[Autonomy, Trust and Medical Ethics in Onora O'Neill's Work].

INTRODUCTION: Autonomy has become a key concept in bioethics. Onora O'neill is perhaps the most representative author and researcher in the philosophical and bioethical fields regrding the concept of autonomy.

OBJECT: To review the concept of autonomy in Onora O'Neill's work so as to understand its relevance in current bioethics.

METHOD: The concept of bioethics is reviewed in relation to three fundamental quesions: 1) Which are the main limitations of the individualistic conception of autonomy? 2) How to understand the relations between trust and autonomy together with their implications? and 3) Which are the implications of principled autonomy for aspects such as doctor-patient relationship and informed consent. The main works by O'Neill are reviewed, specifically regarding medical bioethics.

RESULTS: O'neill's approach is original and relates Kantian autonomy to her own conceptions about trust, and both the individual and social levels of bioethics.

CONCLUSIONS: The author has developed a Kantian non indvidualistic view of autonomy. Her conceptulization of trust and the crises this concept is currently undergoing complement and strengthen the concept of principled autonomy. The implications of O'Neill's concepts go beyond theoretical discussions and in her work she uses examples and analyzes circumstances which demonstrate the applicability of her proposals. O'Neill's work contributes to dealing with the challenges posed by the socio-political context of cost-efficiency oriented health systems and of the so-called defensive medicine.