Autonomy- A Useful Fiction?

I’ve talked before at length about autonomy, and it’s corollary, paternalism. I’ve also mentioned some problems with free will, and how we may be able to solve it with compatibilism.

Today, I want to tie all of these threads together in light of an article I read in my feminist bioethics class.


Autonomy is an evolving concept. As I usually use it, I mean something like: the freedom to make one’s own informed choices, and decisions about how one’s own life should go based on one’s sense of self and personal narrative about values, etc.

This is not what all philosophers mean by autonomy. Autonomy has also been critiqued as being too focused on the individual, and not being attentive enough to the fact that no human is an island, and that our identities and choices are formed in conjunction and are influenced by those around us- and that as long as there is not coercion involved, this is usually a good things. Humans often flourish by having close, interdependent relationships with other humans.

To get around this critique, some philosophers have tried to argue for what they call Relational Autonomy, which tries to situate autonomy in the relationships and networks that I described above.

Still others might ask though, if we are bringing all these things into autonomy, does autonomy even exist anymore?

Other Influencers

In addition to our human networks, we are also situated in environmental networks. On the macro-scale this looks like our culture, our physical surroundings, the climate of the planet we live on or city we live in. And some philosophers have also posited that it should include the microbial beings that live within us, because it seems that they have some say over what we might think, or what actions may be open to us.

Nicolae and Morar provide an argument that the influences these microbial beings have on us might impinge on our ability to exercise our autonomy, and may in fact mean that autonomy is not a worthwhile concept because it is so fraught and complex. They do so by pointing out that for example, an obese person (language, which I do not agree with) may be unable to become thin because of their gut microbiomes, no matter how much they diet. Obviously, this is an infringement on their ability to craft a narrative about themselves and exercise the values they place on being thin (whether or not those values are culturally constructed and toxic).

However, I think that the choosing is what is important. Despite their inability to realize some desired result, they are still taking action. Coming back to compatibalism, I think this is utterly compelling. If you remember, one of our thought experiments about compatabilism involves a person who is choosing not to intervene in a situation occurring outside. They choose not to intervene. However, what they do not know is that the door is barred and they couldn’t have intervened even if they wanted to.

Nicolae and Morar’s example is in some ways the opposite of this. The door is barred, and they don’t know it, but they still choose to try to intervene. This is something that I think is pretty fucking magical.

Why I think we should keep Autonomy

I also think that this example is a great reason why we should keep autonomy as a value. Autonomy emphasizes that we should respect people’s experiences, and goals that they have for their life, and help them to enable those goals, hopefully both inside and outside of healthcare contexts (because health is so expansive and touches on every aspect of our lives.)

The concept of autonomy empowers people to make decisions about how they want their life to go, and to access resources and treatment options that help them build that life. Some of the goals they describe for themselves may be unattainable, but there is still value in the reaching. Furthermore, as technology advances in concert with social ideas and norms, it is my hope that more limitations on autonomy can be overcome.

If we simply stop and say, “well, you can’t do that because of x, y, and z,” that is an ending. People and the narratives that people have of their lives are made of dreams, and yes, often they are unattainable, but in reaching towards those dreams, that ideal sense of self, is where living happens. We are comfortable in fictions. Why should autonomy not be valuable if it is a fiction?

We could imagine autonomy to be like a superhero’s cape- something to put on when we are in danger, to protect ourselves and those around us. Yes, it is an identity, a kind of falsehood, but symbols and ideas are powerful things. Autonomy as a concept has led to great innovations in bioethics and in healthcare settings. Respect for autonomy has led to us listening to a wider range of voices than ever before. Maybe this will evolve over time, maybe it won’t. Maybe we will find better dressings with which to protect ourselves, but in the meantime, we can use this, and even if it doesn’t solve all problems, it lets us believe that we have a choice, that we have power over our own lives. And if that belief isn’t empowering, I don’t know what is.

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