By Thomas Donaldson
Making decisions for ourselves (having autonomy) is a valuable part of being human. Considering the value of autonomy has important implications when someone requests help with something that they cannot do themselves, like asking for assistance to die. This is the focus of a discussion between Dr Bernard Long and myself in the Journal of Medical Ethics (Assisted dying and autonomy as an end in itself: a response to Donaldson | Journal of Medical Ethics and Autonomy, agency and value: an intrinsic approach to the value of autonomy does not escape the expressivist objection – a reply to Long | Journal of Medical Ethics). Does a person’s autonomy provide enough reason to think that assisting them is the right thing to do? Does this mean that a helper does not need to, or even shouldn’t, think about the implications of what they are being asked to assist with? Should autonomy be considered valuable in itself, or should it be valued based on how it is used?
It is important to consider why autonomy is valuable. Without autonomy we couldn’t choose for ourselves what we want to do with our lives, or the kind of people we want to be. Being able to make decisions for ourselves is necessary if we are to have agency. Human agency describes our ability to influence the world around us, taking action to shape it according to our values and decisions. Imagining how we would like the world to be, choosing goals to pursue in our lives and deciding how to try and achieve these goals are all crucial to being an agent. Making our own decisions is necessary to allow us to live lives we have chosen for ourselves, not lives chosen for us by others. Autonomy is valuable in and of itself because without it we would not have agency.
Agency-based virtue ethics (you can read more about this here: Full article: Human Agency and Virtue Ethics) is an ethical theory focused on the importance of human agency. Agency-based virtue ethics describes ways of being in the world that help people to effectively create and achieve goals through collaboration and dialogue with each other, called the virtues. There are also ways of being in the world that hinder the creation and achievement of human goals. These are called the vices. Agency-based virtue ethics highlights the value of autonomy in itself, because human agency would be impossible without it.
Agency-based virtue ethics also recognises the possibility of people making decisions that can be damaging to both their own agency and that of others. This suggests that the value of autonomy could also depend on its results. This is because not all choices that people make are good. Deciding to act with kindness, justice, and love promote human agency and so are valuable. However, deciding to behave in ways that are cruel, selfish, and are destructive towards human agency are not valuable. This suggests that autonomy is both valuable in and of itself, but also has a value that depends on how it is used.
So, the value of autonomy in itself can create a reason to help someone achieve their goals and realise their decisions by helping them when they request assistance, such as with assistance to die. However, this is not the only consideration. When responding to a request for help it is also important to consider if help is being requested to achieve something good, or something bad. The virtues can help with this. If help is being requested for something which is likely to promote human agency, then assisting with it will be a good thing to do.
Just because a person’s autonomy is valuable, it does not mean we should automatically accept a request for help to achieve their goals, such as requests for assistance to die. It is important that all moral factors are considered to ensure that providing the requested assistance is in line with the ways of being in the world that promote human agency.
Author: Thomas Donaldson
Affiliation: Centre of Social Ethics and Policy, University of Manchester, UK
Conflict of Interest: None to declare
Social Media: @TomDonaldson100