Trout and Autonomy

In this posting I want to consider the way individual autonomy interacts with a proposed expansion of the domain of our natural empathy as suggested by J D Trout in (THE EMPATHY GAP, 2009 Viking). Trout argues any expansion of our natural empathy requires good options and the capacity for good decision making. He further argues the poor sometimes don’t have good options they can care about. He still further argues any expansion of our natural empathy is made difficult by our psychological biases such as favouring the status quo, overestimating our capabilities and discounting our future in decision-making. For example most people fail to save adequately for their old age because they over discount the future. Lastly he argues we are sometimes faced by complex decisions for which we don’t have the necessary capabilities needed to make a good decision. Consider for example the controversy surrounding the MMR vaccine, see http://en.wikipedia.org/wiki/MMR_vaccine_controversy .

Trout argues the twin pillars of any great society are creating the conditions in which we can be happy whilst at the same time allowing others a fighting chance to achieve this state, see page 39. He argues our limited capacity for long range empathy makes these goals difficult to achieve in practice. He believes our decision making might be changed to increase this limited capacity. In order to achieve this he believes the state must play a part in improving our decision making. He suggests the state might do this in two ways. Firstly it might improve our decision making by limiting some of our options. For instance he argues drivers who don’t wear seat belts or motorcyclists who don’t wear helmets have psychological biases that underestimate the probability of injury and overestimate their ability to cope once they are injured. To combat these biases he argues the state should simply prohibit such behaviour. Some of the ways he believes the state might limit our behaviour are quite sophisticated. For instance he believes all, who can, should be compelled to save for their old age. He argues this saving should come from wage increases rather than existing income in order to counteract our natural psychological bias to over discount the future. Secondly Trout suggests our decision making would be improved if when faced with complex decisions, for which we don’t have the necessary capabilities needed to make a good decision, we limit our decision making by accepting the accepted wisdom of experts. He believes this suggestion should apply especially to policy makers who should help formulate the aims of society; but should accept the advice of experts in how to best implement these aims. Trout believes if these two suggestions are adopted people would quickly adapt and accept them, see page 180.

I have a great deal of sympathy with Trout’s aims, nevertheless I now want now to consider whether his suggestions would affect our autonomy. I believe for all practical purposes Trout believes his suggestions would not damage most people’s autonomy. I believe Trout would argue even if for some people some options become unavailable that this loss would be more than compensated for by other people having their options increased by better education and a reduction in poverty. Trout it seems to me takes a purely instrumental view of the value of autonomy. I do not share this view and believe the intrinsic value of autonomy is also important. I now want to examine how our apparently different views about the value of autonomy might affect the acceptability of any limitations on our freedom of choice.

Prior to commencing this examination I want to make it clear I agree with Trout’s second suggestion. There are certain situations in which we cannot make truly autonomous decisions and I believe it does not damage our autonomy if in such situations we delegate decision making to experts. For instance in a medical context patients giving informed consent are supplied with a great deal of information which many find hard to understand. Moreover patients are often stressed and may be squeamish about learning about all the details of their condition. It seems clear to me provided a patient can articulate what she hopes treatment can achieve for her and these hopes are realistic that she can make a genuine autonomous decision to delegate all decisions as to her actual treatment to her doctors. It further seems to me that if such a patient is more fully informed she might not really understand the information provided and hence not be able to make a genuinely autonomous decision. In the light of the above I would argue, as does Trout, once policy makers have set out a policy, such as ones concerning our future energy requirements or reducing greenhouse gases, they should delegate the way the actual policy is to be implemented to the agreed experts. I would further argue such delegation does not damage our status as autonomous persons and may even enhance it.

Trout is concerned with good decision making. Moreover it seems he believes if our ability to make good decisions is not damaged then neither is our autonomy. In this blog I have frequently argued an autonomous decision is one we are wholehearted about and that being wholehearted simply involves an absence of desire or any restlessness to change that decision. I also argued in my posting of 01/07/08 that autonomous decisions are decisions that satisfice us rather than the best the best possible decision. It follows any improvement in our decision making whilst it may well improve our capacity for autonomy does not of necessity change the value of our autonomy. A down to earth concept of autonomy is provided by Waller.

“Genuine autonomy requires options available within our actual environment, options chosen on the basis of our conditional preferences and changing circumstances; not mysterious alternatives that transcend all causal and environmental influences. This natural biological view of autonomy with its mundane alternatives, has special value in the medical environment.” (2001, Patient Autonomy Naturalised, Perspectives in Biology and Medicine 44(4), page 584)

In his paper Waller points out in a medical context limitations on a patient’s decision making may lead to passivity that threatens both her physical and psychological well-being, see page 585. It might then be argued, in a more general setting, any limitations placed on our ability to make some decisions also damages our well-being in the same way. Trout might respond to the above by pointing out that in many cases our apparent ability to make decisions is already severely limited or even illusory due to our psychological biases. In reply to such an objection I would point out what affects our physical and psychological well-being is not our actual ability to make decisions but rather our perception of ourselves as decisions makers. Trout appears to concur with the above, see page 57. It follows any limitations placed on some of the decisions we can make may well damage our well-being.

Trout might well further respond that whilst limitations on some of the decisions we can make may indeed damage our well-being in certain areas this damage is more than compensated for by increases in our well-being in other areas or over time. For instance if the autonomy of parents is limited by requiring them to ensure their children are educated this loss is more than balanced by an increase in their children’s well-being over time. Few if any would question such a limitation. However I will still believe any limitations imposed on our autonomy should be a cause of concern. In order to understand this concern we must try to understand why any limitations imposed on our autonomy affect our physical and psychological well-being. I would suggest it is because these limitations may affect our perception of the kind of person we are. This perception is tied to the intrinsic value of autonomy. Dworkin argues autonomy has both instrumental value and intrinsic value.

“But there is a value connected with being self-determining that is not a matter of either of bringing about good results or the pleasure of the process itself. This is the intrinsic desirability of exercising the capacity for self-determination. We desire to be recognized as the kind of creature capable of determining our own destiny”. (1988, The Theory and Practice of Autonomy, Cambridge University Press,
page 112.)

I would argue the intrinsic value of autonomy is fundamental and that our capacity to make decisions, good or bad, becomes meaningless without this value, without us perceiving ourselves and being perceived as the kinds of creature capable of determining our own destinies. In the light of the above I would suggest priority must be given to recognising us as the kind of creatures, who perceive ourselves as being capable of making our own decisions, rather than any attempt to improve our decision making by limiting our ability to make certain decisions in an effort to overcome our harmful psychological biases. My suggested priority does not mean we cannot limit some of the decisions open to us. Further my suggested priority does not mean we can be autonomous without having meaningful choices. It seems obvious if people are to have meaningful choices that they must have a minimal standard of living to enable them to make these meaningful choices. It follows any disagreement between Trout and myself is to a certain extent a matter of degree. It does however mean we should not limit any decisions open to us if by limiting these decisions we might damage the intrinsic value of our autonomy. It might even be open to experiment to see how many limitations on the decisions people can accept without damaging their perception of themselves as the kind of creature capable of determining our own destinies.