Autonomy and Chronic Impairment

Dissertation, The University of Tennessee (2000)
This dissertation challenges the conception of autonomy that dominates bioethics and health care and defends a feminist relational conception of autonomy as an alternative. The work proceeds in four major steps. First, I analyze the conception of autonomy put forth by Tom Beauchamp and James Childress that dominates bioethics and health care. While noting the value of autonomy, I show significant limitations of B&C's view. ;Second, I explore the experience of autonomy for people with chronic impairment. I discover that any acceptable conception of autonomy will account for relational features of self-identity and self-governance. To the extent that autonomous people are "independent", I discover that they have a "situated-independence". That is, their independence is understood in terms of particular and extensive sorts of interconnections and interdependencies with the body, others, and the world. In this scenario, autonomy becomes a social project. ;Third, I present and assess Hardwig's conception of autonomy as the responsible use of freedom. This view is responsive to some of the relational features of self-identity and self-governance already shown to be important. Yet I show that this view has troubling implications. ;Fourth, I advance a feminist conception of relational autonomy, grounded on a notion of relational selves that extends the self from human consciousness to body, others, and the structures of the world. I show that relational autonomy emerges from a cluster of knowledge, skills, personal attributes and social conditions yielding a family resemblance of conditions, at least within cultural groups, although any instance of relational autonomy will have different dynamic configurations. My procedural view remains neutral about the actual content of people's desires, values, beliefs and emotional attitudes. I argue that a conception of relational autonomy requires dropping the language of "respect for" autonomy in favor of "promoting and sustaining" relational autonomy. This view of autonomy retains the value of both B&C's and Hardwig's conceptions of autonomy and avoids their major problem. Despite some problems of its own that may limit its application in practice, I maintain that a conception of relational autonomy is preferable to those advanced by B&C and Hardwig
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