Ethical principle of respect for autonomy and its limitations

Respect for autonomy – one of the four basic ethical principles – is based on the right for self-determination. An autonomous individual should be offered all relevant information so that he/she can understand the consequences of various options, make free choices and im­plement his/her own decisions. Thus, respecting one’s autonomy involves assuming several ob­ligations, including the obligation to assure anot­her person an optimal degree of autonomous decision-making. Based on the principle of au­tonomy are also the right for protection of per­sonal data. Limiting one’s autonomy should be understood as a stepwise, rather than abrupt all-or-nothing way of restricting one’s right to self determination. Limitations of autonomy are ca­tegorised as follows: voluntary limitations, impl­ying that a person wishes to transfer the right to decision-making to another person; enforced li­mitations which are either justified, i. e. enforced as an inevitable consequence of adjusting the conflicting interests of individuals and society, or unjustified, resulting from restricted information, or from pressures hindering free decision-ma­king, and inevitable limitations of autonomy due to one’s incapacity to make free decisions. In the latter case, we have to rely on advance directi­ves or surrogate decision-making. In advance directives, the crucial question is whether at the time when the statement the person was fully aware of his/her future position, future (not ac­tual) preferences, and implications his/her de­cisions. Respect for autonomy, however, should not be the guiding principle in surrogate deci­sion-making; rather, the decision should rely on the principles of beneficence, non-maleficen­ce and justice.