Commentary on Boyd

- Masahiro Morioka
CIAS, Osaka Prefecture University,
Gakuencho, Sakai, Osaka, 599-8531 Japan
International Network for Life Studies


Eubios Journal of Asian and International Bioethics 10 (2000),119.
Boyd concludes her argument by saying that a defensible theory of the nature and value of individual autonomy will fall between radical individualism and extreme collectivism, and autonomy can only take place in a beneficent environment where health professionals respect the dignity of persons. She thinks of autonomy as a facet of process, of relationships, a component of the whole. I fully agree with her on these points. Autonomy without compassionate human relationships will never provide us true satisfaction and happiness.

The problem is how we should evaluate un-autonomous attitudes of a patient. In Japan, some patients prefer not to be autonomous, like Bea, and show passive attitudes, nodding and smiling to every question, and finally say "I will leave everything to you." This attitude has been interpreted as Japanese virtue, "thinking others first, doing for oneself last." Even today, we often see a senior patient say to the doctor "I will leave everything to you" and the doctor replies "Please leave it to me. I will do the best for you." Japanese patients' rights activists have been puzzled by their attitudes because it looks like the abandonment of their own autonomy, and this must be ethically wrong according to theory of bioethics.

Some people say that this abandonment can be interpreted as a sort of autonomous abandonment, based on the patient's own will, hence, this is not contrary to the principle of autonomy. But others doubt this explanation on the ground that once we interpret it as this, we will never be able to distinguish true autonomous abandonment from "cleverly forced pseudo abandonment." We should be very sensitive to power relationship between the doctor and the patient, and power relationship among the family members. What the patient utters sometimes does not represent the patient's true inner ideas and/or emotions. Autonomy theory does not necessarily work in a clinical setting.

We have to see the "human being" before us, instead of seeing the theory existing inside our brain. In this connection, Boyd's idea that autonomy is a facet of process and relationship give us a hint. We have to be careful enough to see "autonomy" or "the abandonment of autonomy" in the midst of the process, and think what sort of relationships have been made between related people so far. This would be a clue to grasp what the patient really wishes. Boyd observed the patient well, and tried to understand the person from the inside. This must be the most important attitude for people around the terminal patient.

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