Why Do Desires Rationalize Actions?

Philosophy

This is a late draft of this paper. The official paper is forthcoming in Ergo: https://www.ergophiljournal.org/ Why do Desires Rationalize Actions? Abstract: I begin the paper by outlining one classic argument for the guise of the good: that we must think that desires represent their objects favourably in order to explain why they can make actions rational (Quinn 1995; Stampe 1987). But what exactly is the conclusion of this argument? Many have recently formulated the guise of the good as the view that desires are akin to perceptual appearances of the good (Stampe 1987; Oddie 2005; Tenenbaum 2007). But I argue that this view fails to capitalize on the above argument, and that the argument is better understood as favouring a view on which desires are belief-like states. I finish by addressing some countervailing claims made by Avery Archer (2016). Imagine that you frequently bet on the horses. I exclaim: "Why do you keep betting on the horses – that's so irrational!". You might reply: "It's not for the money: I am running an experiment and want to know how bookmakers treat regular customers". By explaining what you want, you might succeed in showing that your bets are rational after all. This fact reminds us of a simple truth: our desires make a difference to the rationality of our actions. Why is this true? Why do desires rationalize actions? Some have claimed that the only plausible answer to this question appeals to the guise of the good, according to which desires represent their objects as having some favourable normative property (Quinn 1995; Stampe 1987; Schafer 2013). Perhaps this view best explains why desires rationalize actions. In this paper, I contrast two formulations of the guise of the good, and consider which best explains why desires rationalize actions. The central goal is not to argue for the guise of the good as a whole, but rather to evaluate which of these two formulations of the view can best complete this particular explanatory task. But since this is probably the most important argument for the guise of the good, this is a crucial issue for the view. In section 1 I present the above argument for the guise of the good in slightly more detail. In section 2 I address the view that desires are appearances of the good. Then, in section 3, I discuss the view that desires are beliefs about the good. These two sections make a case for the latter view over the former. Finally, in section 4 I address some countervailing claims made by Avery Archer. 1. The Argument 2 1.1. The Central Question Imagine that Evita prefers adventure, to beer, to caffeine. And imagine that her only options are ascending the Alps, booking a brewery tour, or calling at a cafe. And imagine that ascending the Alps satisfies her desire for adventure, booking a brewery tour satisfies her desire for beer, calling at the café satisfies her desire for caffeine, that none of these options satisfies any other desire, and that Evita knows all this. Under these circumstances, rationality requires Evita to ascend the Alps. Evita's situation is obviously unrealistically simple, and because it is so simple, it may be hard to imagine her being irrational and choosing any option but the rational one. But it nonetheless seems that there is a rational choice for her to make. In that respect, Evita's situation seems to be a simplified model of ours: we have many desires (equivalently: wants, preferences), and these desires bear on what it is rational for us to do. They bear on that issue in proportion to their strengths, and bear on that issue in combination with our beliefs about the extent to which our options might satisfy those desires. At least, this is the standard picture in decision theory. Perhaps you don't accept this theory of rationality in all its details, but so long as you accept the very modest claim that what it is rational for you to do depends at least partly on what you want, that's enough for my purposes here. Let's capture this modest claim more succinctly as the claim that desires rationalize actions. But why is this true? This is our central question: Why do desires rationalize actions? Before we look at possible answers to this question, I should say something about how I am thinking of rationality. I am thinking of rationality in a fairly simple pre-theoretical manner, as acting in a manner that makes sense, given your perspective at the time. I am equally thinking of rationality as the thing that decision-theory aims to analyse. But probably the most important thing to stress is just that I am thinking of rationality as always being contingent on your own perspective: in that sense, I am thinking of rationality as something like structural rationality rather than substantive rationality (see e.g. Scanlon 2007 for this distinction). There is a great deal of very sophisticated discussion about how to understand structural rationality in a more precise manner than this (e.g. Broome 2013; Kiesewetter 2017; Kolodny 2005; Parfit 2011; Scanlon 2007). Thankfully, everything I say in this paper is relatively independent of those debates. The point is easiest to see once my answer to the central question is on the table, and so I relegate my brief remarks on the issue to the end of section 3. 1.2. The Standard Theory We might hope to answer our central question partly by appeal to the nature of desire. The standard theory of desire is that a desire that P is a state which disposes you to do things that you believe will secure P (Smith 1987, 1994; Stalnaker 1981: 15; for criticism, see e.g. Arpaly and Schroeder 2014: 111-116; Schueler 1995; McDowell 1998). For example, given that Evita has a 3 desire for adventure, and believes that ascending the Alps will secure adventure, Evita is disposed to ascend the Alps. For this reason, the standard theory entails that Evita is disposed to do the very thing that it is rational for her to do. That seems plausible (cf. Davidson 2004; Dennett 1987). The standard theory also entails something else plausible: that it is possible to be irrational. According to the standard theory desires are dispositions, and dispositions are not always realized. So the defender of the standard theory can say that there are various conditions that have to be in place for desiderative dispositions to be realized – for desires to result in action – and sometimes the absence of these conditions entails an absence of rationality (Sinhababu 2011). For example, perhaps Evita has depression, and this leaves her desires intact but prevents them from realizing their motivational influence (Swartzer 2015). Her depression might make her irrational by lowering the motivational influence of her strong desire for adventure. So the standard theory entails that people are disposed to be rational, but only fallibly so. But despite these plausible implications, the standard theory of desire does not provide us with an answer to our central question. It permits that we might irrationally fail to act on our desires, but it does not explain why doing so is irrational. That is, if desires are merely dispositions to act in certain ways, then acting on a desire is no more rational than realizing any other disposition you have. Perhaps Evita is also disposed to get sleepy in the afternoons, to get bags under her eyes when tired, to squint in bright light, and to trip over when distracted. These dispositions are nonrational dispositions: there is nothing rational about her realizing these dispositions, nor anything irrational about her for failing to realize them. What is different about the dispositions that constitute her desires? Evita may well have other dispositions which are positively irrational. Perhaps she is disposed to affirm the consequent, to be biased towards the status quo, and to be overconfident in her own views. Realizing these dispositions does not make her rational, but instead the reverse. Again, why are desiderative dispositions different? In short, only some dispositions are rational dispositions, and so far as the standard theory of desire goes, we have no explanation of why desires belong to the privileged kind. This doesn't make the standard theory false, but does make it crucially incomplete. 1.3. The Guise of the Good Since the standard theory of desire alone doesn't obviously provide a satisfactory answer to our central question, we might supplement or replace it with some other theory. And one longstanding theory about desire is the guise of the good (Anscombe 1963: 75; Aquinas ST I-II.1.1, DV 24.2; Davidson 2001: 22–23; Moss 2012; Raz 1999, 2010). This view can be formulated in many different ways, but the broad thought is that desires represent their objects as having some normative property. Some have claimed that this view provides the best explanation of why it is rational to act on our desires – we might think that the guise of the good provides the best 4 answer to our central question. If so, this would provide an abductive argument for the guise of the good (Quinn 1995; Stampe 1987; Schafer 2013). This is an interesting argument. One way to begin evaluating it is to ask what its conclusion ought to be. In the next two sections I will critically contrast two possible ways of filling out this argument. They differ in exactly how they understand the guise of the good, and in turn, differ in exactly how they use the guise of the good to answer our central question. Before I turn to that task, we should note something that our possible options will have in common. Both understand the guise of the good as a constraint on desire. Sometimes the guise of the good is formulated as the view that actions are always undertaken under the guise of the good (e.g. Raz 1999: 22-23, 2010: 111; Setiya 2007: 16-17), or formulated as the view that we intend actions only under the guise of the good (perhaps Aquinas ST I-II.1.1). But the above argument all hinged on the rationalizing force of desire, and so its direct conclusion is a claim about desire and not about action or intention. I now turn to our two options. 2. Desires as Appearances Recently, the most popular way to formulate the guise of the good has been as the claim that desires are appearances of the good (Stampe 1987; Oddie 2005; Shafer 2013; Tenenbaum 2007; see also Moss 2012). The idea is that just as perceptual states present things as being a certain way (e.g. the wall as red), and just as intellectual "seemings" states present things as being a certain way (e.g. 0.999... as less than 1), desires present their objects as good.1 Such presentational states are independent of your beliefs: you can distrust how things seem to you, as when you think you are subject to a visual illusion, or when you know that the intellectual appearances are deceptive. The thought is that when we desire something it seems good to us, though we might believe those appearances to be misleading. Let's call the view that desires are such presentational states presentationalism.2 Presentationalism might seem to answer our central question. Presentational states can clearly rationalize belief (see e.g. Huemer 2007). For example, if you perceive the wall as red, that might well make it rational to believe that the wall is red. So if we think that desires are presentations of the good, it might seem plausible that such states can rationalize action (e.g. Stampe 1987, esp.362). If P is presented to you as good, isn't it rational to do things that you think will promote P? In this way, presentationalists hope to explain the rationalizing force of desire on the 1 For more on intellectual seemings, see e.g. Huemer 2005. 2 Some endorse a version of presentationalism not about desire, but instead about emotion (e.g. Döring 2003). My concern here is purely with presentationalism about desire. 