Evaluating Digital Health Innovation: The Case for Person-Centred Care Metrics Alongside Efficiency.

The moral concept of autonomy has become increasingly important in liberal societies over the last few decades, but discussions of autonomy still have to overcome the challenges arising from the different definitions that the concept has been given. These include self‐governance, self‐expression, a Kantian adherence to principles of obligation towards other agents arising from universalising reason, and the right of a person to act upon their own judgement when deciding about matters of their own life, without interference from others []. The moral principle of respect for autonomy, describing a moral obligation not to interfere with a patient who is choosing to act in line with their own beliefs and values, has become a foundational moral consideration in clinical practice []. This principle highlights the importance of the patient's perspective, ensuring that patients are respected as agents and maintain control over their lives and bodies. Despite the insistence of its authors [], the widespread adoption of Beauchamp and Childress's four principles of biomedical ethics into medical practice and education in liberal societies has been interpreted to give autonomy pre‐eminence over other moral principles. This understanding of autonomy as the ‘first among equals’ [] and as the overriding moral consideration in medical decision‐making, has resulted in autonomy‐based justifications of courses of action or treatment, to the exclusion of other moral considerations, and has been described as the ‘triumph of autonomy’ []. Arguments have been made for autonomy‐based approaches to assisted dying. For example, Petersen and Dige have argued, through their critique of arguments that requests for assisted dying are not autonomous, that assisted dying should be legalised because people can request assisted dying autonomously []. Braun has argued that a person's autonomous request for assisted suicide should be the only requirement for the provision of such assistance, because justifying such assistance by any other moral principle, such as beneficence, creates an expressivist objection where some lives are judged worth living and others not [].