Philosophical Models of Autonomy

“Doctors and lawyers have common responsibilities to ensure the protection of people who lack capacity to decide specific matters for themselves and to promote the autonomy and choices of those who can regulate their own lives.” — The Law Commission

“For both policy makers and practitioners, there is a difficult balance to be struck between maximising autonomy and ensuring adequate protection for those who need it.” — The British Medical Association & the Law Society

The idea of maximising or promoting personal autonomy is a characteristic feature of health and social care policies and is a familiar requirement of the good practice frameworks they prompt. But it is far from clear what this ideal of personal autonomy means in theory and practice. What is it and what does it imply for the day-to-day work of frontline practitioners?

Whilst few in contemporary Western society deny the significance of personal autonomy, debates abound over what it actually consists in, and whether it is ever achievable or unconditionally desirable. For example, some bioethicists denounce the hegemony of personal autonomy over other values, such as welfare, in medical ethics.

This report aims to sketch out the theoretical terrain occupied by this much-contested liberal ideal, and expose four broad models of personal autonomy that all claim to best capture our intuitive beliefs concerning what it is to be the author of our own lives. We will start by looking at its history (Section 2), and then survey the various conceptualisations and distinctions that are applied to it (Section 3.1). With these tools in hand, we will proceed to define four broad models of personal autonomy (Section 3.2.) and then apply them to three case studies, to see how well they lend themselves to public policies which must distinguish autonomous from non-autonomous decision-making (Section 4).

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