The American Journal of Bioethics
Porous or Contextualized Autonomy? Knowledge Can Empower Autonomous Moral Agents Eric Racine, Institut de recherches cliniques de Montreal, Universite de Montreal, and McGill University Veljko Dubljevic, Institut de recherches cliniques de Montreal and McGill University The principle of respect for autonomy and the underlying concept of autonomy implied by this ethical principle have been cornerstones of medical ethics and clinical practice since the later part of the 20th century. Indeed, the exercise of clinical professions has been fundamentally changed based on the progressive recognition of the rights of patients to self-determination and related implications for health care systems of liberal democracies and beyond (Durand 1999). Some bioethicists have explicitly argued for the foundational role of this principle (Engelhardt 1996), while others have criticized its prominence to the detriment of beneficence (Pellegrino and Thomasma 1988); many consider the principle as a fundamental and inescapable component of our normative horizon and one to be considered in a reflective equilibrium with other important principles (Beauchamp and Childress 2009). Beever and Morar (2016) argue that bioethics has generally neglected social and psychological aspects of the concept of autonomy. Moreover, they fault the concept of relational autonomy, often associated with feminist scholarship, for failing to capture explicitly some other important determinants of choice such as evidence about the impact of the microbiome on human behavior and human health. They question the descriptive adequacy of the concept of autonomy and advocate reconsidering the normative value of the principle of respect for autonomy. We highlight two challenges to their argument: first concerning their (implicit) objectivist and essentialist stance toward capacities relevant for autonomy, and second, their misplaced devaluation of the normative principle of autonomy. We propose that a concept of “contextualized autonomy” (e.g., Racine et al. in press)—which relies on a recognition that autonomy is a set of agential capacities (see also Dubljevic 2013) exercised in context and one that originates in the experience of the agent—can integrate the useful insights they describe while avoiding these two pitfalls. We leave aside the nevertheless important task of scrutinizing critically the authors’ claims about microbiome research.
THE OBJECTIVIST AND ESSENTIALIST STANCE TOWARD AUTONOMY Beever and Morar fault mainstream bioethics for not taking into account evidence from the biological and environmental sciences indicating that autonomy is influenced by a host of factors. This is the crux of the criticism of autonomy 1.0, an account of autonomy suggesting that moral agents have a capacity for self-sufficient, self-determined decisions, that is, a capacity defined in abstract terms without much understanding or appreciation of determinants of choice. Importantly, it is true that feminist ethics (autonomy 2.0), and much before that pragmatist theory, have brought attention to some important determinants of choice, notably those of a social and psychological nature (e.g., hierarchies, gendered attitudes). However, feminist theory (unlike pragmatism) may have neglected involuntarily or voluntarily (e.g., to avoid biology-based gender essentialism) other determinants of choice. This is a point we concur with and has led to proposals for “contextualized autonomy” to reflect the broad spectrum of relational, psychological, and biological aspects of choices (Racine et al. in press; Dubljevic 2013). So far, so good. However, Beever and Morar, when reviewing findings and perspectives underlying feminist scholarship and microbiome research, come to the troubled conclusion that the status of autonomy, as an ethical construct, is jeopardized. However, this interpretation needlessly pits knowledge about social and biological determinants of choice against the ability to act autonomously. Unfortunately, the authors join the long tradition of dualist metaphysics (well reflected in autonomy 1.0 and somewhat in autonomy 2.0) where the capacity to act autonomously is salvageable only if considered to be “outside” the realm of causally described (social, biological, etc.) phenomena. Consequently, more knowledge about such phenomena appears to jeopardize the capacity to be autonomous and free; the more we learn about such determinants of choice, the less we seem free. However, more than the actual scientific knowledge, it is perhaps this outdated metaphysics that needs to be criticized and overcome.
Address correspondence to Eric Racine, Institut de recherches cliniques de Montreal, 110, avenue des Pins Ouest, Montreal, Quebec, H2W 1R7, Canada. E-mail:
[email protected]
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February, Volume 16, Number 2, 2016
