Relational autonomy: moving beyond the limits of isolated individualism.

TitleRelational autonomy: moving beyond the limits of isolated individualism.
Publication TypeJournal Article
Year of Publication2014
AuthorsWalter JK, Ross LFriedman
JournalPediatrics
Volume133 Suppl 1
PaginationS16-23
Date Published2014 Feb
ISSN1098-4275
KeywordsAdolescent, Child, Communication, Female, Humans, Male, Models, Psychological, Palliative Care, Parents, Pediatrics, Personal Autonomy, Physician-Patient Relations, Professional-Family Relations, Psychology, Adolescent, Psychology, Child, Withholding Treatment
Abstract

Although clinicians may value respecting a patient's or surrogate's autonomy in decision-making, it is not always clear how to proceed in clinical practice. The confusion results, in part, from which conception of autonomy is used to guide ethical practice. Reliance on an individualistic conception such as the "in-control agent" model prioritizes self-sufficiency in decision-making and highlights a decision-maker's capacity to have reason transcend one's emotional experience. An alternative model of autonomy, relational autonomy, highlights the social context within which all individuals exist and acknowledges the emotional and embodied aspects of decision-makers. These 2 conceptions of autonomy lead to different interpretations of several aspects of ethical decision-making. The in-control agent model believes patients or surrogates should avoid both the influence of others and emotional persuasion in decision-making. As a result, providers have a limited role to play and are expected to provide medical expertise but not interfere with the individual's decision-making process. In contrast, a relational autonomy approach acknowledges the central role of others in decision-making, including clinicians, who have a responsibility to engage patients' and surrogates' emotional experiences and offer clear guidance when patients are confronting serious illness. In the pediatric setting, in which decision-making is complicated by having a surrogate decision-maker in addition to a patient, these conceptions of autonomy also may influence expectations about the role that adolescents can play in decision-making.

DOI10.1542/peds.2013-3608D
Alternate JournalPediatrics
PubMed ID24488536