CONTEXTUAL AUTONOMY: TOWARD A NORMATIVE THEORY OF CLINICAL DELIBERATION IN BIOETHICS

Autonomy is a cornerstone of contemporary bioethics, yet existing models struggle to guide medical decision-making in contexts involving patients, families, healthcare professionals, and institutional constraints. Through a comparative philosophical analysis of principlism, relational autonomy, African conceptions of personhood, and Confucian medical ethics, this article identifies the absence of an integrated normative framework for clinical deliberation. It introduces contextual autonomy as the foundation of a normative theory that articulates the patient's authentic will, significant relationships, contextual factors, and shared responsibilities. Structured around five normative principles and illustrated through a clinical case, this framework provides a coherent model for legitimizing medical decisions in pluralistic societies. Contextual autonomy thus contributes to contemporary bioethics by reconciling universal ethical commitments with the diversity of clinical and cultural contexts.