Autonomy and Paternalism

Date: 2015-10-07; view: 494.

Autonomy is the aspect of persons that undue paternalism offends against. Paternalistic interventions can be both interpersonal (governed by social and moral norms) and a matter of policy (mediated by formal or legal rules). Such interventions are identified not by the kind of acts they involve but by the justification given for them, so that paternalism involves interference with a person's actions or knowledge against that person's will for the purpose of advancing that person's good. Respect for autonomy is meant to prohibit such interventions because they involve a judgment that the person is not able to decide for herself how best to pursue her own good. Autonomy is the ability to so decide, so for the autonomous subject of such interventions paternalism involves a lack of respect for autonomy. See also Paternalism.

But as our discussion of the nature of autonomy indicated, it is often unclear exactly what that characteristic involves. Important in this context is whether autonomy can be manifested in degrees — whether the abilities and capacities that constitute autonomy obtain all at once or progressively. If the latter is the case, then it is unclear that a blanket prohibition against paternalism is warranted. Some people will be less able to judge for themselves what their own good is and hence be more susceptible to (justified) paternalistic intervention (Conly 2013).

Often such an obligation toward another person requires us to treat her as autonomous, independent of the extent to which she is so concerning the choice in question. At least this is the case when a person is autonomous above a certain threshold: she is an adult, not under the influence of debilitating factors, and so on. I might know that a person is to some degree under the sway of external pressures that are severely limiting her ability to govern her life and make independent choices. But as long as she has not lost the basic ability to reflectively consider her options and make choices, if I intervene against her will (for her own good), I show less respect for her as a person than if I allow her to make her own mistakes. (Which is not to say, of course, that intervention in such cases might not, in the end, be justified; only that something is lost when it is engaged in, and what is lost is a degree of interpersonal respect we owe each other.)

However, as we saw in the last section, this move depends on the determination of basic autonomy and an argument that such a threshold is non-arbitrary. Also relevant here is the question of procedural versus substantive autonomy as the ground of the prohibition of paternalism. For if by “autonomy” we mean the ability to govern oneself no matter how depraved or morally worthless are the options being exercised, it is unclear that the bar to paternalism (and respect for persons generally) retains its normative force. As I mentioned above, the response to this challenge must be that the decision making capacity itself is of non-derivative value, independent of the content of those decisions, at least if one wishes to avoid the difficulties of positing a substantive (and hence non-neutral) conception of autonomy as the basis for interpersonal respect.

This is merely a sampling of some of the central ways that the idea of autonomy figures in moral philosophy. Not discussed here are areas of applied ethics, for example in medical ethics, where respect for autonomy grounds such principles as that of informed consent. Such contexts illustrate the fundamental value that autonomy generally is thought to represent as expressive of one of the fundamentals of moral personhood.