The many faces of autonomy

The challenge in maintaining patient autonomy regarding medical decision-ma king and confidentiality lies not only in control over information transfer red to and regarding patients, but in the ambiguity of autonomy itself. pos t-modernity is characterized by the recognition of not just numerous accoun ts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, a nd an element of human flourishing. In each case, it can have a different c ontent, depending in part on whether it is given a nomological or a volitio nal construal. Different accounts of autonomy can lead to strikingly differ ent understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of auto nomy they themselves affirm. In the face of competing accounts of moral pro bity, autonomy in a secular morality and bioethics must by default be under stood in terms of the permission of patients, which makes space for numerou s moral accounts and different communal construals of free choice, which in turn will legitimate different practices of informing patients and maintai ning confidentiality.