Ethic Theory Moral Prac

DOI 10.1007/s10677-013-9448-x

Regimes of Autonomy

Joel Anderson

Accepted: 1 August 2013

# Springer Science+Business Media Dordrecht 2013

Abstract Like being able to drive a car, being autonomous is a socially attributed, claimed, and
contested status. Normative debates about criteria for autonomy (and what autonomy entitles
one to) are best understood, not as debates about what autonomy, at core, really is, but rather as
debates about the relative merits of various possible packages of thresholds, entitlements,
regulations, values, and institutions. Within different “regimes” of autonomy, different criteria
for (degrees of) autonomy become authoritative. Neoliberal, solidaristic, and perfectionist
regimes entail conflicting understandings of what gets you autonomy and what autonomy gets
you—for example, in relation to policies regarding physician-assisted suicide or financial
support for senior citizens. In light of this, justifying a particular understanding of autonomy
is inseparable from the task of arguing for the context-specific merits of a regime of autonomy
as a whole and in relation to other ethical and political commitments.

Keywords Autonomy . Paternalism . Competency . Pragmatism . Ascriptivism . Solidarism .

Neoliberalism . Perfectionism . Physician-assisted suicide . Pension policy

1 A Methodological Shift

Claiming to be autonomous represents an especially significant move in a variety of social

practices. This is because the status of being autonomous partly fixes what others are permitted
and obligated to do or refrain from doing. In particular, if you count as personally autonomous
(in the sense of being competent to make your own decisions), you can legitimately insist on be
taken seriously and not being interfered with in certain ways. In short, the predicate “autono-
mous” is a powerful element within the social practices in which statuses, entitlements,
immunities, liberties, and the like are attributed, withheld, and contested.
Because much depends on who counts as autonomous, there is understandable concern
about ensuring that a person’s status is determined properly — that those who really are
autonomous end up counting as autonomous and that those who aren’t really autonomous
don’t. This concern is heightened by the fact that the attribution of autonomy is based on
judgments about a range of capacities and characteristics that admit of degrees. How
rational, reason-responsive, self-critical, self-conscious, authentic, and free from manipula-
tion does one have to be to count as autonomous? It is usually thought that if a theory of

J. Anderson (*)
Department of Philosophy, University of Utrecht, Utrecht, Netherlands
e-mail: j.h.anderson@uu.nl
 J. Anderson

autonomy is to help sort out this complexity, it should specify the necessary and sufficient
conditions for being really and truly autonomous. The idea is that if we can work out the real
nature of the phenomenon to which our autonomy-talk refers, we will have a solid,
independent basis for adjudicating disputes about who should count as autonomous. All
we have to do is figure out what the core elements of autonomy are on the basis of
considering our intuitions about paradigm cases and counterexamples (e.g. Christman
1989; Oshana 2006; Taylor 2005).
Attempts to discover the core essence of autonomy have not been particularly successful.
Although progress has been made in articulating different dimensions of what is meant by
“autonomy” in various contexts, what little convergence there is seems either to crumble in the
face of the hard cases or to rely on other, independently held normative commitments that are
covertly smuggled in.1 At the end of the day, especially in domains of applied ethics or clinical
social work or public policy, the way in which autonomy gets operationalized is in terms of a
shared understanding of types of cases, thresholds of competence, and so on, but not in a way
that is derived from abstract philosophical theories of the core elements of autonomy.
One might conclude that theorists ought to search more diligently for definitive account
of the core elements of autonomy (or that those working in applied contexts ought to follow
more closely some existing account), but there are reasonable doubts about whether this
quest is well conceived. Gerard Dworkin puts this doubt as follows:
“…I do not think it possible with any moderately complex philosophical concept to
specify necessary and sufficient conditions without draining the concept of the very
complexity that enables it to perform its theoretical role. Autonomy is a term of art
introduced by a theorist in an attempt to make sense of a tangled net of intuitions,
conceptual and empirical issues, and normative claims. What one needs, therefore, is a
study of how the term is connected with other notions, what role it plays in justifying
various normative claims, how the notion is supposed to ground ascriptions of value,
and so on – in short, a theory (Dworkin 1988, 7).”
Of course, one familiar way to develop a theory of autonomy is to focus on a small
number of core elements. But I take the constructivist, pragmatic thrust of Dworkin’s remark
here to point in the direction of a different model of theory-building, one that involves
making explicit what is in play in social practices we engage in, constituted as they are by
participants’ mutually ascribed know-how regarding the rules of the game.
In a sense, this approach involves turning around the usual approach to developing a
theory of autonomy. Instead of debating the abstract core of what autonomy universally is,
we could try to articulate competing conceptualizations of autonomy in terms of competing,
more-or-less coherent packages regarding which ways of treating people are appropriate,
what kind of a society we want to live in, what should get priority, how we can arrange our
society so as to increase our ability to realize certain values, etc. – what I will refer to below
as “regimes of autonomy.”2 Subsequently, we can use these rich, contextualized character-
izations of distinct understandings of autonomy as the points of reference for debates about
how it makes most sense to use the term “autonomous” (or at least what we mean by the

