Social Autonomy in Obstetrics
On the basis of my studies in social philosophy and my critical examination of Hegel’s thesis on the family, which he regards as a core institution of society with ethical relevance and enhancing freedom, I address biomedical ethics, dealing first and foremost with the concept of social autonomy. In a subproject, I would like to investigate how social autonomy could be conceived in the domain of obstetrics. To conduct a normative-conceptual analysis with a view to formulating the conditions that make autonomous decision-making and action possible, three dimensions appear to me to hold relevance.
Firstly, the relationality of the human must be given consideration. This is expressed, on the one hand, in the empirical fact that humans invariably stand in social relationships (to family members, to people close to them, and to nursing and medical staff), and that these relationships in principle influence the possibility of their self-determined room for manoeuvre in their decision-making and actions. In the area of obstetrics, a further relationship is added to these, the relationship with the embryo/infant. Furthermore, it seems to me that on the conceptual level, on the other hand, relationships of recognition, and the self-perception and sense of self-value that depend on them, constitute also conditions – and in the case of ‘successful’ recognition – also the expression of positive self-determination.
Secondly, special attention needs to be directed towards institutional and structural preconditions for the development of (capability for) self-determination. For example, numerous diagnostic and preventative decisions that have to be made by pregnant women during the course of their medical supervision do not automatically mean that their autonomy has been increased. At the same time, pregnant women have little or no possibility of withdrawing from such situations in which decisions of this kind have to be made.
Thirdly, I would like to pursue further the thought that the relationship to one’s own body is a decisive circumstance for the development and practice of the capability for autonomy. Precisely this perception and feeling towards one’s body undergoes change during pregnancy and birth and has to be set in a new equilibrium. It therefore appears to me to serve as a good example for identifying a fundamental dimension of bodily-ness within a notion of autonomy.
Aspiring to perform a normative-conceptual analysis of autonomy that also has recourse to empirical investigations and observations represents a fundamental methodological challenge. ‘Translation difficulties’ arise in two directions. On the one hand, the status of empirical findings has to be determined in a philosophical analysis. On the other, the issue of how the results of a normative analysis can be ‘translated back’ into the practice of obstetrics needs to be addressed.
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