Relational agents and autonomy

: a lesson from anorexia

Abstract

The thesis starts from the practical issue of how value-neutral policy fails patients with anorexia nervosa and aims to articulate what anorexia can teach us about autonomy. English law adopts a value-neutral approach to mental capacity and usually evaluates anorexic patients as competent to refuse treatment. However, in English law force-feeding can be used even if anorexic patients prove to be competent in decision-making. This solution is ethically problematicbecause it presumes that anorexics lack the capacity to refuse treatment, and because it discriminates against them on the ground of their diagnosis. My aim is to resolve this problem by taking into account both the peculiar oppressive situation faced by anorexics and the concerns around autonomy of the value-neutral standpoint itself. I try to do this by radically rethinking ‘autonomy’; and to do so “from the bottom up”. I shall argue that the value-neutral approach cannot take account of the relational issues that constitute both the lack of autonomy of anorexic patients and some central features of the disorder. The idea of autonomy endorsed by English law refers to a human agent who is constitutively private. According to this conception, no one can truly understand if the reasons and values governing a person’s choices are authentic except for their “owner”. My purpose is to show that this conception is fundamentally mistaken, since the very idea of an “owner” of reasons and values cannot be sustained without running into hopeless epistemological and ethical problems. Reasons and values, I claim, are relationally constituted. Even our most private aspects,such as our identity and what really matters to us, are intrinsically linked to others. People’s “privacy” is fundamentally relational: it exists in a dialogical space, and is articulated and exercised in dialogue and in relation with others. In order to be in a position to identify the peculiar kind of oppression in which the anorexic is embroiled, it is necessary to overcome the purely neutral current conception of autonomy and to endorse a relational perspective that does not imply a normative model of good reasons. In this way, my account serves to undermine the liberal framework on which the standard conception of personal autonomy is based, and to help construct a non-discriminative and more responsive approach to anorexic patients’ refusal of treatment.

Date of Award	15 Sept 2021
Original language	English
Awarding Institution	University of Brighton
Supervisor	Bob Brecher (Supervisor) & Arianne Shahvisi (Supervisor)