Singularity and medicine: is there a place for heteronomy in medical ethics?

RATIONALE, AIMS AND OBJECTIVES: In medicine and in clinical practice, autonomy is opposed to heteronomy or paternalism. While autonomy comes down to free choice, independence or self-fulfillment, heteronomy or paternalism are associated with restraints from outside, lack of free choice or dependence. Despite several mediating concepts such as relational autonomy, this opposition stands firm in medical discourse.

METHODS AND RESULTS

Reflecting upon his own heart transplantation but also falling back upon the whole of his oeuvre, we want to analyze what the impact of Nancy's thought can be on the concept of autonomy in medicine. As in Nancy's theory, autonomy and heteronomy are intertwined, how then to understand the autonomous individual in a clinical context? Nancy developed in his book Corpus, the untranslatable French word 'expeausition' to express the exposure of surfaces to one another - playing on the term 'exposition': 'peau', in French, means skin. Skin is literally exposed to contact with another skin or surface. Such exposure and such contact is 'world' he argues, in the same way that a product exchange between two people is. Heteronomy therefore is constitutive for autonomy, not a restraint of it.

CONCLUSIONS

Analyzed from the work of French philosopher Jean-Luc Nancy, there is no such thing as autonomy because every 'self' or 'I' is always already intruded by something from outside. There is no autonomy without heteronomy, he argues and he therefore prefers to speak of an individual as being exposed to the outer world.