Principlism in Bioethics: How to Consolidate Autonomy? A Scoping Review.

<ns3:p> Background The concept of autonomy in bioethics is subject to significant debate, with scholars describing it in contradictory terms—ranging from “fundamental” and “universal” to “blurry” and “flawed”. Despite its central role in safeguarding patients’ rights, informed choice, and personal integrity, the paradoxical nature of autonomy has led to conceptual fragmentation and academic disagreement. Objectives This study aims to reconcile autonomy with other core ethical principles—beneficence, non-maleficence, and justice—by considering it as a non-absolute principle that can be justifiably infringed upon in certain ethical circumstances. Additionally, it explores how emerging interdisciplinary approaches may refine or consolidate autonomy in bioethical discourse. Results A scoping literature review identifies two innovative yet contentious approaches to autonomy: <ns3:list list-type="bullet"> <ns3:list-item> <ns3:p>1. Narrative Autonomy, which emerges from identity politics and philosophy, emphasises the role of personal narratives in shaping decision-making.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>2. Autonomy-Enhancing Paternalism, influenced by behavioural economics and psychology, proposes interventions that subtly guide individuals towards better decisions while preserving their agency.</ns3:p> </ns3:list-item> </ns3:list> Both approaches offer valuable perspectives but lack broad consensus. In contrast, an interdisciplinary “relational turn”, which underscores informed decision-making within a social and collective framework, appears more promising for strengthening autonomy while addressing ethical tensions in bioethics. Conclusions While autonomy remains a fundamental principle in bioethics, its formulation must evolve to remain relevant in contemporary ethical debates. A relational approach to autonomy—one that integrates social responsibility and collective well-being—may enhance human flourishing and promote social justice while addressing the limitations of traditional models. </ns3:p>