5 model of the rationalizing force of presentational states. As such, we might think that there is a good argument for presentationalism: it best explains the rationalizing power of desire. But we should not accept presentationalism. I shall give two reasons to reject it, and then independently show that it provides a poor answer to our central question. First, presentationalism understates the rational responsiveness of desire (see also Gregory 2017a: 214). If I ask whether you want to visit Tonga this summer, you might investigate the issue and deliberate at length in order to decide whether you want to go (and if so, how strongly). The claim that our desires are sensitive to deliberation may be controversial with respect to our non-instrumental desires, but it is undeniable with respect to our instrumental desires. We form instrumental desires by rationally combining our prior desires with our beliefs, and so it obviously follows that we form instrumental desires in light of the beliefs we hold and the inferences we have made about how our beliefs interact with our desires. So our instrumental desires, at least, are rationally responsive. But if such desires are presentational states, they should not be rationally responsive in this manner. How things are presented to us is not something we can significantly change by acquiring further information, or by reasoning. For example, no amount of reasoning will change the colours things perceptually appear to have. So it is not plausible that all desires are presentational states. One might object that presentational states can be influenced by our beliefs. For example, if you are told that there are snakes nearby, this might make nearby vines look more snake-like. But first, the evidence for such "cognitive penetration" is far from decisive – see Firestone and Scholl (2015) for scepticism. Second, even if our beliefs do affect our presentational states in this manner, this falls short of explaining the rational responsiveness of desire. Our instrumental desires can quite clearly be changed by inference. I can deliberate about my goals, and settle on appropriate means to them, and thereby come to desire those means. But cognitive penetration is a merely causal process, not an inferential one. One way to see this is to note that such cognitive penetration is rationally unconstrained: you might make nearby vines look more snakelike by telling me that there are snakes around, but you might achieve the very same effect by telling me that there are not snakes around: the mere mention of snakes might be enough to put me on edge. But our formation of instrumental desires is not a merely causal process like this, but instead a rational process of inference. The second (related) reason to reject presentationalism mirrors a common objection to presentational theories of emotion (see e.g. Brady 2013: 112; Helm 2015). Presentationalism (about desire) lacks the resources to explain the possibility of irrationality in desire (cf. Stampe 1987: 359). This criticism is somewhat ironic, since one of the main attractions of presentationalism is supposed to be that it makes room for desiderative failures (e.g. Tenenbaum 2007: chapters 6, 7, 8). For example, the view is supposed to be attractive because it makes room for the possibility that an agent's value beliefs might fail to align with her desires. According to 6 presentationalism, this can occur just because one can believe the appearances to be illusory (Tenenbaum, ibid). But on reflection, presentationalism is less attractive here than it appears. Presentationalism does make room for the possibility that an agent might reject her desires. And since presentational states can be inaccurate, it also makes room for the possibility that a desire can be incorrect (when, e.g., self-destructive). But presentationalism does not make room for the possibility of irrationality in desire. Presentational states cannot be irrational. No matter what the circumstances, if it perceptually appears to you that the wall is red, you are not irrational. Perhaps under some circumstances you might be irrational to believe this appearance, and perhaps we can say that your perceptual faculties are malfunctioning or inaccurate. But these claims fall short of saying that your perceptual state is itself irrational. So if desires were presentational states, no desire could be irrational. This might seem like a welcome conclusion: isn't it true that desires – such as for cold showers – are not subject to rational assessment? I am doubtful of this claim, for reasons given by Parfit (2011: 54-56). But we can set this aside: even if some desires are beyond rational assessment, other desires clearly are rationally assessable. Since presentationalism treats all desires as presentational states, it cannot permit even this modest claim. For example, intransitive preferences are clearly irrational. Imagine that you prefer to go a conference by train than plane (because it is better for the environment), prefer to go to the conference by plane than not at all (because the conference will be worth the short journey), but also prefer not to go to the conference at all than to go by train (because the conference will not be worth the long journey). An agent with these preferences seems irrational (see e.g. Broome 2006). But presentationalism cannot allow this. If you are subject to some visual illusion whereby A looks better B, B looks better than C, and C looks better than A, you are not thereby irrational, any more than you would be irrational for being subject to a similar illusion about length. So presentationalism cannot explain the irrationality of intransitive preferences. Or, for another example, if you desire that P, and believe that Q leads to P, you should rationally desire that Q (see e.g. Broome 1997). An agent who fails to desire the known means to their ends seems irrational.3 But again, presentationalism cannot allow this. If it appears to you that E is good, and you believe that M causes E, you are not irrational if M does not seem good to you. We are never under any positive rational requirements to form new presentational states. So again, presentationalism cannot explain the irrationality of failing to desire the means to our ends. 3 Perhaps this needs some qualification so that, for example, the desire in question is strong enough to be worth thinking about in this context (cf. Harcourt 2004). But this and other qualifications will leave intact the basic thought that there are some rational requirements to form instrumental desires. 7 The two arguments above may seem local to our instrumental desires: It is our instrumental desires that are most obviously sensitive to information and reasoning, and our instrumental desires that are most obviously vulnerable to criticisms of irrationality. So in response, the presentationalist might restrict their theory, offering it as a theory of only non-instrumental desires. But this move is unattractive for three reasons. First, it is not wholly clear if it would avoid the objections above. Intransitive preferences, for example, seem to be irrational even if when non-instrumental. Second, it forces us to accept a disjointed theory of instrumental and non-instrumental desires, and it seems that a more unified theory would be better if one is available: the rival theory I discuss below need not pay this same cost. Third, most importantly, remember that presentationalism is supposed to explain the rationalizing power of desire. But if it does not extend to instrumental desires, it is not clear how it might explain the rationalizing power of such desires. Since instrumental desires do seem to rationalize actions – they rationalize the pursuit of money, for example – the presentationalist who constrains their theory in this way will fail to fully explain the rationalizing power of our desires as originally advertised. The two arguments above aim to show that presentationalism is false: it offers a theory of desire that cannot make good sense of central features of desire, such as their sensitivity to information and reasoning and the possibility of irrationality in desire. The third problem with presentationalism is that it fails as an answer to our central question. The central question, remember, was to explain why it is rational to act on our desires. Presentationalists hope to explain this by appeal to the fact that desires are appearances of the good, in combination with the fact that presentational states have the power to rationalize belief. But when stated like this it should be obvious that presentationalism would not explain how desires rationalize actions, but instead explain how desires rationalize beliefs, and that is not what we hoped to explain. That is, according to presentationalism, the desire that P is a presentational state in which P appears good. But the general model we are working on is the model on which the appearance as of P rationalizes the belief the P. So according to presentationalism, the primary rational upshot of a desire that P should be the belief that P is good. But this is wrong. First, it is doubtful that desires rationalize beliefs in this manner. If I ask you why you think that a film is good, the reply "because I want to see it" is not an appropriate answer. But in general, perceptual states should rationalize beliefs which share their contents, and so if desires represent their objects as good, a desire that P should rationalize the belief that P is good. Second, desires do seem to rationalize actions, unlike presentational states. What it is rational for you to do seems to depend directly on what you want. But what it is rational for you to do does not depend directly on your presentational states at all. For example, imagine that you are presented with the Muller-Lyer lines (figure 1), and some decision (e.g. whether to accept a bet) hinges on their respective lengths. Though the first line seems longer, let's imagine that you know about the illusion, and have even measured the lines in this case and confirmed that they are really equally long. Under such circumstances, it seems that the appearances are irrelevant to 8 what it is rational for you to do: the rationality of your actions will depend only on what you believe about the lines, and not how they appear. Parallel reasoning suggests that if A seems to you to be better than B, that alone tells us nothing about whether you ought to pursue A: everything depends on whether you accept these appearances. When we rationally evaluate your actions, we do not take into account your presentational states, only your beliefs and desires. It is useful to think of decision theory here, which aims to analyse rationality. It presents a plausible theory of rationality that appeals only to an agent's beliefs and desires, not at all to their presentational states. Figure 1 There is an objection to this last argument that I should address. An objector might suggest that our central goal was to understand why desires make actions rational. But they might think that showing an action to be rational, in the relevant sense, is merely to show that it is intelligible, that it makes sense to the agent in some way (this is certainly how some defenders of the guise of the good put things: see e.g. Johnson 2001). And we might think that presentational states can at least make actions intelligible independently of the contribution they make to an agent's beliefs. For example, perhaps we can at least understand how someone might come to bet on the first Muller-Lyer line being longer if it appears to them that way, even if we know that they know fullwell that those appearances