Trusteeship-based autonomy: comparative view of Islamic and secular bioethics

Patient autonomy is frequently presented as a central source of tension between secular and Islamic bioethics. This article argues that the disagreement concerns less the recognition of patient agency than the moral foundations, scope, and limits of bodily authority. Through comparative conceptual and normative analysis, it examines three secular approaches—principlism, responsibility-based autonomy, and relational autonomy—alongside a prominent strand of contemporary Sunni-oriented Islamic bioethics. The comparison addresses six dimensions: moral authority, the status of the body, the scope of autonomy, conceptions of harm and benefit, structures of responsibility, and the circumstances in which valid consent remains ethically insufficient. The analysis reveals substantial convergence regarding informed consent, decision-making capacity, voluntariness, bodily integrity, harm prevention, professional responsibility, and justice. To clarify this distinction, the article develops trusteeship-based autonomy as an analytical model in which patients exercise genuine medical choice within obligations associated with embodied life. The model separates substantive limits on available interventions from paternalistic transfers of decision-making power away from patients. The article’s principal contribution is to provide a comparative framework that moves beyond the conventional opposition between secular autonomy and religious paternalism by distinguishing patient agency, valid authorization, and substantive permissibility.