The Good of Autonomy and Care for the Whole Person
James Helmer, PhD, Associate Professor, Theology Department, Xavier University
Although the value of respect for autonomy remains central to contemporary practical and theoretical bioethics, this foundational principle continues to receive sustained criticism. For example, philosopher Charles Foster has argued that autonomy's "tyrannical" status cannot be intellectually or ethically justified and ought be jettisoned in favor of other ethical considerations such as non-maleficence and beneficence (Charles Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law). Similarly, in his recent book What it Means to be Human: The Case for the Body in Public Bioethics, legal scholar Carter Snead contends that the contemporary preoccupation with the value of autonomy in public bioethics betrays an orientation of "expressive individualism" -- an anthropologically distorted and highly individualistic conception of the human person that critically overlooks essential features of the human experience as relational, embodied, and vulnerable to risk and to harm, and that ignores the social embeddedness and fundamental interconnectedness of human being, human agency, and human flourishing. As Snead describes it, the dualistic expressivist self, whose flourishing consists in the creation and pursuit of projects that reflect its most deeply held values, is a disembodied ego defined by the exercise of its will and by transactional social relationship.
While appreciative of Snead's attempt to articulate a more "communitarian" bioethics, and sympathetic to the overall anthropological perspective that he defends, in this paper I offer a friendly rejoinder to his generalized critique of autonomy. In arguing from an Aristotelian Thomistic perspective, I maintain that in order to sustain the type of critical argument that Snead is advancing against expressivism, one need refine the argument in order to distinguish sufficiently between different conceptions of autonomy (moral, political, personal). Once the various senses of autonomy are sufficiently distinguished, however, Snead's generalized critique of autonomy is significantly weakened insofar as the specific criticisms that he advances do not apply universally. In conflating different conceptions of autonomy (moral, political, personal), Snead overlooks autonomy's status as a good essential to individual and collective human flourishing.
While appreciative of Snead's attempt to articulate a more "communitarian" bioethics, and sympathetic to the overall anthropological perspective that he defends, in this paper I offer a friendly rejoinder to his generalized critique of autonomy. In arguing from an Aristotelian Thomistic perspective, I maintain that in order to sustain the type of critical argument that Snead is advancing against expressivism, one need refine the argument in order to distinguish sufficiently between different conceptions of autonomy (moral, political, personal). Once the various senses of autonomy are sufficiently distinguished, however, Snead's generalized critique of autonomy is significantly weakened insofar as the specific criticisms that he advances do not apply universally. In conflating different conceptions of autonomy (moral, political, personal), Snead overlooks autonomy's status as a good essential to individual and collective human flourishing.