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Background Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. Methods 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. Full articles were screened. All included articles were critically appraised, and a synthesis was produced. Results Fifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. 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. Conclusions Three main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.

Many popular artificial intelligence (AI) ethics frameworks center the principle of autonomy as necessary in order to mitigate the harms that might result from the use of AI within society. These harms often disproportionately affect the most marginalized within society. In this paper, we argue that the principle of autonomy, as currently formalized in AI ethics, is itself flawed, as it expresses only a mainstream mainly liberal notion of autonomy as rational self-determination, derived from Western traditional philosophy. In particular, we claim that the adherence to such principle, as currently formalized, does not only fail to address many ways in which people’s autonomy can be violated, but also to grasp a broader range of AI-empowered harms profoundly tied to the legacy of colonization, and which particularly affect the already marginalized and most vulnerable on a global scale. To counter such a phenomenon, we advocate for the need of a relational turn in AI ethics, starting from a relational rethinking of the AI ethics principle of autonomy that we propose by drawing on theories on relational autonomy developed both in moral philosophy and Ubuntu ethics.

Background Respect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized. Main body Here, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis. Conclusion This article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices.

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making.

Background The implementation of palliative care in China faces distinct challenges influenced by cultural and societal factors that significantly affect terminally ill patients and their families. This case study examines how palliative care interventions adapted to Chinese cultural factors such as death taboos, indirect communication styles, family-centered decision-making, and relational harmony helped empower a patient’s autonomy, facilitate self-expression, and support personal transformation while aligning with Chinese cultural norms. Methods This retrospective study utilized Interpretative Phenomenological Analysis (IPA) to conduct a thorough qualitative investigation of a single case, focusing on how a Chinese terminal cancer patient engaged with and responded to culturally adapted palliative care interventions. The data encompassed notes and audiovisual materials produced throughout the patient’s palliative care process, supplemented by targeted retrospective data collection. The data, originally in Chinese, were translated into English for analysis, using back-translation and independent verification to maintain linguistic and cultural accuracy. Results This study identified three critical mechanisms through which culturally adapted palliative care enhanced the patient’s autonomy and facilitated personal transformation while maintaining relational harmony. The three mechanisms were: (1) a guided card game facilitating autonomous decision-making, (2) spiritual dialogues facilitating self-discovery and transformation, and (3) a communal concert balancing individual expression with relational harmony. Together, these mechanisms empowered the patient to assert personal autonomy and attain meaningful self-expression, all while maintaining significant involvement from family and community. Conclusions This study underscores the critical role of cultural adaptation in implementing palliative care interventions for Chinese patients. The findings demonstrate that culturally adapted palliative care interventions, grounded in relational autonomy, effectively supported a Chinese patient’s autonomy and personal transformation while maintaining relational harmony. These insights are instrumental in informing the provision of culturally adaptive end-of-life care practices in Chinese healthcare.

Background Women’s healthcare decision-making autonomy in Somalia is essential for empowerment and viewed as a fundamental human right. In fragile states, local socio-cultural structures and gatekeeping norms uniquely influence the typical drivers of agency, such as education and wealth. This study provides the first national analysis of the levels and determinants of healthcare autonomy among married women using data from the 2020 Somalia Demographic and Health Survey (SDHS). Methods We analyzed a nationally representative sample of 7,492 married women. A multilevel mixed-effects binary logistic regression model was employed to account for the hierarchical structure of the data, with individuals nested within primary sampling units (PSUs). Autonomy was conceptualized using a relational framework and defined as meaningful participation in healthcare decisions (either alone or jointly). Results Overall, 67.1% of women reported healthcare autonomy. A “Permission Paradox” was identified: women reporting that obtaining permission was a major barrier had significantly higher odds of autonomy (AOR = 1.79; 95% CI: 1.43–2.23; p  < 0.001), suggesting that agency in this context is a negotiated process. Conversely, an “Education Anomaly” was observed, whereby secondary education was associated with a 41% reduction in the odds of autonomy (AOR = 0.59; p  = 0.001). Regional context emerged as the strongest predictor; women in Bakool had nearly 4.5 times higher odds of autonomy (AOR = 4.47; p  = 0.001) compared to those in Awdal. Conclusion Healthcare autonomy in Somalia represents a negotiated agency embedded in geospatial heterogeneity. One-third of women remain entirely excluded from health-related decisions. Policy responses should move beyond individualistic models toward decentralized, culturally grounded interventions that address structural gatekeeping and regional disparities to advance meaningful health equity. Trial registration Not applicable.

This article challenges a key tacit assumption underpinning legal and ethical instruments in health care, namely, that people are ideally bounded, independent, and often also strategically rational individuals. Such an understanding of personhood has been criticized within feminist and other critical scholarship as being unfit to capture the deeply relational nature of human beings. In the field of medicine, however, it also causes tangible problems. I propose that a solidarity-based perspective entails a relational approach and as such helps to formulate new solutions to complex ethical and regulatory questions, ranging from caring for people at the end of their lives to improving policies for organ donation and better governance of health data. It also underscores the importance of universal health care. Although a solidarity-based perspective does not require health to be seen as an individually enforceable right, it does influence our understanding of individual rights: it draws attention to how their meaning is shaped by shared social practices. I conclude by arguing that, in light of current pressures for medicine to become more personalized, using a relational understanding of personhood to shape policies and practices is a much needed endeavor.

How social media impacts the autonomy of its users is a topic of increasing focus. However, much of the literature that explores these impacts fails to engage in depth with the philosophical literature on autonomy. This has resulted in a failure to consider the full range of impacts that social media might have on autonomy. A deeper consideration of these impacts is thus needed, given the importance of both autonomy as a moral concept and social media as a feature of contemporary life. By drawing on this philosophical literature, we argue that autonomy is broadly a matter of developing autonomy competencies, having authentic ends and control over key aspects of your own life, and not being manipulated, coerced, and controlled by others. We show how the autonomy of users of social media can be disrespected and harmed through the control that social media can have over its users’ data, attention, and behaviour. We conclude by discussing various recommendations to better regulate social media.

Autonomy is a core concept for medical decision-making in the United States. Yet as issues of social justice have been increasingly appreciated by American bioethicists, so has the difficulty of reconciling autonomy with unjust contexts. Bioethicists have turned to the feminist concept of relational autonomy to address these issues, but there is disagreement over its implementation. This paper aims to clarify the relationship between unjust circumstances and respect for autonomy by analyzing the utility of relational autonomy for medical decision-making in nonideal social contexts.