are misleading. In turn, perhaps parallel reasoning tells us that normative presentational states can make actions intelligible. We should be careful with this objection. One thing that gives it false credibility is the fact that under some circumstances (e.g. when tired) you might form the belief that the first line is longer, despite knowing, in the abstract, about the Muller-Lyer illusion. So we must be careful with the claim that your behaviour can be rendered intelligible by how things appear to you: sometimes it can, but only because the appearances are (irrationally) influencing your beliefs. We should instead focus on the case where you definitely believe that the lines are of equal lengths, and still make choices that rely on this being false. With respect to this kind of case, it strikes me that such behaviour really would be unintelligible. If you are fully aware that the two lines are of equal lengths, what sense can we make of your betting that the top line is longer? In turn, it would strike me as unintelligible if someone acted on the normative appearances if they failed to accept those appearances as veridical. But in case this is not so intuitive to others, there is a second more decisive problem with this objection. Our central question concerned the capacity of desires to rationalize actions. But the 9 objection relied on the thought that appearances can render actions intelligible. More is required to make an action rational than to make it intelligible: behaviour might be irrational but intelligible, if, for example, it exemplifies an understandable kind of human bias (cf. Johnson 2001: 190-191). To this extent, even if appearances could render actions intelligible, that would not suffice to show that they can render actions rational: they might render acts intelligible only by showing them to result from an understandable kind of irrationality. And to be clear, our central question really does concern rationality rather than intelligibility: desires make actions sensible, not merely predictable (and again, think of decision theory, which is definitely intended as a theory of rationality). So even if appearances could render actions intelligible (again, which I doubt), that would not show that they can render actions rational. And that stronger claim is not plausible: acting on the appearances, against your beliefs, is surely irrational. In summary, there are at least three reasons to doubt presentationalism. Presentationalism cannot explain the way in which our desires are sensitive to information and reasoning. Presentationalism cannot explain the possibility of irrationality in desire. And most crucially for our purposes, presentationalism cannot adequately answer our central question: presentationalism suggests that desires rationalize beliefs, rather than actions, and this is not plausible. Pace presentationalism, the primary rational output of desire is action, not belief. In the face of these objections, the presentationalist might weaken their claims. They might agree that desires are not literally appearances of the good, but maintain that they are nonetheless similar to such states. But in this form the view is too vague to be able to answer our central question, as originally advertised. After all, if the presentationalist says that desires are similar to presentational states only in that they have the power to rationalize something, that at best asserts, rather than explains, the fact that desires can rationalize actions. But if the presentationalist says that desires are similar to presentational states in other respects which genuinely explain why they rationalize things, they need to say in which respects they are similar, so as to show that they can be similar enough to rationalize something without being so similar as to rationalize only belief. Without such details, the view fails to explain why desires rationalize actions. 3. Desire as Belief If we want to go beyond the standard theory of desire and endorse some theory in the vicinity of the guise of the good, we should not endorse presentationalism. Instead, I suggest that we should endorse desire-as-belief, according to which desires are beliefs rather than appearances of the normative properties (Campbell 2018; Gregory 2017a, 2017b; Humberstone 1987; Little 1997; McNaughton 1988: 106-117; Price 1989; see also Scanlon 1998: 7-8, 37-49). In what follows I point to some reasons to think that desire-as-belief is preferable to presentationalism as an answer to our central question. It is worth repeating that my goal is not to argue comprehensively for any version of the guise of the good, but rather to make progress with the internal debate as to which formulation of that 10 view is best. To that extent, my primary goal is to argue that desire-as-belief answers our central question, and does so in a manner better than presentationalism, and not to provide a comprehensive evaluation of desire-as-belief. To fully evaluate desire-as-belief, we might want to investigate other attractive features of the view. For example, perhaps it can explain how moral beliefs can motivate us, without our having to abandon the attractive view that all motivation is explained by desire (for discussion, see Gregory 2017b; McNaughton 1988; Smith 1994; especially 111-125). Or for another example, perhaps it can allow us to explain how we get self-knowledge of our desires: by attending to what we think is good (cf. Byrne 2011, secs 4-end; Suikannen forthcoming; and also cf. Ashwell 2013; Fernández 2007; Moran 2001, 114–16). And perhaps there are other arguments for desire-asbelief (e.g. Bramble forthcoming; Campbell 2018; Gregory 2017a: 202-203; Humberstone 1987). Moreover, to fully defend desire-as-belief, we would need to address various objections it faces. For example, it might seem that desire-as-belief conflicts with the idea that desires and beliefs have different "directions of fit" (Smith 1994, 111–16). Or it might seem that desire-as-belief conflicts with the idea that children and animals can have desires without having normative beliefs. Or it might seem that desire-as-belief is inconsistent with the possibility of perverse desires (Stocker 1979; Velleman 1992). Or it might seem that desire-as-belief is inconsistent with the possibility of irrationality in desire, such as akrasia (Smith 1994: 117-125). Or it might seem that desire-as-belief is inconsistent with decision theory (Lewis 1988, 1996). These objections are all interesting and deserve responses.4 But insofar as our goal is just to evaluate how the guise of the good ought to be formulated so as to capitalize on the argument with which I began (§1), none of these issues are directly relevant. My claim in this paper is that the best argument for the guise of the good supports only desireas-belief, not presentationalism. If desire-as-belief is unattractive or objectionable for independent reasons, then my argument in this paper would contribute a premise in a broader argument against the guise of the good. As you might guess, this is not my goal in developing the arguments here, but you need not share my goals to endorse my central claim here, which is really the conditional claim that if we endorse the guise of the good, we should do so in the form of desire-as-belief. With these caveats noted, I return to our central topic. Desire-as-belief promises to provide a very simple explanation of why desires rationalize actions. It is an absolutely central principle of 4 For responses to the objection from direction of fit, see Gregory 2017a: 203-205; Little 1997, 63–64; Price 1989, 120–21. For relevant claims about the objection from children and animals, see Campbell 2018: 1156-1157; Gregory 2017a: 210-212; Korsgaard 2009: 110-2; McDowell 1994: 114-124. For responses to the objection from perverse desire, see Alvarez 2010, 218–19; Anscombe 1963, 75; Gregory 2013. For responses to the objection from irrationality in desire, see Bramble forthcoming, Campbell 2018: 1150-1153; Gregory 2017a: 207-210; Gregory 2017c. For responses to Lewis' objection regarding decision theory, see Bradley and List 2008; Bradley and Stefánsson 2016; Hedden 2015: 156–62; Stefánsson 2014; Price 1989. 11 rationality that you should live up to your own normative beliefs. To do otherwise is to be akratic, and akrasia is the paradigm case of irrationality: it involves inconsistency between one's normative beliefs and one's actions. Since desire-as-belief tells us that desires are normative beliefs, it combines with the injunction against akrasia – the enkratic principle – to tell us that it is rational to act on your desires. This line of thought is simple and compelling: unlike presentationalism, desire-as-belief promises to explain why desires rationalize actions, and it does so via a principle of rationality that absolutely everyone ought to accept. So we might argue for desire-as-belief on the grounds that it best explains why desires rationalize actions. But there is a problem. We have been thinking about the guise of the good, and so we might naturally think of desire-as-belief in the following way: Desire-as-belief*: To desire that P is to believe that P is good. In contrast, the enkratic principle is standardly formulated in (roughly) the following way (e.g. Broome 2013: 90; Ewing 1947: 120-1): The Enkratic Principle: Rationality requires you to φ if you believe that you ought to φ. These two views don't obviously combine to explain why desires rationalize actions. Desire-asbelief* tells us that desires are beliefs about the good, whereas the Enkratic Principle makes no claims about such beliefs, only about ought beliefs. So how could the Enkratic Principle possibly combine with desire-as-belief* to explain why desires rationalize actions? This problem can be fixed. Though the guise of the good is typically understood as saying that desires represent their objects as good, we might instead understand desire-as-belief as saying that desires are beliefs about (normative) reasons (see also Gregory 2013). This would not be the guise of the good, as such, but it would be close enough: it is still a view on which desires represent their objects as having a favourable normative property. That is, we might understand desire-asbelief as follows: Desire-as-belief: To desire to φ is to believe that you have normative reason to φ.5 But even with this modification, desire-as-belief still doesn't combine with the Enkratic Principle to explain why desires rationalize actions: one makes a claim about reasons beliefs, the other a claim about ought beliefs. But we are closer. To complete the argument, we need to clarify our central question. We might seek to explain why we are rationally required to take actions that we most strongly desire to do, taking all of our desires into account. Alternatively, we might seek to 5 If we think that agents can desire things that they believe to be beyond their control, this needs to be qualified with "if you can". Alternatively, we might think that such states are wishes rather than desires, and so ignore the qualifier (cf. Gregory 2013: 69-70; Velleman 1992: 12-17). Either way, this issue does not materially affect the discussion that follows. 