The value of autonomy

Autonomy has both intrinsic and instrumental value. The intrinsic value of autonomy arises from its relationship with rationality and its necessity for agency, moral personhood and the ascription of moral responsibility. As O’Neill recognised, ‘ethics can be addressed only to those who can reason, deliberate and act; . . . [such] debates must take agency . . . seriously’.62 If I am to be held responsible for both the good and bad things I do, then I must have sufficient agency to be counted as the author of those acts, which demands that I have chosen to do the act for my own reasons, irrespective of the existence of possible alternatives.63 This in turn requires that I am an autonomous individual. If I shot someone because a more physically powerful person forced the gun in my hand and squeezed my finger on the trigger I would not be held responsible for the death. Similarly, if I had been brainwashed or hypnotised into shooting someone I would not be held responsible. The importance of autonomy here is that it is an essential constitutive element of agency and the more autonomous one is the better one is able to act as an effective moral agent.64 However, while autonomy may be necessary to agency it is arguably not sufficient. It is possible for people to be autonomous, in the sense of instrumentally rational selfdetermination, but not be morally responsible agents because they lack the capacity to recognise, and be motivated by, moral norms.65 This does not wholly undermine the connection between autonomy and agency since rationality, even in the ‘thin’ sense of instrumental rationality, remains necessary for agency.66 This simply shifts the debate to the value of agency, which derives from the control agents have over their lives; while agency does not stop us from being acted upon it does allow us to shape and affect the world and our own lives within it. Although the value of agency rests in the possibility of control, its importance does not lie in independence from others’ influence. The claim that I would rather make a bad decision than cede the decision

to an expert does not undermine my agency.67 Rather, it is a necessary part of responsible agency that I decide whether or not to accept the expert’s advice, or indeed allow the expert to decide for me. The value of agency is predicated on the equality of moral agents such that, without some justification other than the claim that he or she knows better than me, no moral agent has the authority to impose his or her opinion or decision on any other moral agent. It is perfectly rational and autonomous to acknowledge and rely on the expertise of others where there is good reason to do so. However, if autonomous persons are to be moral agents, they must be allowed to make those decisions and it smacks of the arrogance of infallibility to claim that simply because healthcare professionals are recognised as experts they should be allowed to override the patient’s agency. The alternative to agency is that we are only capable of reaction rather than action: that the environment and our instinctive responses to that environment wholly shape our lives. In such a world praise and blame would be tools of ‘manipulation or training’ and we would have no reason to retain ‘reactive attitudes’ such as gratitude and admiration.68 This would undermine ideas of responsibility, personhood and a sense of self.69 As Wolf commented:
A world in which human relationships are restricted to those that can be formed and supported in the absence of the reactive attitude is a world of human isolation so cold and dreary that any but the most cynical must shudder at the idea of it.70
Thus, if we are to see ourselves as responsible agents, and we must if we wish to hold on to reactive attitudes to each other, autonomy is essential.71 Furthermore, far from being isolationist, autonomy is crucial to developing social relations that have any meaning beyond purely instinctive behaviour. Additional support may be gained, for this argument that autonomy is intrinsically valuable, from the similarities between the characteristics of personhood that give the individual intrinsic moral value and the nature of autonomy. The features that constitute personhood include conscious .

awareness of self and others; the ability to reason; the ability to act independently of external control; and an awareness of the self as a being with a future.72 The more persuasive accounts of autonomy tend to require a rational being that is consciously self-aware and hence would count as a person.73 If personhood is seen as intrinsically valuable then so must autonomy. As Richards suggested, ‘The development of . . . [autonomy] is, from the earliest life of the infant, the central developmental task of the becoming of a person.’74 What this means is that morality is contingent on the existence of autonomy, which is the central characteristic of personhood that allows us to be treated as equal members of the moral community, be held responsible for our actions and be capable of relationships based on reactive attitudes. The primary argument against the intrinsic value of autonomy is based on a determinist position that attacks the very possibility of autonomy. However, if autonomy is not wholly undermined and some degree of selfdetermination is possible then the argument that autonomy is intrinsically valuable holds fast. Determinism holds that all of our decisions and actions result from the interaction between our genetically controlled characteristics and the environment (including other beings). Every thought I have is a consequence of the interaction between the environment and the physical architecture of the cognitive part of my brain. I am acted upon by external factors and I react to them in a way that would be entirely predictable if only we knew enough about the laws of nature. I am not capable of self-reflection or rationality and the appearance of, and belief in, such behaviour is an illusion caused by chemical reactions that result from the interactions mentioned earlier. There is insufficient evidence to know whether this extreme form of determinism is true. However, even assuming it is, we behave as if it is not and for some people the belief that one has some control over one’s own life is psychologically valuable. Irrespective of whether autonomy is an illusion, those people with a strong internal locus of control are adversely affected if their autonomy is obstructed by, for example, the withholding of information.75 It is also arguable that treating people as if they have autonomy is valuable because it may mean that that those