1
Note that the point I am making here is different from the objection raised by those, like Richardson (2001),
who argue – against “neutralist” approaches – that autonomy can function as a normative principle only by
incorporating substantive claims about what is objectively valuable. Unlike my approach here, such ap-
proaches remain committed to the enterprise of elucidating what, in a general sense, autonomy is.
2
The term “regime” can be misleading. It is intended neither to refer to a government nor to anything sinister
but rather, quite broadly, to a normative socio-cultural order, a way of thinking about and organizing the
distinctive elements in a social practice. For more on the conception of “regimes,” see section 3 below.
Regimes of Autonomy

term). For example, to anticipate the discussion of section 4–6 below, instead of asking first
what the core meaning of “being autonomous” is, one can begin by contrasting a consis-
tently “neoliberal” package of views on autonomy-related matters with a consistently
“solidaristic” package, and then go on to justify a particular usage of the predicate “is
autonomous” in terms of the reasons in favor of a neoliberal or solidaristic approach.
I don’t wish to deny the benefits of clear, unambiguous definitions (particularly of
stipulative definitions for practical purposes), nor to suggest that we should to dispense
with autonomy-talk altogether. Appreciating the resonances and associations between the
language of autonomy and the language of other normative concepts (freedom, paternalism,
enablement) is part of the task of orienting oneself in the domains in which the term
“autonomy” is regularly employed.3 The point is rather that the clarification of what we
mean when we label someone autonomous requires an elaboration of the broader practical
context within which that label has application.
This is largely because, when we attribute autonomy to someone, we are not just
identifying general properties of the person but are situating those properties relative to
the relevant thresholds for how it is appropriate to treat him or her. If you don’t know what
rights and obligations follow from appropriately attributing autonomy to someone, you don’t
really know what it is to be autonomous. And knowing to what extent a person is
autonomous is necessarily a matter of knowing how it is appropriate to treat her. As Mark
Lance and Heath White put the point in drawing a parallel distinction between “stance” and
“metaphysical” approaches to personhood, approaches that focus on the necessary and
sufficient conditions leave unanswered questions of what it is appropriate, practically, to
do vis-a-vis a particular person (Lance and White 2007; see also Anderson 2008). But once
it becomes clear that such approaches postpone the task of working out the practical
implications of meeting necessary and sufficient conditions for being autonomous, it turns
out that they are not really offering a theory of autonomy of the sort that Dworkin rightly
identifies as what is needed. One advantage, then, of a “stance” approach of the sort I
propose here is that it takes up the full task from the outset.
Before continuing, it is perhaps worth anticipating the objection that this way of pro-
ceeding will only leave us mired in details, further exacerbating confusing disagreements
about how to use the term autonomy. My proposal to examine competing understandings of
autonomy in terms of constellations (or “regimes”) of practical implications, institutional
structures, social practices, and conceptual linkages is indeed a departure from the standard
approach of identifying the “core” of what autonomy is in terms of the most basic and
abstract principles that “no one could reject.” But my sense is that all too often any
agreement that does get secured on the basis of abstract first principles typically provides
an abstract and underspecified characterization of the concept, so that people don’t really
know what they are agreeing to when they accept a particular definition. This is related to the
point just made: if we don’t understand what the practical implications are of endorsing
autonomy, we haven’t really grasped the concept. So any genuine agreement on the concept
will have to make clear what people are agreeing to when they agree that a particular person
is autonomous – whatever the downstream implications of that are – instead of signing on to
core principles, only to discover later that they meant something quite different in practice