12 explain why rationality favours every action to whatever extent it satisfies some desire we have. I take the possibilities in turn. First, perhaps we are seeking to explain why we are rationally required to do whatever we most strongly desire to do. We can explain that via the Enkratic Principle, and the following claim, which is a natural extension of desire-as-belief: Overall-desire-as-belief: To most strongly desire to φ is to believe that you ought to φ.6 Overall-desire-as-belief combines with the Enkratic Principle to explain why you rationally ought to do whatever you most strongly desire to do. It explains, for example, why it's rational for Evita to ascend the Alps. If we want to explain why agents are rationally required to do whatever they most strongly desire to do, then Overall-desire-as-belief, combined with the Enkratic Principle, does the job. The second possibility – which I find more compelling – is that we are seeking to explain why rationality favours actions to whatever extent that they satisfy desires. It is surely tempting to think of our central question in this way. Return to Evita. Since her desire for adventure is strongest, plausibly she rationally ought to ascend the Alps. But imagine that she instead books the brewery tour. We might think that this is irrational, since she prefers adventure to beer. But nonetheless, we might think that her action is at least more rational than calling at the cafe, since she prefers beer to caffeine. In order to explain this, we should endorse a view on which rationality favours every action to the extent that it satisfies a desire, so that rationality favours Evita booking the brewery tour to some extent, even if it doesn't favour it as much as her ascending the Alps. Once we endorse this view, we can see that the requirement to do whatever you most strongly desire is just a consequence of the more general truth that actions are rationally favoured to whatever extent they satisfy desires (cf. Brunero 2010: 33-34; Schroeder 2008, 2009; see also Fogal ms). But once we agree to this, we should modify our understanding of the Enkratic Principle in a similar manner. The Enkratic Principle says that rationality requires us to do whatever we believe we ought to do (see e.g. Broome 2013: 90). But just as I suggested that a desire can rationally favour an action without rationally requiring it, the same is true of our normative beliefs. Imagine you believe that you have conclusive reason to A, less reason to B, and still less reason to C. Rationality might require you to A, but if you do B instead, that is at least more rational than 6 More generally, how should defenders of desire-as-belief understand the strength of desire? The most obvious option is to do so in terms of the strengths of the reasons the agent believes they have. Overall-desire-as-belief is a natural implication of that view, insofar as what you ought to do is what you have most reason to do. Of course, believing that a reason has a certain strength might have further effects on what you are motivated to do, on where you direct your attention, and so on. But on this view these things are (normal) effects of the strengths of your desires, and not constitutive of those desire strengths. I plan to expand on these claims in other work. 13 doing C.7 Again, we might see the requirement to do what you believe you ought to do as just a consequence of the more general truth that actions are rationally favoured to whatever extent you believe you have reason to do them. So we might reformulate the Enkratic principle as follows: The Enkratic Principle+: Rationality favours φing to the extent that you believe you have reason to φ. The Enkratic Principle+ combines with desire-as-belief to answer our central question. Desireas-belief tells us that desires are beliefs about reasons, and the Enkratic Principle+ tells us that rationality favours acting on such beliefs. These views together explain why rationality favours acting on our desires. Let me summarize. The basic thought is that desire-as-belief says that desires are normative beliefs, and so rationality favours acting on our desires just because rationality condemns akrasia. Spelling this thought out more precisely requires us to take a stand on our central question: whether we are seeking to explain why actions are required if we most strongly desire to do them, or else to explain why actions are favoured to whatever extent we desire to perform them. In the former case desire-as-belief needs to be extended in a natural manner to combine with the Enkratic principle to answer the question. In the latter – more plausible – case the Enkratic principle can be extended in a natural manner to combine with desire-as-belief to answer the question. Either way, there is a plausible version of desire-as-belief, and a plausible version of the Enkratic principle, that combine to answer our central question. In turn, the argument with which we began supports desire-as-belief: there is an inference to best explanation for a version of desire-as-belief, since the view ably explains why desires rationalize actions. I conclude that desire-as-belief is preferable to presentationalism insofar as we seek a version of the guise of the good that explains why desires rationalize actions. I said at the start that these claims are independent of various controversies about rationality. I can now explain that claim in slightly more detail. I shall take three central controversies about rationality, and show that none threatens my claims above. (If you are not interested in these debates, you could skip the remainder of this section.) First controversy: John Broome argues that rationality only governs things within our control, and so only governs states of mind, and not actions (Broome 2013: 88-9, 151-2). If true, this would undermine our central question, since it entails that actions are never rational. And if true, this would also undermine the enkratic principles I discuss, since actions are never rational. But Broome's view is plausible only to the extent that there are mental precursors to action that are the real subjects of evaluation when we seemingly rationally evaluate acts. For example, Broome might suggest that when we say an act is rational, we are really saying that the intention to act in 7 Though see Arpaly 2000 for a complication. 14 that way is rational. But once we allow this, we can see that our central question, and the enkratic principle, could be modified in a manner compatible with Broome's view: we could ask why desires rationalize intentions, and we could understand the enkratic principle as saying that normative beliefs rationalize intentions. From these claims, we might infer desire-as-belief just as I suggest. In short, since Broome's view tells us to modify our central question and enkratic principles in perfectly parallel ways, it leaves my central argument intact. Second controversy: Some authors have claimed that rational norms are wide-scope norms (e.g. Broome 2013, and see Kiesewetter 2017 for comprehensive discussion). Such authors claim that rational norms never favour single states of mind or acts, but instead only combinations of these, such as to (either not believe P or else not believe Q or else not believe P→Q) or else to (either not intend to φ or else not believe that you ought to φ). If true, this might undermine our central question, and our enkratic principles. But again, this is no great concern: If the wide-scoping view is right, we ought to modify our central question and enkratic principles in perfectly parallel ways, leaving my central argument intact. For example, we might infer that desire-as-belief is the best explanation of the rational requirement to [either φ or don't desire to φ], given the enkratic principle to [either φ or don't believe you ought to φ]. Third controversy: Some authors have claimed that attitudes which are themselves irrational place no new rational requirements on us. For example, they claim that irrationally forming a belief does not make it rational to accept the consequences of that belief. But again, this suggestion makes no significant difference to the basic argument that I have defended, since it would compel us to modify our central question and enkratic principles in just the same ways. To the extent that it is true, we should think of our central question as the question of why rational desires rationalize actions, and desire-as-belief explains that given an enkratic principle according to which rational normative beliefs rationalize actions. In each case, the basic point is that these debates about rationality force us to revise both our central question, and the enkratic principle, in just the same way. So long as these two things march in step, desire-as-belief will emerge as a perfectly good explanation of the rational upshot of desire. So these difficult debates about rationality do nothing to undermine the reasoning according to which desire-as-belief, unlike presentationalism, can explain why desires rationalize actions. 4. Archer Finally, I turn to two further objections made by Avery Archer (2016). Archer's main argument is that our central question itself is misguided. But Archer first briefly argues in favour of presentationalism over nearby views such as desire-as-belief (2016: 3-4). As a result, his later main critical discussion focuses on presentationalism. But his reasons for preferring presentationalism to desire-as-belief are mistaken, and are mistaken in ways that mirror the mistakes in his main critical discussion. 15 In particular, Archer argues that presentationalism is preferable to desire-as-belief on the grounds that presentationalism can explain why it is rationally permissible to have conflicting desires (2016: 3-4; see also Tenenbaum 2007: 38-9). The idea is that since it is perfectly rational to be subject to conflicting perceptual appearances, presentationalism rightly entails that it can be rational to have conflicting desires. In contrast, since it is normally irrational to have conflicting beliefs, desire-as-belief wrongly entails that it is irrational to have conflicting desires. So Archer claims. But first, though it is rational to be subject to conflicting perceptual appearances, we should remember that this is rational only because no combination of presentational states is irrational. This is just the claim that caused problems for presentationalism, above. Second, if I am subject to two conflicting perceptual experiences, I should think of at least one of them as presenting things incorrectly. But this is not the way things are with desire: when I have conflicting desires, I need not think of any of these desires as representing things incorrectly. My desires for beer and for health conflict, but I do not think either of these desires is mistaken: each of these things really is worthwhile in the relevant respects. Desires do not contradict one another as perceptual appearances can, but instead compete, and do so in a manner that leaves it open that each correctly represents something of genuine significance (cf. de Sousa 1974; Williams 1973). But third, and most importantly, we must be very careful in interpreting desire-as-belief. Desireas-belief says that to desire that P is to believe you have reason to bring P about. So imagine that you desire that P, but that you also have a conflicting desire that ¬P. If desiring that P is believing that you have reason to bring P about, your desire that ¬P should be understood as the belief that you have reason to bring ¬P about. It should be clear here that these beliefs are perfectly consistent: they can both be true, since you might well have reasons to bring P about and competing reasons to bring ¬P about. Here, your conflicting desires might just accurately represent a genuine normative conflict, and so could surely be rational. Desire-as-belief entails that conflicting desires are beliefs about conflicting reasons, and not conflicting beliefs about reasons. For this reason, it avoids Archer's objection. The broader point is that when we think about desire-as-belief, we should remember that it is the whole content of the desire that is represented as favoured by reasons. If we imagine a desire with a more complex