Abstract
How much understanding should be required of a person with respect to her actions and their implications for her to be autonomous with respect to her decisions to perform them? I defend a thin approach to the question of how much understanding of her acts a person should possess for her possibly to be autonomous with respect to her decisions to perform them: That a person could be autonomous with respect to her decision to perform a certain action if she understood both the nature of the act and its expected implications under the intensional description under which she intentionally performed it. This paper is divided into three sections. First, I argue that a concern for the moral value of autonomy does not undergird the ethical requirement to secure a person’s informed consent to her medical treatment. Second, I respond to several objections that have been leveled against this argument that focus on its implicit premise that only a thin understanding of one’s actions is required for one to be autonomous with respect to one’s decisions to perform them. I conclude by indicating why this minimalist account of autonomy that I defend is preferable to its more robust competitors.
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Notes
- 1.
This focus in this essay is on “local” models of autonomy, which provide an account of what it is for a person to be autonomous with respect to some particular mental state or act, rather than on “global” accounts, which focus on what it is to have a capacity for autonomy.
- 2.
Here, the focus will be on what it is for a person to be autonomous with respect to her decisions—although the arguments for the thin approach to the degree of understanding that is required can be reprised with suitable modifications to establish the degree of understanding required for a person to be autonomous with respect to her actions or her effective first-order desires.
- 3.
In this paper I am addressing the question of how much understanding a person must have of her actions and their implications for her to be autonomous with respect to decisions to perform them, and so when I write of a person’s understanding of her actions this should be understood as encompassing their implications, also, since a person’s understanding of these is required for her to understand the actions that she performs (or considers performing).
- 4.
Beauchamp and Childress do go some way in this direction, noting that the degree of understanding that is required will be context-dependent—although this is still merely the first step towards providing such an account (Beauchamp and Childress 1994, 123).
- 5.
This characterization of what it is to be autonomous is compatible with a wide variety of views of how much understanding of one’s actions is necessary for one to be autonomous with respect to one’s decisions to perform them.
- 6.
This claim is compatible with a person choosing to abdicate her decision to her healthcare provider, perhaps believing that he will make a better decision for her than she will.
- 7.
Many, but not necessarily all, cases. It might be that the healthcare provider inadvertently failed to secure his patients’ informed consent to her treatment for a reason other than negligence that could be excused.
- 8.
Note that the claim that they suffered from diminished autonomy with respect to these acts is compatible with both the claim that they were nonautonomous with respect to them, and the (weaker) claim that while they were autonomous with respect to them, this was to a reduced degree.
- 9.
A version of this objection appeared in the original version of this paper; this (more robust) version was pressed on me by John Christman.
- 10.
Widely, but not universally (see Mullin 2007).
- 11.
I thank Jessica Flannigan for pressing a version of this objection.
- 12.
This “Degree Condition” for autonomy is supplemented by both a Threshold Condition and a Tracing Condition to provide an account of “practical autonomy” (Taylor 2009, 6–11). Note that as it was explicated in Practical Autonomy and Bioethics this account of practical autonomy is incomplete. This is because, in brief, it held that a person would be autonomous with respect to her decision to perform a certain action if the information on which she based her decision had not been affected in some way without her knowledge by another with the aim of leading her to make a particular decision, or particular type of decision, or, if it had, she was aware of how it had been so affected (the Threshold Condition), and if she was satisfied that the decision-making procedure that she used to make the decision in question was that which she was satisfied with in making decisions of that type (the Degree Condition). But this account allows the possibility that a person could be manipulated into being satisfied with a decision making procedure that she used to make a decision D when she normally would not be satisfied with that procedure in making a decision of type D. And if such manipulation was done with the intent of her making a particular decision D without admitting the possibility that she would revise her decision then she would not be autonomous with respect to D. Given this possibility, the original Threshold Condition must be modified, so that it applies not only to the information on which the person in question bases her decision about whether or not to do X, but also to the information that the persons’ satisfaction with her decision is based upon. I thank Steve Weimer for pressing me on this point.
- 13.
This is a good thing for Maclean, for there are two problems with his first premise, both in itself and when conjoined with the example of Iago and Othello. First, the question is not whether A’s capacity for autonomy (i.e., his ability to be autonomous) would be compromised by the degree to which he understands his actions and their implications, but whether the degree to which he understands them is sufficient for him to be autonomous with respect to them. This, however, might be merely a semantic issue, and there will be no violence done to the premise if this were changed. However, when Maclean applies this premise to the case of Iago and Othello he claims that Iago did not constrain Othello’s ability to ensure that he was sufficiently well-informed about his situation. This claim is either straightforwardly mistaken (for the very point of Othello is to show how Iago manipulates Othello) or else Maclean has an implausibly restricted view of what would count as one person’s constraining another.
- 14.
As part of his argument against the thin account of understanding that a person must have of her actions and their implications in order for her to be autonomous with respect to her decision to perform them, Maclean argues that control should not be understood as an intentionally characterized concept, and that one person could exercise control over the actions of another without thereby intending to do so. In support of this view he offers an example in which children inadvertently switch train tracks from one line to another, and thus “undermined the railway company’s control of the train’s route”; an example, he believes, whereby one party’s control is undermined unintentionally by another. But this example fails to show that control can be exercised unintentionally, for the children do not control the direction that the train goes in; they merely affect it. To see the distinction here, consider the difference between a leaf’s being blown by the wind as it falls, and its being choreographed in its falling by someone with a radio-controlled device whose receiver and engine she has attached to the leaf, so that it will weave the patterns that she desires as it descends. Here, the wind would not control where or how the leaf falls, but would merely affect this; the person with the radio-controlled device, however, would control it, and not merely affect it, for she would intentionally direct its falling. More generally, note that Maclean’s example here fails to touch the examples of Othello and Pseudo Othello, for the childrens’ switching of the tracks does not affect (and so cannot control) the decisions of the railway company’s personnel; nor does it affect (and hence does not control) their actions. Instead, they merely affect (but do not control) the outcomes of these decisions and actions. As such, Maclean’s example is irrelevant to the Shakespearian examples which focus on establishing that for one person to control the decisions (and hence actions) of another she must intend to do so, for it does not address this point at all.
- 15.
Although it might be that this would still be the most defensible approach, as is indicated below.
- 16.
This appears to be the understanding of autonomy that Mele accepts at times (Mele 1995, 180, 181).
- 17.
This criticism of the thin account of how much understanding is necessary for autonomy is similar to that which Berlin (Berlin 1969, 124) recognizes could be leveled against the negative account of freedom.
- 18.
A weaker requirement might be that a person is autonomous with respect to her decisions only if it is likely that they will lead to her will being instantiated in the world. But while this might be a more plausible version of the more robust approach to autonomy, this plausibility comes at the cost of even more vagueness is its application.
- 19.
An earlier version of this paper was presented at the “Thick Concepts of Autonomy Conference” at the Center for Advanced Study of Bioethics, Westfalische-Wilhelms-Universität, Münster, Germany, October 2012. I thank all of the participants in that programme for their exceptionally helpful comments on my paper which helped me to improve it greatly.
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Taylor, J.S. (2022). How Much Understanding Is Needed for Autonomy?. In: Childress, J.F., Quante, M. (eds) Thick (Concepts of) Autonomy. Philosophical Studies Series, vol 146. Springer, Cham. https://doi.org/10.1007/978-3-030-80991-1_7
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