More Autonomy

In Melbourne Australia Harry Kakavas lost $20.5 million to a casino. He sued the casino arguing it should have known he was a pathological gambler and as a result not taken his money. He lost his case in the Australian High Court. The Court ruled that Kakavas did not show that he suffered from a disability, special to him, which was exploited by the casino. What sort of disability is relevant in such a case? It would seem in this particular case that Kakavas did not have the ability to make meaningful decisions, decisions which were in his own interests, whilst gambling. Gambling affected his autonomy. The Kakavas case raises questions about the nature and extent of autonomous decisions. In this posting I will examine both of these questions. I addition I will consider when we have a duty to intervene when someone makes a non-autonomous decision; provided of course we have the power to do so as the casino involved with Kakavas did,

Which of the decisions we make are autonomous? It might be thought that these decisions must be important decisions which we make only after careful consideration. A patient giving informed consent might be seen a paradigmatic example of such an autonomous decision. If this is so someone making a decision without appropriate reflection might be said to be making a non-autonomous decision. It might then be argued we can safely ignore her decision because it does not represent her ‘real self’, see Berlin (1). It is not a decision she would have made if he had more adequately reflected on it. I would suggest such an attitude is one of moral arrogance.

I now want to argue almost all of the decisions we make are autonomous. A common theme throughout all my postings is that someone’s autonomy depends on what she ‘cares about’. Caring about in this context means not merely wanting something; it means someone’s identity, her ‘real self’, is dependent on what she cares about. Moreover I have argued in previous postings what someone ‘cares about’ is defined by what she is satisfied with. Satisfaction in this context simply means no resistance to a decision, no restlessness with that decision (2). There is no desire to change the decision. It is important here to be clear satisfaction with a decision does not equate with being happy about a decision. As I have argued before someone with a terminal illness may decide to commit suicide and be completely satisfied with her decision but nonetheless her satisfaction does not imply she is happy about it. Accepting the above means if someone is satisfied with some decision and has no inclination to change her decision that her decision is an autonomous one. I would suggest that people are satisfied, as defined above, with almost all of their decisions. The above leads to the tentative conclusion that almost all of the decisions we make are autonomous.

At this point an objector might be prepared to accept that for a decision to be autonomous it must be based on what we care about. However she might be unwilling to concede that it naturally follows that almost all of our decisions are autonomous. My objector might argue we can only know what we care about after adequate reflection. She might then further argue that because most of our decisions are non-reflective that most of our decisions are non-autonomous. If my objector’s argument is to carry any weight then she must accept one of two options. Firstly someone may make an autonomous decision based on what she cares about and be dissatisfied with her decision. Or secondly she must accept that being satisfied with a decision is a necessary condition for that decision to be an autonomous decision based on what the agent cares about but argue it is not a sufficient condition. Let us examine the first option. An agent can make an autonomous decision and be dissatisfied with it. I accept an agent can make an autonomous decision she’s not happy with, see above, but I can’t accept she can make an autonomous decision she’s not satisfied with. Let us accept satisfaction with a decision does not simply mean the agent has some smug feeling but means she has no resistance to her decision, no restlessness to change it. It follows if an agent is dissatisfied with a decision that she either resists the decision or seeks to change it. She is ambivalent about her decision. I don’t accept that any decision someone is ambivalent about and seeks to change can be an autonomous decision. It follows an agent cannot make an autonomous decision she is dissatisfied with.

Let us consider my objectors second option that being satisfied with a decision is a necessary condition for that decision to be an autonomous one based on what the agent cares about but that it is not a sufficient one. My objector might suggest that for a decision to be an autonomous one not only must the agent be satisfied with it but that she must have reflected on it. This suggestion would mean most decisions we make are non-autonomous. Of course for many of the decisions we make this doesn’t matter. No one is really concerned whether someone’s decision to have an ice cream is an autonomous one or not. However let us consider a family on a summer’s day sitting on the bank of a fast flowing river eating ice cream. Let us assume one of the children falls into the river and without any thought the mother jumps in and saves the child. Was this a non-autonomous decision? I would argue it was an autonomous decision. Indeed the mother might feel hurt if someone suggested afterwards her actions were mindless. She might say she minded very much, she loved her child, and that she couldn’t act any other way, reflection was pointless. The above suggests for a decision to be autonomous all that matters is that the agent cares about it. It suggests that caring about a decision is both a necessary and a sufficient condition for that decision to be autonomous in conditions in which the agent has been neither coerced nor deceived. Of course sometimes an agent may have to reflect on what he cares about but it is caring about rather than reflection that guarantees a decision is autonomous. Indeed it might be argued the fact that an agent feels a need to reflect on a decision make the autonomy of the decision less certain.