content – such as a negated content – we should remember that the negation modifies the thing favoured, not the favouring itself. That is why desire-as-belief is consistent with the fact that it's rational to have conflicting desires. With this point in hand, let's turn to Archer's main argument (2016: 9-end). Archer claims that one can rationalize a course of action with a coin flip just as well as you can with a desire (2016: 12). For example, if I am deciding whether to cook Lasagne or Stroganoff this evening, I might decide by flipping a coin, and it seems perfectly rational for me to follow this procedure. But if that is so, then there is no special rationalizing force of desire to explain: desires rationalize no 16 more than a purely arbitrary procedure, and in turn there is no need to endorse the guise of the good as an explanation of a special rationalizing force possessed by desire (2016: 9-end). Archer rightly recognizes a very natural response on behalf of the defender of the guise of the good (2016: 12-16). We might think that such a coin flip rationalizes later actions only because it is backed by some prior desire – some representation of goodness. But Archer argues against this suggestion (ibid). The idea is that such a prior desire would have to be a disjunctive desire, i.e. a desire to cook either Lasagne or Stroganoff. But Archer argues that the guise of the good (understood as presentationalism) lacks the resources to explain how such a disjunctive desire could rationalize the later decision to cook just one of these foodstuffs (ibid). After all, the perception that either P or Q hardly rationalizes the belief that P. But this line of argument is mistaken. Again remember that desire-as-belief says that to desire that P is to believe you have reason to bring P about. I take it that a disjunctive desire is a desire that PQ. If desire-as-belief is right, a disjunctive desire that PQ is the belief that you have reason to bring it about that PQ. And that belief surely does rationalize an action that brings P about. That is, a desire to cook either Lasagne or Stroganoff should be understood as belief that one has a reason to cook either Lasagne or Stroganoff, and this belief would rationalize the decision to cook either: cooking either allows you to comply with a reason you believe you have. Here, again, it is important to get clear about how desire-as-belief treats the contents of desire: it treats the whole thing as something favoured by reasons. Again, if we imagine a desire with a more complex content – such as a disjunctive content – we should remember that the disjunction modifies the thing favoured, not the favouring itself. That is why desire-as-belief is consistent with the thought that disjunctive desires rationalize actions. Since desire-as-belief can explain how a desire for either Lasagne or Stroganoff would rationalize the decision to cook either, we can maintain the obvious response to Archer's argument: coinflips only rationalize actions when backed by desire, and in turn the rationalizing power of desire is indeed something which needs explaining. 5. Conclusion In this paper I have argued that desire-as-belief represents a better answer to our central question than presentationalism. I began by outlining the main argument for the guise of the good: that we must think that desires represent their objects favourably in order to explain why they rationalize action. I then explained why presentationalism is nonetheless implausible: it cannot explain the sensitivity of desires to reasoning, cannot explain the possibility of irrationality in desire, and worst, fails to explain why desires rationalize actions. I then explained why desire-asbelief may be a more promising view. It explains why desires rationalize action by appeal to a familiar principle of rationality – Enkrasia. Finally, we should not be swayed by Archer's arguments against desire-as-belief and more generally against our argument for desire-as-belief. 17 Those arguments rely on mistaken assumptions about how desire-as-belief should analyse desires with complex contents. Acknowledgements For assistance with this paper, I thank audiences at Humboldt, Luxembourg, and St Louis (at SLACRR), as well as colleagues at Southampton. Referees for this journal also provided very useful suggestions. Bibliography Alvarez, Maria. 2010. Kinds of Reasons: An Essay in the Philosophy of Action. Oxford University Press. Anscombe, Gerturde E.M. 1963. Intention: 2nd Edition. Harvard University Press. Archer, Avery. 2016. "Do desire provide reasons? An argument against the cognitivist strategy" in Philosophical Studies 173(8), 2011-2027. Arpaly, Nomy. 2000. "On Acting Rationally Against One's Best Judgment" in Ethics 110(2), 488513. Arpaly, Nomy. and Schroeder, Tim. 2014. In Praise of Desire. Oxford University Press. Ashwell, Lauren. 2013. "Deep, Dark... or Transparent? Knowing Our Desires" in Philosophical Studies 165(1), 245–256. Bradley, Richard., and List, Christian. 2008. "Desire-as-Belief Revisited". Analysis 69 (1): 31–37. Bradley, Richard., and Stefánsson, H.Orri. 2016. "Desire, Expectation, and Invariance". Mind 125 (499), 691–725. Brady, Michael. 2013. Emotional Insight. Oxford University Press. Bramble, Ben. Forthcoming. "Evaluative Beliefs First" in Mark Timmons (Ed.) Oxford Studies in Normative Ethics: Volume 8. Oxford University Press. Broome, John. 1997. "Reasons and Motivation" in Proceedings of the Aristotelian Society Supplementary Volume 71, 131-46. Broome, John. 2006. "Reasoning with preferences?" in Serena Olsaretti (Ed.) Preferences and WellBeing. Cambridge University Press, 183–208. Broome, John. 2013. Rationality Through Reasoning. Wiley Blackwell. Brunero, John. 2010 "The Scope of Rational Requirements" in The Philosophical Quarterly 60(238), 28-49. Byrne, Alex. 2011. "Knowing What I Want" in JeeLoo Liu and John Perry (eds), Consciousness and the Self: New Essays. Cambridge University Press. 165–83. Campbell, Doug. 2018. "Doxastic desire and attitudinal monism" in Synthese 195(3), 1139-1161. Davidson, Donald. 2001. "How is Weakness of the Will Possible?" in his Essays on Actions and Events. Oxford University Press. 21-42. Davidson, Donald. 2004. Problems of Rationality. Oxford University Press. Dennett, Daniel. 1987. The Intentional Stance. Bradford books. De Sousa, Ronald. 1974. "The Good and the True" in Mind 83(332), 534-551. 18 Döring, Sabine. 2003. "Explaining Action by Emotion" in The Philosophical Quarterly 53(211), 214230. Ewing, Alfred. 1947. The Definition of Good. Routledge and Kegan Paul Fernández, Jordi. 2007. "Desire and Self-Knowledge" in The Australasian Journal of Philosophy 85 (4), 517–536. Firestone Chaz, and Scholl. Brian J. 2016. "Cognition Does Not Affect Perception: Evaluating the Evidence for "Top-Down" Effects" in Behavioural and Brain Sciences 20, 1-77. Fogal, Dan. ms. "The Primacy of Rational Pressure". Gregory, Alex. 2013. "The Guise of Reasons" in American Philosophical Quarterly 50(1), 63-72. Gregory, Alex. 2017a. "Might Desires Be Beliefs About Normative Reasons For Action?" in Julien Deonna and Federico Lauria (eds) The Nature of Desire. Oxford University Press, 201-217. Gregory, Alex. 2017b. "Are All Normative Judgements Desire-like?" in The Journal of Ethics and Social Philosophy 12(1), 29-55. Gregory, Alex. 2017c. "How Verbal Reports of Desire May Mislead" in Thought 6(4), 241-249. Harcourt, Edward. 2004. "Instrumental Desires, Instrumental Rationality" in Proceedings of The Aristotelian Society Supplementary Volume 78(1), 111–129. Hedden, Brian. 2015. Reasons without Persons: Rationality, Identity, and Time. Oxford University Press. Helm, Bennett. 2015. "Emotions and Recalcitrance: Reevaluating the Perceptual Model" in Dialectica 69, 417–433. Huemer, Michael. 2005. Moral Intuitionism. Palgrave Macmillan. Huemer, Michael. 2007. "Compassionate Phenomenal Conservativism" in Philosophy and Phenomenological Research 74, 30-55. Humberstone, Lloyd. 1987. "Wanting as Believing" in Canadian Journal of Philosophy 17, 49-62. Johnson. Mark. 2001. "The Authority of Affect" in Philosophy and Phenomenological Research 63(1), 181-214. Kiesewetter, Benjamin. 2017. The Normativity of Rationality. Oxford University Press Kolodny, Niko. 2005. "Why Be Rational?" in Mind 114(455), 509–563. Korsgaard, Christine. 2009 Self-Constitution. Oxford University Press Lewis, David. 1988. "Desire as Belief" in Mind 97(387), 323-332. Lewis, David. 1996. "Desire as Belief II" in Mind 105(418), 303-313. Little, Margaret. 1997. "Virtue as Knowledge: Objections from the Philosophy of Mind" in Nous 311(1), 59-79. McDowell, John. 1994. Mind and World. Harvard University Press. McDowell, John. 1998. "Are Moral Requirements Hypothetical Imperatives?" in his Mind, Value, and Reality. Harvard. 77-94. McNaughton, David. 1988. Moral Vision: An Introduction to Ethics. Blackwell Moran, Richard. 2001. Authority and Estrangement: An Essay on Self-Knowledge. Princeton University Press. Moss, Jessica. 2012. Aristotle on the Apparent Good. Oxford University Press 19 Oddie, Graham. 2005. Value, Reality, and Desire. Oxford University Press. Parfit, Derek. 2011. On What Matters, Volume I. Oxford University Press. Price, Huw. 1989. "Defending Desire As Belief" in Mind 98(389), 119-127. Quinn, Warren. 1995. "Putting Rationality in its Place" in Rosalind Hursthouse, Gavin Lawrence and Warren Quinn (eds), Virtues and Reasons: Philippa Foot and Moral Theory. Oxford University Press. 181-208. Raz, Joseph. 1999. "Agency, Reason, and the Good" in his Engaging Reason; On the Theory of Value and Action. Oxford University Press. 22-45. Raz, Joseph. 2010. "On The Guise of The Good" in Sergio Tenenbaum (Ed.), Desire, Practical Reason, and the Good. Oxford University Press. 111-137. Scanlon, Tim. 1998. What We Owe to Each Other. Harvard University Press. Scanlon, Tim. 2007. "Structural Irrationality" in Geoffrey Brennan, Robert Goodin, Michael Smith, and Frank Jackson, (eds) Common Minds. Themes from the Philosophy of Philip Pettit. Oxford University Press. 84-103. Schafer, Karl. 2013. "Perception and the Rational Force of Desire" in The Journal of Philosophy 110(5), 258-281. Schroeder, Mark. 2008. "Having Reasons." Philosophical Studies 139, 57-71. Schroeder, Mark. 2009. "Means-End Coherence, Stringency, and Subjective Reasons" in Philosophical Studies 143, 223-48. Schueler, George F. 1995. Desire. MIT Press. Setiya, Kieran. 2007. Reasons without Rationalism. Princeton University Press. Sinhababu, Neil. 2011. "The Humean Theory of Practical Irrationality" in the Journal of Ethics and Social Philosophy 6(1), 1-13. Smith, Michael. 1987. "The Humean Theory of Motivation" in Mind 96(381), 36-61. Smith, Michael. 1994. The Moral Problem. Blackwell Stalnaker, Robert. 1987. Inquiry. MIT Press. Stampe, Denis. 1987. "The Authority of Desire" in Philosophical Review 96, 335-81. Stefánsson, H.Orri. 2014. "Desires, Beliefs and Conditional Desirability". Synthese 191(16), 4019– 4035. Stocker, Michael. 1979. "Desiring the Bad: An Essay in Moral Psychology" in Journal of Philosophy 76(12), 738–753. Suikkanen, Jussi. Forthcoming. "Judgment Internalism: An Argument from Self-Knowledge" in Ethical Theory and Moral Practice 21(4), 1-15. https://doi.org/10.1007/s10677-018-9923-5 Swartzer, Steven. 2015. "Humean Externalism and the argument from depression" in Journal of Ethics and Social Philosophy 9(2). Tenenbaum, Sergio. 2007. Appearances of the Good. Cambridge University Press. Tenenbaum, Sergio. 2008. "Appearing good: A reply to Schroeder" in Social Theory and Practice 34(1), 131-138. Velleman, David. 1992. "The Guise of the Good" in Nous 26, 3-26. 20 Williams, Bernard. 1973. "Ethical Consistency" in his Problems of the Self. Cambridge University Press. 166-186.


