Philosophy, Psychiatry, & Psychology

Accountability and Autonomy

According to Peteet et al., a person with the virtue of accountable is someone who “embraces being accountable” (p. 51, emphasis removed). The virtue is said to involve two central components:

• • Relational component: “we are accountable to others within relational contexts”

• • Responsibility component: “we are accountable for fulfilling responsibilities appropriate to the relationship” (p. 52, emphasis in original).

What is more, “[a]ccountable people are open to input from others in legitimate roles, take responsibility for their own attitudes, thoughts, emotions and actions, and work to improve or correct their responses to have a positive impact” (p. 51).

Peteet et al. motivate interest in accountability by linking it to autonomy. They claim that, “clinicians have lacked a clear way to relate autonomy to the relational and moral dimensions of mental health and flourishing” (p. 49) and propose that accountability can play this role.

To say that accountability can help foster autonomy might initially seem counterintuitive. On one understanding of autonomy, it involves freedom from limitations and constraints. To be required by another party to carry out certain tasks, for instance, does not seem to promote your autonomy. Even more so if there is a hierarchical relationship involved in which the other person is in a position of power over you.

Suppose Jones works for Samantha, and one day she assigns him the onerous task of reviewing the company’s end-of-the-year budget. This is within the purview of Jones’s job description, and Samantha is not doing anything unfair or unprofessional in assigning him this job for the first time. Furthermore, Jones is qualified to carry it out. He is now accountable to Samantha and accountable for completing this task. But has his autonomy increased in the process? In one natural sense of term ‘autonomy,’ it seems that the answer is no; instead it has declined noticeably. Jones is [End Page 61] now operating under the weight of this heavy professional obligation. It constrains him.

So the first issue that I hope Peteet et al. will clarify in more detail, is what sense of ‘autonomy’ they have in mind when they link autonomy to accountability. They do offer some hints in their paper. For instance, they clarify that autonomy is to be, “understood as both individual mastery and freedom from pathological constraints” (p. 49). But freedom from pathological constraints is a low threshold to meet, and it is unlikely to be sufficient for autonomy since there are many autonomy violations which do not involve pathological constraints. Furthermore, I am not sure what “individual mastery” involves.

Later in the paper, we do get a bit more detail. Peteet et al. write that, “This makes it possible for the accountable person to act autonomously. The accountee has the ability to see that it is right to do what the accountor justifiably expects, and to do so because it is right” (p. 52). These remarks suggest a different approach to autonomy. At least with respect to responsibilities in relational contexts, autonomy seems to be a matter of reflective endorsement of those responsibilities. Hence in our example, so long as Jones judges that it is right (or at least permissible) for Samantha to assign him to review the budget, then his autonomy is not compromised.

Supposing that this is the approach Peteet et al. have in mind, two issues seem to be worth additional discussion. One is about what further conditions need to be in place to protect a person’s autonomy. After all, Jones could judge that what Samantha is doing is right, but only...