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.