Philosophy

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously.

© The Author(s) 2020. Published by Oxford University Press on behalf of Duke University School of Law, Harvard Law School, Oxford University Press, and Stanford Law School. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence (http://creativecommons. org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact email@example.com Journal of Law and the Biosciences, 1–10 doi:10.1093/jlb/lsaa037 Advance Access Publication 4 June 2020 Original Article Understanding Autonomy: An Urgent Intervention Samuel Reis-Dennis * Alden March Bioethics Institute Albany Medical College 47 New Scotland Ave, MC 153, Albany, NY 12208 *Corresponding author. E-mail: email@example.com ABSTR ACT In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, † Samuel Reis-Dennis, PhD, is Assistant Professor in the Alden March Bioethics Institute at Albany Medical College. He earned an MA and PhD in philosophy from the University of North Carolina, Chapel Hill before spending two years at Johns Hopkins University as a Hecht-Levi Postdoctoral Fellow in the Berman Institute of Bioethics. His primary research interests are in normative ethics and moral psychology and their application to medical ethics. His work has been published in leading journals in bioethics and philosophy, including the Hastings Center Report, the Journal of Medical Ethics, Philosophical Studies, and the Australasian Journal of Philosophy. Dr. Reis-Dennis is also a Clinical Ethics Consultant at Albany Medical Center. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 2 • Understanding Autonomy: An Urgent Intervention justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously. K E Y W O R D S: Autonomy, Isolation, Pandemic, Principlism, Public health, Quarantine I. INTRODUCTION The principle of respect for autonomy can serve as the basis for social rules and formal laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. This consensus reflects our field's adoption of an unjustifiably simplistic notion of autonomy, a trend so widespread that we have come to take it for granted. In fact, I believe that the entire landscape of bioethics, including the principlist approach to bioethical reasoning, depends upon it. In this paper, I will argue that bioethicists have embraced an indefensibly 'thin' notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions.1 I will show how the thin understanding might lead us to see respect for autonomy as both a far more demanding and less demanding principle than we would intuitively accept: less demanding because the thin notion implies that if left unchecked by other principles such as beneficence, autonomy would license obviously unethical conduct, and more demanding because the thin view makes it seem as though any and all capacitated patient wishes must carry some of the principle's moral weight. This approach to autonomy has always been costly, but never has it been so prevalent and so damaging as it is in the current moment, as we struggle to make sense of our rights and duties in a global pandemic. Indeed, our impoverished understanding of autonomy may be preventing us from living up to our obligations as ethicists. I fear that by failing to rigorously consider and explain autonomy we are confusing those who have turned to us for clear ethical thinking in a time of crisis. I will begin by explaining the deficiency of the thin conception of autonomy and what we lose by so readily accepting it. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy. I show how this idea of autonomy could serve as a plausible foundation for laws that limit the behavior of capacitated agents, and I suggest that our insistence on the importance of informed consent implies a commitment to this thick understanding. I then argue that unreflective endorsement of the thin conception leads to a distortion of the ethical field and encourages an unjustifiably hasty submission to consequentialist impulses. More than that, it deprives us of powerful analytical tools that would help us to think seriously about the foundations of social rules, human rights, and justice. 1 This general treatment of autonomy is widespread. For a classic example, see Beauchamp, T., and James F. Childress. Principles Of Biomedical Ethics. Oxford University Press, 2019. In this study, Beauchamp and Childress offer intentionality, non-control, and understanding as psychological conditions on autonomy. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 Samuel Reis-Dennis • 3 II. THE 'THIN' CONCEPTION OF AUTONOMY It is now widely believed that no single ethical theory or principle could possibly provide a sufficient account of our considered bioethical judgments. To demonstrate this, books and lectures introducing students to bioethics often begin by reminding their audiences that a pure ethic of beneficence could not explain why flagrant violations of patient rights would be unjustifiable even if such violations maximized welfare. These introductions explain, reasonably, that the basic patient protections we hold dear are plausibly grounded in a right to autonomy and the inviolable dignity that each person possesses as an 'end in himself '. With the principle of autonomy on the table, the next step on the road to a multiprinciple approach involves explaining why autonomy, on its own, is insufficient to ground our ethical reasoning. One standard way to make this point is to imagine a public health crisis and argue that beneficence (and perhaps other principles, including justice) is required to justify 'constraining', 'limiting', 'curtailing', or 'overriding' autonomy in the name of the public good. Here, for example, are Beauchamp and Childress, in their classic, Principles of Biomedical Ethics: The principle of respect for autonomy and the principle of beneficence (which requires acts intended to prevent harm to others) sometimes come into contingent conflict when addressing situations that arise in governmental and professional responses to serious infectious-disease outbreaks, such as severe acquired respiratory syndrome (SARS). Persons exposed to SARS may put other persons at risk. The government, under its public health responsibilities, and various health professionals have an obligation based on beneficence and justice to protect unexposed persons whenever possible.2 Nancy Kass, in her influential article 'An Ethics Framework for Public Health', employs a similar strategy, writing that 'threats to autonomy are the most obvious threats posed by public health regulations and legislation', and describing autonomy primarily as a 'right of non-interference'.3,4 Nathan Bostick, Mark Levine, and Robert Sade5 are even more explicit about the conflict between autonomy and laws mandating isolation and quarantine: Quarantine and isolation may be either voluntary or mandatory. When mandatory, they may be effective in limiting the spread of communicable diseases, but produce tension between the public goal of disease containment and the protection of individuals' autonomy. Standards of medical ethics place great emphasis upon respect for patients' selfdetermination. In contrast, public health measures can incorporate mandatory interventions if necessary, and public health statutes can authorize the restriction of individual liberties in times of public peril, thereby overriding patient autonomy.6 In his article 'Quarantine, Isolation, and Health Care Workers', Adam Webb writes: 'Limiting autonomy through quarantine and isolation may be ethically justified by our moral obligation to prevent harm to others if the ethical framework strikes 2 Beauchamp and Childress, 23. 3 Kass, N. E. An Ethics Framework for Public Health. Am. J. Public Health vol. 91, 11 (2001): 1776-82. 4 Kass, 1780. 5 Bostick, N. et al. Ethical Obligations of Physicians Participating in Public Health Quarantine and Isolation Measures. Public Health Rep. (Washington, D.C. : 1974) vol. 123,1 (2008): 3–8. 6 Bostick, Nathan et al., 4. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 4 • Understanding Autonomy: An Urgent Intervention the appropriate balance between our notions of communal justice and individual autonomy'.7,8 And in the introduction to his essay 'The Ethics of Quarantine', Ross Upshur9 writes, 'The purpose of this article is to discuss some of the ethical issues raised by quarantine and present requirements for its justification from an ethical perspective. This discussion draws on recent scholarship on public health ethics, particularly with respect to autonomy-limiting actions by public health authorities'.10 I hope that these five examples are enough to give readers a sense of what I mean when I refer to the bioethical consensus on the relationship between autonomy and public health restrictions. My suspicion is that the thin understanding of autonomy the consensus is based upon, according to which such rules constitute 'constraints' or 'limits' on the autonomy of capacitated agents, will be instantly recognizable. This conception of autonomy leads straightforwardly to a conclusion that is especially relevant during public health crises: autonomy on its own cannot justify good social rules and laws that protect public health and safety.11 While autonomy may be the dominant principle of the individual clinical encounter, the story goes, other principles, usually beneficence, perhaps justice, must lead in the public sphere. The thesis that any constraint on the conduct of a capacitated agent constitutes a limit on that agent's autonomy has had powerful and wide-ranging consequences in bioethics. Beyond its application to the ethics of quarantine, this conception of autonomy fuels and gains strength from the 'principlist' approach to ethical reasoning that has come to dominate the field. Once one embraces the thin conception of autonomy, the need for multiple principles is straightforward: We obviously require rules of conduct, including laws, that constrain capacitated agents, and if such rules and laws necessarily limit autonomy, then it follows that some principle other than autonomy must justify these limits. And so the principlist project gains plausibility, and beneficence, the consequentialist principle underlying the intuitive thought that rules are justified insofar as they conduce to welfare, can gain a foothold on the ethical landscape.12 In espousing such a view of the field, the bioethicist allows himself to sidestep careful consideration of autonomy in its 'thicker' traditional sense of rational self-governance that grows out of the work of Immanuel Kant,13 and turns instead to the task of balancing the multiple principles that allegedly support our considered ethical judgments. 7 Webb, A. Quarantine, Isolation, and Health Care Workers. Continuum vol 21. (2015): 1745–1750. 8 Webb, 1748. 9 Upshur, R. The Ethics of Quarantine. Virtual Mentor vol. 5(11) (2003): 393–395. 10 Upshur, 393 11 I have in mind rules mandating isolation and quarantine, but the reasoning applies to other social rules as well. 12 Of course, the road to principlism could run in the other direction, as well, with the theorist beginning with beneficence and then coming to see the need for other principles to constrain it. Either way, the key point is that the arguments bioethicists use to explain why autonomy must often be "overridden" or "curtailed" by other principles depend on the "thin" understanding of the concept. I'm grateful to an anonymous reviewer for suggesting this clarification. 