My objector might accept that for a decision to be an autonomous one the agent must care about her decision but suggest we don’t really care about many of our decisions. For instance she might point out my decision to buy an ice cream on a sudden whim is not based on what I really care about in the way we have been using the term. We only care about important decisions and only these decisions can be autonomous or non autonomous, mere whims don’t count. I believe this might be the position Frankfurt would adopt, see (3). I however would adopt a slightly different position. I would suggest an autonomous decision need not be one an agent cares about but any decision he makes which is not discordant with what he cares about. If my suggestion is accepted then most of the decisions we make, including my whim to buy ice cream, would be autonomous. At this point my objector might point out my suggestion seems to weaken the connection between autonomy and personal identity. Frankfurt argues our identity is linked to what we care about.

“Caring is important to us for its own sake, insofar as it is the indispensably activity through which provide continuity and coherence to our volitional lives. Regardless of whether its objects are appropriate, our caring about things possesses for us an inherent value by virtue of its essential role in making us the distinctive kind of creatures that we are.” (4).

I agree our identity is connected to what we care about. It might appear that because identity and autonomy are connected that autonomous decisions must be decisions we care about. I believe appearance is unjustified. I have suggested above that autonomous decisions are connected to what we care about, our identity, by being decisions which are not discordant with what we care about, our identity. Of course when making most decisions we don’t reflect about our identity. Nonetheless I would suggest our identity is always present even if only in the background. I would further suggest this presence gives continuity and coherence to our lives. If autonomous decisions are any decisions which are not discordant with what we care about then not all autonomous decisions play an equal part in defining our identity. Indeed some like my decision to have an ice cream may play no part. Nonetheless if I continually buy ice cream I may be said to be someone who likes ice cream and this plays a small part of my identity. In the light of the above it appears an agent caring about her decision is not necessary for her decision to be an autonomous one. Moreover someone’s being satisfied with her decision is both a necessary and sufficient condition for the decision to be an autonomous one in circumstances in which she has not been deceived or coerced.

I have argued that most of the decisions we make are autonomous decisions. In addition I believe we should always accept an autonomous decision even if this decision harms the decision maker provided of course the decision does not harm others. I believe we must give precedence to respecting autonomy over acting beneficently. It seems to me someone’s identity is tied to her autonomy, tied to what she finds appropriate, what satisfies her. If we fail to respect someone’s autonomy we fail to respect her. Let us consider an example. Personally I detest is smoking. Moreover smoking harms smokers. Let us assume I one of my friends is a smoker who on hearing I am going to a shop asks me to buy her some cigarettes. As I am going to the shop anyway I will not be inconvenienced if I buy her cigarettes. Let us also assume she is completely satisfied with her decision, she will not smoke in my presence or that of other non-smoker and that she fully understands the dangers of smoking and is not deceiving herself. Let us further assume I refuse to buy her cigarettes because I believe these will harm her. I am helping her to prevent harming herself by not respecting her autonomous request even though satisfying her request would not inconvenience me. I am giving priority to acting beneficently over respecting her autonomy. I would suggest in this example I am merely paying lip service to respecting her as a person. Perhaps I might console myself that I am respecting her real self, but this real self is really an ideal self created by me. In this example I believe I could justly be accused of some sort of arrogance.

If we accept we should respect autonomy over acting beneficently and most decisions we make are autonomous in the sense used above then we have to accept a large number of decisions which are unwise or even foolhardy. Kakavas’ decision to gamble in the casino was certainly an unwise one but was it also a non-autonomous one? If it was an autonomous one then the casino should respect his decision however unwise it was. In theory it seems there might be completely satisfied gamblers. However in practice most gamblers feel guilty about their gambling and have some resistance to their compulsion to gamble. It follows most gamblers’ decisions to gamble are non-autonomous decisions. It seems probable that Kakavas’ decision to gamble was a non-autonomous one. It follows the casino could not justify, allowing Kakavas to continue gambling, on respect for his autonomy.

In normal life we generally accept peoples’ decisions, even if many of these are not autonomous decisions, provided we have no reason to suspect that these decisions will harm the decision maker. Kakavas’ gambling clearly harmed him. How could a casino possibly justify allowing Kakavas to gamble if his gambling was both non-autonomous and harmed him? One possible justification concerns the nature of the harm involved. Kakavas’ gambling harmed him financially but it might have done only limited harm to his capacity to make autonomous decisions. Kakavas’ capacity to make autonomous decisions was impaired whilst gambling but perhaps it remained unimpaired at other times. He could have made an autonomous decision not to go to the casino in much the same way a recovering alcoholic makes a decision not to go to a bar. The casino might argue even if Kakavas was harmed it was respecting his autonomous decision to go gambling and it was justified in respecting this decision because respecting autonomy should take precedence over acting beneficently. I would accept the above argument. However I would be some what sceptical about a gamblers ability to make a decision she knows will make her feel guilty without any resistance to her decision.