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  • Autonomy, Judgment, and Theories of the Good
  • Brent M. Kious (bio)
Keywords

competency, autonomy, voluntariness, objective good, utilitarianism

I am grateful for the insightful comments that have been furnished by Drs. Gala, Moseley, (2015) and Perring (2015) following their reading of my paper (2015). Happily, I find myself in the position of being able to accept many of their criticisms, which identify many of the limitations of my argument as I see them. In only a few cases do I feel that their remarks are misplaced.

The first concern raised by Moseley and Gala is that the paper gives the regrettable impression that persons with anorexia nervosa (AN) generally have few cognitive deficits and primarily experience problems in valuing. But as is widely known, this is false: many persons with AN reason poorly and suffer perceptual distortions. I did not mean to deny this, but the work by Tan et al. (2006) strongly suggests that some persons with AN are not afflicted by significant deficits in reasoning/ perception, and then only the fact that they do not value their own good can account for their non-autonomy. I would add that, in my clinical experience, many patients with AN do not exhibit any noticeable perceptual distortions or deficits in reasoning. Still, these patients sometimes seem non-autonomous. Likewise, I suspect that if a person had all the behaviors of AN but none of the usual cognitive/perceptual distortions, we would still judge her non-autonomous if she declined life-saving medical attention.

Perring’s first salvo is to claim that “the criteria of competency….need to refer to the psychological abilities and properties of the person themselves. In judging autonomy, we assess the person’s rationality and their ability to control themselves” (2015, 17). He thinks this makes my claim about the relationship between autonomy and values “wrong-headed.” He notes (correctly) that I argue that autonomy depends on voluntariness, and (less correctly) that voluntariness depends on whether one’s desires are self-destructive, but then claims (incorrectly) that this means that, on my view, a person’s autonomy depends on others’ judgments.

In fact, however, the relationship between a person’s values and autonomy is much like the relationship between her reasoning and autonomy. In the latter case, there is a fact about whether she is reasoning well (although observers may differ), and this helps to determine her autonomy. In the former case, there is a fact about whether she values well (although observers may differ), [End Page 21] and that helps to determine her autonomy. In both cases, we make judgments about the agent’s autonomy that depend on judgments about her. But in neither is her autonomy itself a matter of judgment per se. True, I base the argument that our concept of autonomy has certain features on the way we use it in our judgments. However, this does not imply that autonomy is a property of others’ judgments, no more than the fact that features of our concept chair can be inferred from judgments about chairs implies that being a chair depends on persons’ judgments.

This goes toward some of Perring’s other concerns. He suggests that my claim “that conventional theories of autonomy already covertly… embody a view of the good…” is methodologically “odd” (p. 19). But the method used in the paper is just straightforward conceptual analysis. We start with the facts that we use the concept autonomy in a certain way (to account for intuitions about when paternalism is appropriate), and that philosophers have claimed that the best analysis of it is value-neutral; I produce examples showing that this conventional analysis is inconsistent with current practice, and suggest that these inconsistencies point toward a better analysis, which is value-informed. The only complication is that the gap between what the value-neutral analysis says about autonomy and what conscientious practices imply about autonomy is filled by ambiguities in our concept of voluntariness. These ambiguities allow it to reflect evaluative considerations covertly. My point is that, although conventional theories of autonomy do not agree prima facie that autonomy is value-laden, they are stretched to do so through use.

Another concern raised...

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