13 Kant, I. Groundwork For The Metaphysics of Morals, (Arnulf Zweig and Thomas E. Hill, Jr. ed., Oxford: Oxford University Press, 2002). D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 Samuel Reis-Dennis • 5 III. THE 'THICK' CONCEPTION OF AUTONOMY It would be a shocking embarrassment to Kantian ethics if it turned out that the only way to justify laws and social rules was by appeal to their good consequences. Unsurprisingly, Kant and his followers reject this consequence-based view. In fact, Kant thought that rather than restricting or limiting autonomy, rules can actually express the autonomy of those who are bound by them. Far from holding that autonomy would license pure individualism if left unrestricted by consequentialist constraints, Kant thought that autonomy was the very foundation of good social rules. When we teach our students that Kantian ethics is a form of deontology, we emphasize that it is a 'rule-based' system of ethics that sets limits on behavior. Kant's famous 'Categorical Imperative' is one obvious example of such a conduct-shaping rule: the injunction to treat humanity always as an 'end in itself' constrains action without requiring other principles to limit autonomy.14 Rather, the idea is that this rule is an expression of our autonomy: insofar as we are rational, we will autonomously hold ourselves to it. It is important to note that 'rationality' in Kantian ethics goes beyond the logic of preference satisfaction. Instead, it implies, roughly, taking up a deliberative point of view from which one can see beyond one's own desires and consider the effects of personal or public policies on other agents. To think rationally in this sense is to recognize that the perspectives of other rational agents have the same basic significance as one's own, and to act on principles that one could justify to other stakeholders.15 Along these lines, another of Kant's formulations of the Categorical Imperative enjoins us to conform to the laws of an imagined 'Kingdom of Ends'. In other words, we are to act in accordance with those rules and principles that rational legislators would make for a society of imperfectly rational subjects, including themselves. The thought exercise may sound fanciful, but it has deep affinities with ordinary moral thinking. It invites the deliberator to recognize that he is not the only person who has the capacity for autonomous reasoning and action, that others have the same basic moral status and rights he has, and that, insofar as they are rational, all of these morally equal stakeholders will value living by their own standards on fair terms with others. Realizing such conditions of free and equal coexistence in the 'Kingdom of Ends' would require laws and rules that we could all endorse and live by. Given the theoretical background from which they arise, it is no surprise that Kantians have argued that such regulations would put a high priority on safeguarding human dignity and rationality, promoting moral equality, and allowing the legislator-subjects to exercise their capacity for autonomy by pursuing their permissible projects.16 The introduction of the 'Kingdom of Ends' as a theoretical device, and the injunction to act in accordance with principles rational legislators could endorse, are not to be confused with the claim that we must all bend to the will of the 'collective'. The thick sense of autonomy as rational self-governance, which can be expressed in both individual and collective action, demands we value the lives and interests of others, but 14 See Kant's Groundwork for the Metaphysics of Morals for his discussion of the Categorical Imperative and its various formulations. 15 I'm grateful for comments from Tom Hill that helped me to clarify this point. 16 My elaboration of the Kingdom of Ends formulation of the Categorical Imperative is influenced by the work of Thomas E. Hill, Jr.. See, for example, his paper: Hill, T. The Kingdom of Ends." In Proceedings of the Third International Kant Congress, White Beck L. ed., vol 4. (1972). D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 6 • Understanding Autonomy: An Urgent Intervention it does not imply that the 'majority rules'. Rather, it requires acting on principles and rules that safeguard our capacities to self-govern and that reflect a respect for humanity. While deliberation in light of these values can be (and is) an individual ideal, it can also be the basis for law, as we will see shortly. Embracing the thick sense of respect for autonomy as a genuine moral value also goes beyond the assertion of personal liberty rights. Again, it requires taking up a deliberative perspective from which we can see that all moral agents deserve equal consideration. It demands that we acknowledge the humanity of our fellow citizens and that we bring our behavior into line with rules and laws that reflect a commitment to equality and respect.17 Although these ideas are rarely discussed in contemporary bioethics, they are in fact crucial to the justification of one of its most famous ideals: informed consent. A brief review of informed consent will help to highlight the extent to which our thinking about this bedrock principle depends upon the thick conception of autonomy. It is a consensus view in bioethics and in contemporary medical practice that patients have a right against being treated without their knowledge or against their wills. It is also widely accepted that the right of informed consent has its roots in the principle of autonomy. What is the philosophical basis of this right to self-governance? One possibility is that affording patients the right to make decisions for themselves is the most effective means of ensuring their well-being. But this attempt at justification does not explain our sense of violation when paternalistic infringements on autonomy successfully promote patient welfare. When a patient has the capacity to make health care decisions for herself, the wrongness of denying her the right to do so consists in a kind of disrespect, and this is true even if nonconsensual treatment clearly conduces to her best interests. Imagine, for example, a physician secretly administering medication to a capacitated patient without her knowledge. The medication will make the patient better off, but the paternalistic intervention is still a disrespectful violation of the patient's autonomy. It fails to take her seriously as a rational agent who can deliberate about her own ends and act on her own principles. The wrongness of the disrespectful refusal to treat a patient as an autonomous agent does not simply disappear when the violation is good for her and maximizes overall welfare. It is worth emphasizing that the obligation to obtain the informed consent of capacitated patients before treating them is a 'conduct-constraining rule' that has its foundations in the principle of respect for autonomy. Indeed, its justification is rooted in the thick understanding of autonomy that I have been discussing. In allowing patients to self-govern, medical providers recognize them as persons whose perspectives matter and who enjoy the same basic status and rights as other rational agents. Paternalistic intervention, even for a patient's own good, is a violation-a failure to appreciate the non-instrumental value of the patient's rational agency. We use the language of 'respect for persons' in this context because norms of informed consent reflect an 17 Kant thought that rational legislators would endorse a principle of beneficence, but this principle is not equivalent to the principle of beneficence that bioethicists are familiar with. For one thing, it is not maximizing; for another, it is not a 'free-standing' principle, but instead is justified via the principle of autonomy, which is expressed in the rational deliberation of ideal legislators. I am grateful to an anonymous reviewer for suggesting this clarification. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 Samuel Reis-Dennis • 7 acknowledgment that the perspectives, preferences, and plans of others carry the same ethical weight as one's own. IV. AUTONOMY AS A BASIS OF LAW It is unrealistic to expect everyone to be moved by considerations of respect and equality all the time. Some people are reckless, willfully ignorant, and malevolent, and even good people can have moments of selfishness, carelessness, and self-deception. For this reason, and others, we require laws to govern and limit behavior, to set social expectations, and to express collective disapproval of certain modes of conduct. The fact that our need for laws may arise in part because of the human tendency to fall short of the ideals of autonomous self-governance I have been discussing, however, does not imply that they must be justified in terms of beneficence. Rather, law, including regulations mandating isolation and quarantine, can be based on the principle of respect for autonomy itself.18 Like Kant's famous categorical imperative, legal orders mandating quarantine and isolation are conduct-constraining rules.19 As the brief study of informed consent showed, the fact that these orders impose limits on behavior does not imply that they are restrictions on autonomy to be justified by another principle. In fact, I think that such rules are plausibly derived from, and expressive of, the principle of respect for autonomy. The wrongness of paternalistic denial of informed consent consists in failing to treat others with the respect they deserve as persons who have their own interests, plans, and values; the wrongness of breaking quarantine consists in the same: it amounts to a declaration that the interests, plans, and values of others are not as morally weighty as one's own. It is an affront to equality that would run afoul of a system of moral principles we could all autonomously (rationally) accept. Of course, this is only a very brief sketch of one kind of Kantian conception of the basis of social rules. And I should emphasize that I am not claiming to have proven that it is the correct account of the foundations of social restrictions. Still, I do hope to have shown that it is a reasonable candidate, one worthy of rigorous consideration and discussion. Indeed, the autonomy-based understanding of social rules has been taken seriously by philosophers and political theorists for centuries. It is not an exaggeration to say that it has had a world-changing influence on our shared social thought about concepts such as justice, dignity, and human rights.20 And yet, when one reads contemporary bioethical scholarship about the role of autonomy in times of crisis, one finds remarkably few traces of this Kantian story. Instead, one learns that autonomy is suitable for individual interactions, but must be overridden in the name of beneficence when public health is at stake. In these dire circumstances, one might conclude, we must think like consequentialists; autonomy is at best a secondary concern. We are now in a position to see how misleading this model is. As I have argued, it is not necessarily true that legally mandated isolation and quarantine limit or constrain 18 Thank you to an anonymous reviewer for prompting me to clarify this point. 