‘determined’ to respond to moral obligations will do so if such moral obligations exist. Thus, treating people as if they are autonomous may result in behaviour that is beneficial both to themselves and to others within the community. Similarly, behaving as if people have autonomy allows us to retain reactive attitudes towards them making the world more ‘human’ and less mechanistic than it might be in their absence. Finally, it is also arguable that the very idea of scholarship and argument about autonomy suggests that we implicitly believe that we have some degree of autonomy. R€ossler has suggested that:
The failure to lead, or at least the difficulty of leading, an autonomous life is something we are able to comprehend as such, in its very recalcitrance, only because and insofar as we both do and want to understand ourselves always already as being autonomous . . . Otherwise the possibility of that failure would not always be our irritating and disquieting companion.76
This point, that our very concern with autonomy betrays our desire to be autonomous, may be taken one step further. If extreme determinism is true, and it is important to ‘live in accordance with the facts’, then it is important to accept that we have no free will. This acceptance requires us to adopt a particular reactive attitude towards ourselves: that we are blameless for our lives and our conduct. However, extreme determinism precludes reactive attitudes. Even the attitude that we do not have free will presupposes and asserts that we at least have sufficient free will to take the stance that we lack free will.77 This means that living in accordance with extreme determinism would prevent us from adopting any attitude towards ourselves, including that, as beings lacking autonomy, we are blameless. Thus, it is paradoxically illogical to argue that we should behave as if extreme determinism were true. Finally, autonomy may also be intrinsically valuable because of its role in our identity. By making particular choices such as our choice of career and our friends, we foster the development of our character. Thus, autonomy, in the sense of rational self-determination, is essential to our ‘integrity’ as a person.78 The capacity for rational self-reflection allows us to question the values and beliefs to which we are exposed. This in turn allows us to decide for ourselves whether or not to identify with the value or belief in question. Autonomy allows us to choose our goals and the way in which we go about achieving them. It allows us to decide how

to behave towards others. Autonomy is, in other words, crucial to our self-definition. Apart from its intrinsic value, autonomy is also important for its instrumental value. Two instrumental values have already been mentioned. First, for people with an internal locus of control, respecting autonomy is beneficial to their well-being.79 Even when the researchers do not take account of the differing needs of patients with an external locus of control, there are many studies that suggest that the provision of information, which is one aspect of respecting autonomy, is clinically efficacious.80 It may further be the case that helping those with an external locus of control to become more autonomous may be a valuable long-term strategy providing it is done sympathetically and supportively.81 Second, treating people as autonomous may encourage some to take responsibility, accept their obligations and so act in a morally good way, which may be beneficial both to themselves and to the community in general. Another instrumental value is that through reason a person will be better, and more consistently, able to attain desired outcomes (known in this context as ‘goods’).82 Since the capacity for autonomy is a matter of degree and people can be more or less autonomous, this means that the more autonomous a person is the better.83 This has, as a consequence, the possibility that respecting a person and treating him or her as an end, and not just a means to an end, requires us to recognise not only a duty of non-interference but also a positive obligation to support and enhance that person’s autonomy. It is, however, important to recognise that this value is contingent. J.S. Mill argued that since each person’s self-knowledge is usually better than other-regarding knowledge, and since the person who cares most for someone is usually him or herself – and this is especially so when considering society’s interests in its members – competent persons should be allowed the liberty to decide for themselves on matters that affect their own lives.84 This argument supports the principle of

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