Autonomy

As an eleven year-old I was shipped off – as indeed I have done with my own children – to Irish college for a period of about two weeks during the Summer holidays. In my case it was to Coolea in the West Cork Gaeltacht. Then as now Irish college was a right of passage marking a transition to adolescence and an element of free will in the choices one made. In my case it provided the location for my first heart-crushing love affair ( I wonder if she still has the fairy locket I gave her?) and my first inhaled cigarette in the toilet behind the school. I went ‘green’ with the nausea I felt at the time and two days later began to turn yellow. My parents were called and I was brought home to be installed in the guest bedroom in our house, sick, jaundiced and very sorry for myself. Old Doc Carey , the family doctor called every day to check on my progress. One day I summoned up the courage to ask him whether smoking the cigarette had caused the illness. He hesitated for a moment before replying, “Young fella I should say yes to you as a lesson learnt as to the foolish choice you made in dragging on the fag. But I won’t. No, ladeen, you got infectious hepatitis from one of the other lads, I expect. Or the water.” 

That honesty of response, that recognition by a 60 year-old man of the autonomy of an eleven year-old boy to make choices, even if they were wrong, stayed with me forever and I have tried to be faithful to that moment in my own practice over the years.

Autonomy derives from the Greek autonomia (autos self + nomos Law) but in modern usage has a number of applications. Catriona MacKenzie and Natalie Stoljar in Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self (OUP, 2000, 4-5) explain:

"In bioethics autonomy is often equated with informed consent. In rational choice theory, autonomy is equated with voluntary, rational choice. In other contexts, for example, within liberal political theory, autonomy is considered to be an individual right. For liberals of a libertarian persuasion, the right to autonomy is construed as a negative liberty, a right of the individual to freedom from undue interference in the exercise of choice (moral, political, personal, and religious) and in the satisfaction of individual preferences. For Rawlsian liberals, autonomy is understood in Kantian terms as a capacity for rational self-legislation, and is considered to be the defining feature of persons."

Isaiah Berlin explained Kant’s perspective further:

“one of the things Kant believed most fervently was that the one thing which all men could do was to choose between right and wrong. He had begun by thinking that moral choices were dictated by some degree of expertise … But… he was convinced by Rousseau that in moral matters all men are experts. There is no need for expertise; no man, if he is sane at all, ignores the difference between right and wrong – he may be mistaken about what he thinks right, and he may be mistaken about what he thinks wrong, but he knows the difference.” 

It is noteworthy that in the proclamation of the various early Human Rights Charters this Kantian perspective was avoided and individual autonomy is not specifically mentioned reflecting significant political reservations about self versus national government even in the most liberal of democratic countries. It is only recently that international conventions such as the Convention on the Rights of Persons with Disabilities (Adopted by General Assembly resolution 61/106 of 13 December 2006) in recognizing the importance for persons with disabilities of their individual autonomy and independence, including the freedom to make their own choices declares in Article 3 that as a General Principle there should be (a) Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons.

When you think about it autonomy is the wall on which all rights are hung. Without the recognition that an individual will to distinguish between right and wrong is the core principle of any human rights instrument then any delegated rights to that individual will flounder in a sea of misappropriation.