die tyd van die Verligting uitgebrei om ook na
individue te verwys, grotendeels deur die werk van Immanuel Kant en John Stuart Mill.
In medisyne is die outonomie model gegrond op die idee van die waardigheid van die
persoon en die beroep wat mense op mekaar het tot privaatheid, selfbepaling, die
daarstelling van hulle eie waardesisteem en lewensplan, gebasseer op inligting en
redenasie, en die vryheid om op die uitkoms van sulke redenasie te reageer. Outonomie
word dus vergestalt in die etiese en wetlike bepaling van ingeligte toestemming.
Feministe en multikulturele denkers beweer egter dat, siende outonomie gebasseer is op
die Verligting ideale van rasionaliteit, objektiwiteit en onafhanklikheid, sonder die nodige
begrensing deur emosionele en spirituele kwaliteite, dit die individu noodsaaklik isoleer
en dus nie die dehumanisering en depersonalisering van moderne wetenskaplike mediese
praktyk teenwerk nie. As sulks, vererger dit dus die problematiese magsverskil tussen die
dokter en pasiënt. Die beroep van medisyne is ‘n unieke professie aangesien dit
werksaam is in die sfeer waar geloof, moraliteit, metafisika, wetenskap en kultuur
bymekaar kom. Dit is ‘n bevoorregde spasie aangesien gesondheidswerkers
verantwoordelikheid vir die sorg van hulle pasiënte aanvaar buite die gewone morele
spasie wat deur gelykheid en outonomie gedefinieer word. Pasiënte moet noodgedwonge
van hulle outonomie en mag aan deskundiges afstaan en outonomie kan dus nie
genoegsaam die morele roeping wat medisyne saamvat en definieer, vasvang nie.
Bewustheid van die afhanklikheid van pasiënte hoef egter nie in ‘n negatiewe lig, as
gebrek aan outonomie of onbevoegtheid, beskou te word nie, maar moet eerder die begrip
van ons gedeelde menslike kwesbaarheid en die wete dat ons almal uiteindelik pasiënte
is, versterk. Dit is verder nie nodig om die konsep van outonomie heeltemal te verwerp
nie. ‘n Wêreld sonder outonomie is ondenkbaar. Wanneer ons bewus word van hoe die
konsep in die moderne wêreld as ‘n sosiale konstruk funksioneer, kan ons die positiewe
aspekte daarvan inspan om ‘n nuwe identiteit te bewerkstellig. Ons kan die moontlikheid
van self-stilering, ingesluit in outonomie, gebruik om onsself in verantwoordelike morele agente te omskep sodat ons nie slegs teenoor onsself verantwoordelik is nie, maar ook
teenoor ander, hetsy in ons eie spesie of in ‘n ander. Verantwoordelike agentskap is
afhanklik van volwasse denkers wat gedagtig is aan die noodsaaklike diversiteit van die
morele lewe en die komplekse aard van die morele subjek. Ek voer dus aan dat die
ontwikkeling van moderne individualisme nie volstrek verwerp moet word nie, siende dat
ons nie na ‘n tipe premoderne vorm van gemeenskap kan terugkeer, of dit oortref deur ‘n
postmoderne dekonstruksie van die self nie. Ons het verder ook nie ‘n nuwe woord nodig
om die konsep van outonomie in die morele lewe mee te vervang nie. Ons het eerder ‘n
ander instelling van ons menswees in die wêreld nodig; ‘n instelling wat streef na
volkomendheid, nie net van onsself nie, maar ook van die morele gemeenskap. Ons kan
slegs volkome wees wanneer ons ons interafhanklikheid as sosiale en morele entiteite, as
Homo moralis, erken en aangryp.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/19906 |
| Date | 03 1900 |
| Creators | Rossouw, Theresa Marie |
| Contributors | Van Niekerk, Anton A., Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 369 p. |
| Rights | Stellenbosch University |
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