These criticisms have resulted in significant philosophical works calling for a reconceptualisation of autonomy in relational terms. An individualistic understanding of autonomy has been criticized from different theoretical standpoints. Nonetheless, the nature and value of this principle still generates much debate. Since then, respect for autonomy, along with the other principles of beneficence, nonmaleficence, and justice, has provided the dominant theoretical framework for medical ethics. Beauchamp and Childress further developed and popularised the concept in the book Principles of Biomedical Ethics. The Belmont Report originally conceptualised respect for autonomy under the notion of respect for persons. Respect for autonomy has become a key concept in contemporary bioethics. This should in turn lead to better decision-making in real-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. New dialogue among traditionally divergent standpoints will clarify the meaning. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Results are organized according to: (a) an individualistic interpretation of autonomy (b) critiques of this individualistic interpretation of autonomy (c) relational autonomy as theoretically conceptualised (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations. Twenty-eight articles were published in the last 5 years publications were originating from 18 different countries. Resultsįifty publications met our inclusion criteria. All included articles were critically appraised, and a synthesis was produced. Using PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint.
Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions.
Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular.
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