19 I am focused on rules mandating isolation and quarantine, but other legal restrictions on behavior, such as rules forbidding murder and assault, are also plausibly justified by appeal to autonomy along the lines I develop here. 20 See, for example, the work of John Rawls, Arthur Ripstein, Onora O'Neill, Allen Wood, and Pauline Kleingeld among others. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 8 • Understanding Autonomy: An Urgent Intervention autonomy. Indeed, depending on how the regulations are formulated, they could express autonomy by reflecting our acknowledgement of the equal standing and rights of all rational agents. This means that if the Kantian picture I have sketched is accurate, then the justification of mandatory quarantine and isolation is not necessarily rooted in beneficence. Rather, it could just as easily be rooted in autonomy: such regulations may be those that rational legislator-subjects, seeking to make rules and laws that reflect their concern with the autonomy and dignity of their fellow citizens, would be rationally compelled to accept. One virtue of this Kantian understanding of rules is that it allows us to distinguish between good and bad quarantine policies in ways that a purely beneficence-based account would not. Suppose, for example, that the welfare-maximizing quarantine policy was one that forced poor people with no families to provide services to the rich at great personal risk. Such a policy, though welfare-maximizing, would be obviously unacceptable, but its hideousness could not be explained by appeal to beneficence. One compelling way to elucidate its wrongness is grounded firmly in the thick, roughly Kantian, understanding of autonomy I have been considering: such a policy treats humanity in others as a mere means to the end of maximizing welfare, rather than as an end-in-itself. It fails to recognize the dignity of all members of the community.21 Of course, the principlist has more than beneficence at his disposal and would no doubt reject the quarantine policy I've imagined. But on what grounds? He might attempt to integrate the principle of beneficence with other principles, perhaps by suggesting a policy that called for maximizing welfare as far as possible without violating autonomy. I will not evaluate the merits of such a proposal, but it is important to see how it would differ from a system of autonomy-based regulations. Autonomy-based rules and laws would do more than ensure that certain baseline rights are not violated in the pursuit of utility maximization. Rather, they would have positive aspirations as well, aiming to realize and reflect values such as dignity, humanity, and respect. Policies motivated by such concerns may turn out to promote welfare, but they would not be justified on that basis. The principlist may also appeal to justice as a constraint on beneficence. But the principle of justice, too, is plausibly grounded in autonomy along the lines I have sketched. Indeed, the work of John Rawls,22 perhaps the most influential theorist of justice of the last century, grows in large part from these Kantian roots.23 In A Theory of Justice, Rawls argued, roughly, that principles of justice could be derived with the help of theoretical devices (most famously the 'original position' and the 'veil of ignorance') meant to invite us to consider the principles of justice free and equal agents would choose if they were ignorant of their places in society. The strategy is part of an attempt to derive a theory of justice based on what self-interested agents would 21 It is worth noting that adopting the "thick" understanding of autonomy does not preclude us from valuing happiness and well-being. And indeed no Kantian would claim that human happiness is never a morally relevant concern. The point is not that beneficence is not a genuine value, but rather that the "thin" conception of autonomy encourages us to overemphasize it. I do not mean to suggest that autonomy is the only genuine moral principle, or that we should never make appeals to welfare or other values. My goal is to show how serious consideration of the thick notion of autonomy might enrich our understanding of the foundations of moral and legal rules. 22 Rawls, J. A Theory Of Justice. Cambridge, Mass: Belknap Press of Harvard University Press (1971). 23 See Rawls's 'A Theory of Justice'. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 Samuel Reis-Dennis • 9 rationally (autonomously) choose while contracting with others whom they view as moral equals. Of course, there are many theories of justice, and I will not argue for Rawls's influential (and often criticized) conception here. My point is only that our endorsement of the thin notion of autonomy has deprived us of theoretical resources we might use to consider what justice requires and why. At the very least, autonomybased views according to which justice is a matter of following procedures agreed upon by morally equal individuals who have their own preferences, values, and goals, should be understood and confronted. Unfortunately, the assumption that autonomy is fundamentally at odds with the very idea of formal restrictions on conduct blocks such engagement before it can begin. V. TAKING AUTONOMY SERIOUSLY I think there is much to be said for the autonomy-based account of rules, but I do not claim to have shown that it is correct. My goals have been less ambitious: I have merely tried to give readers a sense of what we have lost by too readily accepting the thin conception of autonomy and what we might gain by extending our consideration of the thick conception beyond the domain of informed consent. I have tried to show how understanding respect for autonomy as a principle that could not only justify basic protections against paternalism but that could also generate positive rules of conduct, including laws, would shift the foundations of our contemporary bioethical consensus. In fact, taking up the thick conception would force us to rethink the roles of at least three of the major bioethical principles: First, we would not be able to so quickly conclude that in matters of public health, the principle of respect for autonomy must be 'limited' or 'constrained.' Rather, we might turn to the thicker notion of autonomy as a source of good rules that we could rationally endorse.24 Second, and relatedly, we could tap into powerful and historically influential resources when theorizing about the foundations of justice. Finally, the possibility of autonomy-based reasoning toward good rules and laws would force theorists to make new arguments in order to justify the lofty standing normally afforded to the principle of beneficence. This last point is worth examining in more detail. Taking the thick conception of autonomy seriously bars the standard entrance by which the principle of beneficence typically appears on the bioethical stage. As we have seen, when we understand autonomy as a license to do whatever one wants to do, then we quickly come to require another principle to justify conduct-limiting laws and rules. Beneficence is an obvious candidate, and so our embrace of the thin conception of autonomy may tempt us into taking an illicit shortcut to consequentialist thinking. But if we understood respect for autonomy as a principle that, once fully explained, could generate rules, then we might think twice before affording beneficence such a prominent place in our conceptual landscape. This is not to say that beneficence is not a legitimate ethical principle. Rather, the point is that the theorist who wished to emphasize beneficence would need to make arguments to justify its importance that did not rely on the erroneous claim that without beneficence we would be unable to restrict out-of-control autonomy. I can now explain something I wrote at the outset, namely that adopting the thin idea of autonomy would lead one to think that the principle of respect for autonomy 24 Rules forbidding murder, assault, election fraud, and other obviously immoral acts are obvious examples, but rules mandating quarantine and isolation could be justified by appeal to autonomy as well. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August 2020 10 • Understanding Autonomy: An Urgent Intervention is both more and less demanding than we could accept. It would make it seem less demanding by inviting the conclusion that the right of autonomy would authorize obviously unethical conduct if left unchecked by other principles. It would make it seem more demanding by implying that any denial of a capacitated patient's wishes would constitute a violation, or at least a limitation, of that patient's autonomy. Both conclusions rest on serious misunderstandings that we avoid by taking up the thick conception of autonomy that grows out of the Kantian tradition. As we have seen, autonomy is compatible with, and indeed can justify, rules that limit conduct. Thus, the charge that the principle of autonomy would license any behavior whatsoever if left unchecked by other principles is unfounded. And just as the thick notion of autonomy does not license acts that express disrespect and violate dignity, it does not give one the right to make demands of others that disregard their status as equal moral agents with their own values and plans. This means that the often-repeated charge that autonomy is running riot in the clinic as increasing numbers of patients demand that their doctors perform medically inappropriate procedures is also confused. The right of autonomy is not the right to demand that others comply with one's requests; it is a right to make decisions that deeply affect one's own life in accordance with rationally acceptable principles.25 To review: I have argued that by understanding autonomy as the right of capacitated adults to do whatever they want to do, we uproot the concept from its foundation in the idea of rational self-governance in accordance with rules. As a result, we deprive ourselves of powerful theoretical resources we might use to consider the justification of legal and moral requirements, as well as the foundations of justice. Just as dangerously, we trick ourselves into thinking that consequentialist reasoning is necessary and helpful where it may not be. The Covid-19 pandemic has put our field in the spotlight in ways that few of us have experienced. It has presented us with an opportunity to help the public think through ethical problems with clarity, honesty, and seriousness. The thin understanding of autonomy undermines this project. And while it has been widely taught and embraced by generations of bioethicists, its grip on our thinking need not be permanent. In this paper, I have tried to show how much we stand to gain by stepping back from the current consensus and affording the concept of autonomy the thoughtful and historically informed consideration it deserves. ACKNOWLEDGMENTS I am grateful for the support and guidance of Tom Hill. His scholarship and encouragement inspired me to write this paper, and his comments have strengthened it. I would also like to thank Justin Bernstein, Vida Yao, Elizabeth Reis, Matthew Dennis, Pamela Reis, and two anonymous referees for their helpful feedback on earlier drafts. 25 Hill, T. The Importance Of Autonomy. In Autonomy and Self-Respect (Cambridge: Cambridge University Press, 1991), at 48. D ow nloaded from https://academ ic.oup.com /jlb/article/7/1/lsaa037/5850807 by guest on 12 August