Rethinking Autonomy: Response to Gerard Hastings

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Rethinking Autonomy Response to Gerard Hastings
Catriona Mackenzie Philosophy Department,
Macquarie University, Sydney
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Outline

• Why is the conception of personal autonomy
  underpinning market rhetoric and ideas of
  consumer sovereignty impoverished?
• Is there a more plausible conception of autonomy
  from the perspective of the aims of public
  health?

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The libertarian or maximal choice view of
autonomy

• Equates autonomy with the satisfaction of
  individuals preferences
• Advocates maximal choice and minimal regulation
• Emphasises personal responsibility for risks
• De-emphasises corporate and societal
  responsibilities to marginalised and
  disadvantaged individuals and communities

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Philosophical Justifications

1. Liberal neutrality thesis the state has no
   business promoting particular values or imposing
   restrictions on individual choice
2. The freedom necessary for autonomy is negative
   liberty. Interference can only be justified if
   the exercise of a persons liberty threatens
   harms to others (J.S. Mills harm principle)
3. Coercive or paternalistic interference by other
   persons or the state constitute the main threats
   to autonomy.

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Problems

• The state can and does play a crucial role in
  shaping our values and fostering autonomy
• Negative liberty is not sufficient for autonomy.
  Autonomy requires access to genuine opportunities
  and the social goods that enable them. These
  goods depend on a well-functioning state
• State regulation and public health interventions
  are crucial for well-being and autonomy

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An alternative relational approach to autonomy

• Autonomy is a complex competence requiring
  extensive interpersonal, social and institutional
  scaffolding.
• Relational approach is attentive to
• the effects of social inequality, injustice and
  oppression on autonomy
• the social constrains and influences on
  individual choice
• What matters is the range of meaningful choices
  available to individuals and communities
• An interest in promoting autonomy entails an
  interest in promoting social justice

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Implications for public health

• Relational approach focuses attention on
  background conditions shaping individual health
  choices
• Is the consumption of junk food an autonomous
  choice or a constrained choice, given these
  background conditions?
• Public health interventions (eg. regulation of
  junk food marketing) can foster autonomy
• To address health inequalities we must address
  the social, economic, environmental etc.
  inequalities that cause them

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Additional suggestion

• To reassert our autonomy we need to reclaim the
  concept reject libertarian, maximal choice
  conception, rethink autonomy as relational