Abstract

The subject of this dissertation is autonomy in medical ethics. The main thesis is that while there are some positive aspects to the principle of autonomy, the overall concept presents significant dangers for the future of medicine. The problems are found in the fact that modern principles of autonomy in medical ethics are moving towards a libertarianism that is dangerous because it produces a form of moral thinking that is incompatible to Scripture. ;In chapter one, I begin with a summary of the work of evangelical ethicist Nigel Cameron. Using Cameron as a point of departure, I investigate his claim that the Western medical ethics has tradition of transcendent moral accountability. The pagan and Christian versions of the Hippocratic Oath are reviewed along with later statements. Two modern medical ethicists who continue the tradition of transcendent moral accountability are also summarized: Edmund Pellegrino and Paul Ramsey. ;Chapter two addresses the rise of autonomy as a foundational principle in medical ethics. The philosophical roots of autonomy in medical ethics are traced to Immanuel Kant and John Stuart Mill. Two historical influences that have contributed to the rise of autonomy in medical ethics are then summarized: the experience of Nazi Germany and the emergence of life-sustaining technologies. Because definitions of autonomy differ, a tripartite paradigm for autonomy is developed. This paradigm is then used to evaluate patient and physician autonomy in chapters three and four respectively. ;In chapter three I utilize the theological concept of the "image of God" to determine the degree to which patients have partial moral autonomy. I also review the use of conscience and Scripture as limits on patient autonomy. In chapter four I argue that the sanctity of human life is a necessary limit on the partial moral autonomy of a physician. Furthermore, I discuss the dangers of limiting decisions to experts under the category of the physician and civil autonomy. ;In my conclusion I review aspects of autonomy in medical ethics which are consistent with transcendent moral accountability, those which are not, and prospects for the future