Autonomía relacional. Hacia una nueva concepción de autonomía en las profesiones de ayudala medicina y el trabajo social

Abstract

This paper considers that the Anglo-Saxon origin of the concept of autonomy conditions its meaning and exercise in all health care situations. Therefore, its foundation, which is currently taken as a guiding principle of healthcare practice, is inappropriate for the relationship of helping in situations of vulnerability or cultural differences. The greatest incidence of the principle of autonomy in the helping professions is due to North American bioethics, with the work of Tom L. Beauchamp and James F. Childress , Principles of Biomedical Ethics (1979). From that moment on, the principle of autonomy acquired a status like no other ethical principle, and a procedure for its implementation was established: informed consent. This study proposes, as a challenge, 1) to analyze the historical concept of autonomy from a liberal perspective and its impact on the professional helping relationship as a fundamental principle of bioethics. 2) to identify the limitations of the current concept of autonomy in the care practice of vulnerable groups. 3) to develop a theoretical foundation that supports the concept of relational autonomy from three ethical perspectives: the ethics of care, the ethics of responsibility, and virtue ethics. 4) to propose the practice of relational autonomy in the field of care processes for vulnerable groups. This paper critically analyzes the instruments established for the materialization of the principle of autonomy in the healthcare and social-healthcare fields -informed consent and advance directives-in groups such as dependent elderly people, people with serious mental disorders, and people from other cultures, including immigrants. Starting from the shortcomings of the conception of autonomy as an individual reality, this work develops the concept of relational autonomy linked to the concept of vulnerability, and its foundation relies on the ethics of care, responsibility, and virtues. In short, this research seeks to support the concept of relational autonomy from a perspective of complementarity with the current concept of autonomy, allowing professionals to look beyond individual characteristics when this principle comes into play in health care processes. It positions itself in favor of an idea of autonomy, in the context of health care, that emphasizes the relationship, in a threefold sense: 1) the relationship with the other, with whom I am engaged in the helping relationship; 2) relationship as an anthropological foundation that conceives the person in a context of relationship or interdependence; 3) the understanding of the principle of autonomy in its relationship with other principles. We have adopted this idea of autonomy as relational autonomy.