Critics of Autonomy

Autonomy is amongst the most-praised modern ideals; and the rhetoric of the self-determining individual — who authors their own life, free from the arbitrary authority of others — saturates liberal-democratic societies. Moral philosophy, bioethics and political theory have, for the most part, shared this enthusiasm. Similarly, the past few decades have seen the language of autonomy increasingly colonise politics, law and the care professions, particularly in the guise of giving individuals ever-more choice in certain aspects of public service provision.

Critics of autonomy have not, however, been cowed by its dominance, and many attacks upon it are excoriating. For instance, feminist opponents have decried autonomy as “a thoroughly noxious concept” which shares in a “myth of masculinity” that requires disavowal of relationships that sustain us. Radical critiques of psychiatry lament an “illusion of autonomy” which suppresses social explanations of action and emotional distress, leading to a ‘magical voluntarism’ vastly exaggerating the power of the human will. Moral philosophy, in its valorisation of individual and rational autonomy, is said to admire “a naked Emperor of questionable legitimacy.”  In medicine, an “autonomy cult” has been accused of tyrannising patients and medical staff alike. Similarly, commentators on social policy have bemoaned an “uncompromising and rigid worship of personal autonomy” and warned that the “mythology of pure and rational autonomy” leads to a false image of ourselves which is “naive, out of touch with an adequate understanding of human motivation, and, ultimately, philosophically and morally untenable.”  Condemnation from communitarians, social scientists, and religious thinkers, amongst others, is no less damning, as we shall see.

The charges facing autonomy are varied: it is impossible or impracticable to achieve; it displaces other fundamental goods, such as solidarity or dignity; it is itself worthless or loathsome; it leads to or entrenches atomisation and other social ills; it is inappropriate for vulnerable, fallible and communal creatures like ourselves; it is an ideological fiction reinforcing a moribund rights-based liberalism; and so on. This report seeks to untangle these diverse and often-contradictory criticisms so that the case against autonomy can be assessed more readily. We will range over philosophy, politics, law, and other areas, with special attention paid to autonomy in medicine, psychiatry and care practice.

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