FEATURE ARTICLE Understanding the Principle of Autonomy in Bioethics: Support for Conscience or Destroyer of Ethical Reasoning?

This practice among many peoples and in accord with some religious traditions in northern Africa affects hundreds of thousands of women. Initial awareness of this practice among the people and ethicists of the First World brought responses of abhorrence and condemnation. Subsequent debate tempered the negative reaction only moderately. Some argued for the importance of respecting local customs and beliefs despite the fact that embedded in such practices is the subordination and mutilation of women. I begin with this issue because a well-meaning doctor once asked me whether or not he could perform female circumcision for a woman from another culture who was demanding it because her husband expected it. After rehearsing the usual arguments, the physician then played the trump card: “But she wants it and you ethicists are always telling us to respect the principle of autonomy for patients!” In what follows, I would first like to explain how autonomy needs to be understood as a condition of moral choice, but has been misconceived as an independent principle of objective morality. Second, I will examine some of the consequences of not distinguishing objective principles from subjective conditions in determining moral courses of action. And, third, I will offer a reflection from out of the Catholic moral tradition that might help deal with this impasse