(12/14) What is Autonomy?

Autonomy is the term used for an individual’s control over their own life. In modern ‘Western’ societies, individuals expect to have a wide range of personal freedoms and the right to make decisions about their lives and their bodies. The humanist philosopher AC Grayling, in his book What Is Good?, describes autonomy as: ‘self-government, independent thought, and possession of the right and responsibility to make choices about one’s own life — not least moral choices.’

In her 2017 submission to the Oireachtas Joint Committee on Equality and Justice, Dr Louise Campbell, a bioethicist with a special interest in medical ethics, quoted the following definition of autonomy.

‘… autonomy is not a defence of ‘mere, sheer choice’ for its own sake, but the view that every competent person “has a right to make momentous personal decisions which involve fundamental religious or philosophical beliefs about life’s value for him-[or her-] self”.

And ‘”If we are serious about protecting autonomy, we have to accept that autonomous individuals have different views about what makes their life worth living”.

Dr Campbell concluded: ‘According to this view, the ultimate arbiter of the quality or value of a person’s life is that person him- or herself.’

Humans are social animals

Autonomy is sometimes criticised as being unbridled selfishness: ‘I can do what I like with my stuff and my life.’ But all of us are social creatures. We come from communities and we are part of communities, ranging from families to the groups we join throughout our lives. Those communities shape us and we have responsibilities towards them. We are not isolated individuals: we are affected by the actions of others and our actions affect them. As responsible individuals we consider the consequences of our actions for ourselves and for others.

In Ireland the state, through legal changes, has allowed individuals more rights in relation to contraception, divorce, marriage equality and abortion for example. These rights are there for all who wish to exercise them — they are not compulsory. The law enables choices.

Nearly all of these choices were opposed by vocal (usually religious) groups. In our society we have accepted that no one group can dictate to others how they should behave, particularly in the more private areas of their lives. The state mediates between groups and general makes laws that enable people to make choices, rather than laws which prohibit actions.

Advance Healthcare Directive

In earlier articles I mentioned the Advance Healthcare Directive (AHD) which allows individuals to state their wishes about their healthcare in the event that they become unable to make their own decisions. AHD has legal force through the Assisted Decision-Making (Capacity) Act. 

Of course, at present if one states a preference for an assisted death in an AHD form, it would have no force because it is illegal to help someone to die. Perhaps one day it will be possible in Ireland to make such an advance declaration which is effective.

Alan Tuffery is a member of End of Life Ireland. We are a voluntary group advocating for legislation to allow Voluntary Assisted Dying in Ireland. This is the last in a series of twelve short articles on issues about voluntary assisted dying (VAD). The first article can be found here.