Transcript Rethinking Autonomy: Response to Gerard Hastings

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 person’s liberty threatens harms to
others (J.S. Mill’s 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
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