restricted access Autonomy and Addiction
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Canadian Journal of Philosophy 36.3 (2006) 427-447

Autonomy and Addiction

Neil Levy
Centre for Applied Philosophy and Public Ethics
University of Melbourne
Parkville, 3010
James Martin 21st Century School
Oxford University
Oxford OX1 1PT
United Kingdom

Whatever its implications for the other features of human agency at its best — for moral responsibility, reasons-responsiveness, self-realization, flourishing, and so on — addiction is universally recognized as impairing autonomy. But philosophers have frequently misunderstood the nature of addiction, and therefore have not adequately explained the manner in which it impairs autonomy. Once we recognize that addiction is not incompatible with choice or volition, it becomes clear that none of the standard accounts of autonomy can satisfactorily explain the way in which it undermines fully autonomous agency. In order to understand to what extent and in what ways the addicted are autonomy-impaired, we need to understand autonomy as consisting, essentially, in the exercise of the capacity for extended agency. It is because addiction undermines extended agency, so that addicts are not able to integrate their lives and pursue a single conception of the good, that it impairs autonomy.

 I Accounts of Autonomy

Available accounts of autonomy fall into two broad classes: procedural and substantive (Mackenzie and Stoljar, 2000). Substantive accounts place restrictions on the kinds of preferences compatible with autonomy, whereas procedural accounts are neutral with respect to the content of preferences. Substantive and procedural accounts further divide into structural and historical procedural accounts, on the one hand, and strong [End Page 427] and weak substantive accounts, on the other; there are also accounts that combine substantive and procedural elements. In what follows, I shall not attempt to address every theory in all its variants. Instead, I shall briefly sketch the main lines of some of the better known, with the aim of showing how and why they fail to give the right result when they are applied to at least some cases of addiction.

First, then, a lightning tour of some of the better known accounts of autonomy, beginning with the procedural accounts and moving through to the substantive. The best known account of autonomy is the structural theory associated with Harry Frankfurt (1988). On this view, roughly, someone counts as autonomous if she identifies with her effective first-order desire, where identification is cashed out in terms of a special higher-order desire that that first-order desire be her will. Autonomy is thus a question of the structure of the agent's hierarchy of desires.

This structural account of autonomy is subject to what some see as a devastating counterexample, from cases of manipulation (Slote, 1986; Fischer and Ravizza, 1998). An agent whose preferences are systematically manipulated by a neuroscientist of whose presence she is not aware fails, intuitively at least, to count as autonomous. Yet such an agent might identify with her effective first-order desires. Indeed, there seems no reason, in principle, why her identification might not itself be subject to manipulation. For this reason (amongst others), some philosophers have urged that we place historical constraints upon our conception of autonomy. 

Important historical accounts of autonomy have been developed by Gerald Dworkin (1988) and by John Christman (1991). Christman, for in- stance, argues that for a preference to be autonomous, it must pass a his- torical test: the agent must endorse not only her preference, but also (actually or counterfactually) the process by which she came to acquire it. However, historical accounts themselves seem vulnerable to an objection of much the same kind as that which motivated proponents to reject the Frankfurtian view. It seems that we can as easily be manipulated into en- dorsing a process of preference acquisition as into endorsing a preference. 

Indeed, I can be manipulated into endorsing the very act of manipulation; some philosophers have argued that we should see the preferences of women in some sexist cultures as manipulated in just this way. In fact, there seem to be plenty of real-life cases in which agents who are the victims of extremely unjust societies not...