Autonomy and Trust in Bioethics explores the complex issues of autonomy and trust in the modern life as they apply to medicine, science, biotechnologies and the impact that these fields have on a variety of people, both those working in those fields and those who work with them. Individual autonomy and related concepts that figure so prominently in modern bioethical discussions are compared in many ways, both philosophically and ethically, to issues of trust and how autonomy and trust may or may not be compatible under certain views of the responsibilities and obligations of medicinal, scientific and biotechnological advances.

Part 1 investigates the meteoric rise of the importance of autonomy in modern bioethics and the relationship that its rise may have had to the concurrent fall of the importance of trust. The nature of autonomy and trust in light of their respective entailments for the medical, scientific and biotechnology sectors as well as the public are reviewed in light of the current status of the importance of autonomy and informed consent.

Part 2 addresses the issues of the importance of autonomy in light of questions of individuality, informed consent, capacity for consent and consumerism. From the increasing value placed on autonomy in a modern medical setting, the author also looks at the effect on trust and the relationship between patients and doctors.

Part 3 addresses one of the more contentious issues in bioethics in modern life. Reproductive technologies and reproductive autonomy are examined by looking at the evolution of issues related to reproductive technology and how the most delicate and polemic points have changed from fertility control to infertility control. The various ‘rights’ that some groups want to encourage and the inevitable conflict when the rights of one group are set against the rights of another are evaluated with an historic and ethical view of the responsibilities and obligations of all the parties involved in any reproductive question, especially those of a child born through new or controversial reproductive technologies.

Part 4 explores the ethical inadequacy of individual autonomy and the possibility of principled autonomy as proposed by Kant. The requirement that autonomy be more than individualistic is considered and the demands that accepting this pluralistic and principled autonomy places on the nature of autonomy, consent and trust are developed with examples from modern issues in bioethics. Additionally, O’Niell draws on an extensive history of study of Kantian philosophy to explore the relationship between a Kantian principled autonomy, practical reason and the importance of trust in human rights, political legitimisation and human obligations. The author analyses the justifications for basic principles of human rights and the merits of grounding the basic rights in ideas of goodness, human obligation or a Kantian principled autonomy.

Part 5 discusses the application of principled autonomy to genetic technologies with particular attention paid to elements of genetic technologies that might violate the rejection of coercion and deception that a principled autonomy requires. Genetic exceptionalism, the idea that genetic test results have a bearing on more than the individual tested, is the source of much debate and issues of privacy and trust in genetic information disclosure.

Part 6 explores the issues of trust as held by the public for many agents that are involved in the medical, scientific and biotechnology areas, as well as sources of information and regulation of these areas. Examples of direct and harmful coercion and deception are contrasted with what might be considered beneficial coercion or deception by paternalistic agents and the effects these both have on the resulting relationships, autonomy and trust. The contrast between trustworthiness and trust is considered, as well as the various motivations that people might have for not trusting in a trustworthy entity, or for trusting in an entity that is not trustworthy. The nature of the relationship between trustworthiness and trust is analysed in light of opinion polls that show that most people do trust modern medicine, science or biotechnology, yet are unwilling or hesitant to place trust in them.

Part 7 illustrates the harm done to and by those who needlessly trust or needlessly mistrust. Blanket scepticism and blanket gullibility both have cost for the people on both ends of the deal and result in harm that may spread to those who have no control over the situation. Here, specific situations regarding trust and suspicion arising from cases of the use of human tissues are discussed. The costs and benefits of informed consent, in strong and weak perspectives, must be weighed against the need for full disclosure or even unforeseen future need.

Finally, part 8 discusses the media and how it affects issues of trust and autonomy in modern bioethical concerns. Individual choice and the consequences for others may limit the expression of autonomy in modern society and the opinions people have about various policies or practices may or may not be compatible with the freedom of choice of others. The bioethical questions and environmental concerns may make the fundamental obligations of the group limit the autonomy of the individual. The role of democratic legitimisation is explored in context. The media also plays an important role in public opinion and trust and yet freedoms of speech, press and expression may give unwarranted free reign to journalists to distort information that can detrimentally alter the trust relationship between an individual and bioethical entities. While auditing of the medical, scientific or biotechnological community may increase trustworthiness, the media is not held to the same standard and may in fact decrease trust in those which are most trustworthy.

The author argues that trust will not be taken seriously without a serious look at all the ideas that principled autonomy entails. The ideas that underlie principled autonomy for the individual in terms of the relationship with medical, scientific or biotechnology bodies must take seriously the ideas of rejecting coercion and deception, not only in direct communication with those bodies, but in indirect communication through information dispersed by other sources such as the media.