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The Concepts of Autonomy, Competence and Biopolitics

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Guantanamo and Other Cases of Enforced Medical Treatment

Part of the book series: SpringerBriefs in Ethics ((BRIEFSETHIC))

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Abstract

In order to enter the specificity of the debates related to the application of the notion of autonomy in current bioethical contexts, I shall first construct a more general framework within which the cases presented in the following chapters will be evaluated. Starting from a historical analysis of autonomy, I will then apply it to biomedical contexts, drawing a critical map of the current inconsistencies in its application to cases of enforced treatment (be it by not allowing withdrawal of medical treatment or by forced continuation of medical treatment depending on the circumstances), suggesting ultimately that a possible solution for properly identifying possible improvements in our approach could come from an investigation of the political meaning and value of the choices made by (medical) authorities.

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Notes

  1. 1.

    Plato (1984).

  2. 2.

    Beauchamp and Childress (1983, pp. 59–60).

  3. 3.

    Kant (1998), (1981).

  4. 4.

    Kant., I., Grounding for the Metaphysics of Morals, ibid., p. 14.

  5. 5.

    For example, Onora O’Neill distinguishes between the formula of universal law (FUL), the formula of the end in itself (FEI) and formula of autonomy (FA). O’Neill (2004, pp. 93–109).

  6. 6.

    Beauchamp and Childress (1983, p. 61).

  7. 7.

    Mill (1974, pp. 136–138, 184–189).

  8. 8.

    Jennings (2007, pp. 75–76).

  9. 9.

    Berlin (2002, pp. 118–172).

  10. 10.

    In her famous defence of abortion, Thomson presents us with a thought experiment: if we would wake up (after having been kidnapped by the Society of Music Lovers) attached to a famous violinist whose life would depend on us, we could choose to go beyond our obligations and stay attached to him for 9 months to save his life, but if we did not, we could not be labelled to be selfish or inhumane: 9 months is a very long time and it represents a level of exceptional commitment that one can refuse to undergo. Thomson (1986, pp. 37–56).

  11. 11.

    Surely the distinction between the Kantian and Millian versions of autonomy provided in this chapter is far from satisfactory if perceived as an attempt to give a conclusive portrayal of the ideas of the authors. This, however, is obviously not my intention. My aim is to give a general version of the two approaches such that the reader can understand the reasons behind my inclination towards a Kantian analysis as a way to solve the controversial cases considered in this book.

  12. 12.

    O’Neill (2002).

  13. 13.

    Slowther (2007, p. 173).

  14. 14.

    Stirrat (2005, pp. 127–130).

  15. 15.

    Berlin, I., Op. Cit.

  16. 16.

    Rawls (1999, pp. 248–250).

  17. 17.

    Scoccia (1989–1990, pp. 318–334).

  18. 18.

    Harris (1994, p. 194).

  19. 19.

    Giordano (2005, p. 48).

  20. 20.

    See for example: Engelhardt (2003).

  21. 21.

    McHale and Fox (1997, pp. 280–281).

  22. 22.

    Harris (1994), Op. Cit, Chap. 10.

  23. 23.

    Dworkin (1993, pp. 222–229).

  24. 24.

    Agich (2003).

  25. 25.

    I am aware that the legal entitlements of such a practice vary greatly between states and sometimes even regions, and as such I will not refer to any particular legal system here, but only to the a priori condition that any such system would have to guarantee.

  26. 26.

    Mental Capacity Act, 2005, available at: www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1 [accessed on 4 January 2015].

  27. 27.

    Mental Health Act 2007, available at: http://www.legislation.gov.uk/ukpga/2007/12/contents [accessed on 4 January 2015].

  28. 28.

    See, amongst others: Dworkin (1998).

  29. 29.

    See, for example: Harris (2003, pp. 281–286).

  30. 30.

    Gillon (2003, pp. 307–312).

  31. 31.

    Faith (2015).

  32. 32.

    Verkerk (1999, pp. 358–368).

  33. 33.

    Kant, I., Grounding for the Metaphysics of Morals, Op.Cit., p. 41.

  34. 34.

    For a matter of convenience, I will use only the term suicide in a broad sense without listing refusal of treatment or euthanasia every time.

  35. 35.

    This approach has been gradually challenged in recent decades, with Switzerland, Oregon and Belgium representing -perhaps above all- countries where euthanasia is perceived more and more as a morally sound option.

  36. 36.

    Euripides (1928, p. 153).

  37. 37.

    Battin (1994, p. 191).

  38. 38.

    See, for example: [For an act to be considered rational] “the state of affairs promoted by that choice or act must be worth promoting. That is, it must promote some objectively valuable state such as well being, achievement, knowledge, justice and so on.” Savulescu (1999, pp. 405–413).

  39. 39.

    This position might be gradually more accepted in Western societies (especially within bioethical circles), but I want nonetheless to stress it for sake of clarity.

  40. 40.

    Keown (2002, p. 1).

  41. 41.

    Hume (1986, pp. 22–23).

  42. 42.

    Aristotle (1976, p. 130).

  43. 43.

    Hooker (1997, p. 42).

  44. 44.

    Scally (1995, p. 32).

  45. 45.

    Feinberg (1972, p. 161).

  46. 46.

    Wolff (1970, p. 14).

  47. 47.

    See also Wolff’s more extreme claims in his article (1969), p. 608, where he affirms that: “obedience is heteronomy [sic]. The autonomous man is of necessity an anarchist”.

  48. 48.

    Ginsberg (1965, p. 80).

  49. 49.

    See, amongst others: Edelstein (1943). Available at: www.pbs.org/wgbh/nova/doctors/oath_classical.html.

  50. 50.

    Takala (2007, p. 228).

  51. 51.

    Giordano, S., Op. Cit, p. 230.

  52. 52.

    In a study on Eating Disorders published by Jacinta Tan, Tony Hope and Anne Stewart, one anorexic patient replied as follows to the question “would you make the illness magically disappear if you could?”: A-“Everything. My personality would be different. It’s been, I know it’s been such a big part of me, and I don’t think you can ever get rid of it, or the feelings, you always have a bit in you.” Tan et al. (2003, pp. 533–548). See also in the same journal: Tan (2003).

  53. 53.

    Szasz (1998, p. 299).

  54. 54.

    Szasz (1960, pp. 332–336).

  55. 55.

    Szasz (1998), Op.Cit., p. 301.

  56. 56.

    Mill (1955, p. 18.)

  57. 57.

    Foucault (1991, p. 8).

  58. 58.

    Szasz (1998), Op.Cit., p. 303.

  59. 59.

    Foucault (1988, pp. 180–183).

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  1. The Edmond J. Safra Center for Ethics, Tel Aviv University, Tel Aviv, Israel

    Mirko Daniel Garasic

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Garasic, M.D. (2015). The Concepts of Autonomy, Competence and Biopolitics. In: Guantanamo and Other Cases of Enforced Medical Treatment. SpringerBriefs in Ethics. Springer, Cham. https://doi.org/10.1007/978-3-319-22653-8_1

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