3
On the irreducible contribution that specific terms make to articulating standpoints, see especially Charles
Taylor (e.g., 1985). Indeed, as the author of the “Autonomy” entry for the International Encyclopedia of
Ethics (Anderson 2013), I think that useful contributions can be made in mapping the diverse ways in which
this term is used, and even some of the structure to that usage. It is quite possible, however, that many debates
in which the term “autonomy” currently figures centrally would be more fruitful if they dispensed with the
term altogether.
 J. Anderson

than they expected. Moving towards a usefully shared sense of how to use a concept requires
an orientation towards understanding the whole package, and this means being up-front
about the political stakes involved in a particular understanding of autonomy.
My aim in this paper is ultimately two-fold. First, I’m trying to illustrate what would be
involved in taking an approach that focuses not on identifying the “core elements” of what
autonomy really is but rather on articulating competing conceptions (or “regimes”) of
autonomy in terms of its practical implications, appropriate operationalization, social con-
textualization, and so on. I begin by outlining a view of autonomy as a normative social (or
“deontic”) status. Autonomy is attributed to individuals in the context of various social
practices, and that attribution then licenses certain further moves in the relevant practice.
Importantly, both the criteria and what gets licensed are not metaphysical universals but are
historically contingent dimensions of a particular normative social order, which I refer to as a
“regime of autonomy.” Having laid out this framework, I turn to providing an interpretation
of what is involved in taking seriously the question of which regime of autonomy to prefer.
I’m interested, second of all, in proposing a way of framing that normative debate in terms of
several ways in which the variety of possible regimes cluster. Here it is useful to distinguish
neoliberal, solidaristic, and perfectionist versions of a regime of autonomy, as a way of
bringing out (part of) what is at stake in these disputes. I conclude by describing how these
disputes can proceed and how such disputes might best proceed.

2 Autonomy as a Deontic Status

In my discussion here, I will be focusing on those usages of autonomy in which it plays the
role of a conditional status, something that one must acquire. Unlike dignity, autonomy is
not something one is born having. In this sense, being autonomous depends on having
developed certain capacities well enough to count as autonomous. The debate then turns on
which capacities those are and how much of them one must have.
The talk of “conditional status” is meant to capture the idea that, once you have these
capacities (to the relevant degree), that earns you a certain “normative status” (or a “deontic
status,” following Brandom 1994). That is, what it means to be taken to be autonomous is, in
large part, to be licensed to make certain moves in the practice. Those who count appropri-
ately as autonomous are thereby entitled to expect a certain way of being taken seriously that
those who are not deemed autonomous are not thus entitled. One can, then, distinguish two
aspects of autonomy: “what gets you autonomy” (conditions) and “what autonomy gets you”
(practical implications) (Anderson 2013). I’ll take them in turn.

2.1 What Gets you Autonomy

Whether one is focused on identifying “the core elements” of autonomy or not, there
are various characteristics singled out as criteria for autonomy, in the sense of “what
gets you autonomy”. Most have something to do with leading one’s life in a way that
accords with what one genuinely cares about. But there is wide variation in the forms
of influence or manipulation that might render a person non-autonomous, as well as a
wide variation in the degree to which the ascription of autonomy is conditional on
engaging in rational reflection, and what “rational” means here. One could base the
ascription on the idea that one must have the ability to step back from habits,
conventions, and upbringing to reflect critically on how one really wants to live
one’s life. Or one could focus on the importance of having a range of worthwhile
Regimes of Autonomy

options available, or of being able to actually live in accordance with one’s choices.
In short, views differ significantly regarding the list of core elements.4
Whatever the content of the requirements, one must always determine to what degree any
of the relevant characteristics must apply before one can be said to meet the threshold
requirements for autonomy-ascription. And one of the most fundamental differences be-
tween views of autonomy — has to do with the relative demandingness of the threshold, and
this is my focus here.

2.2 What Autonomy Gets you

Corresponding to this variation in the requirements for autonomy is a range of differences in

what the status affords you. Thus, one can ask not only “what gets you autonomy,” but also
“what autonomy gets you.” Typically, for example, a person who counts as personally
autonomous thereby is taken to deserve to be treated in certain ways, and these normative
implications relate, for example, to rights of non-intervention, rights to support, and respon-
sibilities towards oneself and others.
To take an example, it is widely held that qualifying as autonomous (at some threshold-
level) thereby licenses one to refuse (or authorize) certain medical procedures or psychiatric
treatments. Having autonomy ascribed to you gets you a ticket—you are empowered thereby
to make certain moves in certain social practices, such that the failure of others to respect
these entitlements is subject to appropriate sanctions. But what moves, exactly, is one
licensed to perform? Views differ. For example, some argue that authorization of risky,
experimental, or cosmetic treatments requires that one meet a higher standard of autonomy-
competence than in the case of treatment that is routine, well established, and urgently
needed (e.g., Feinberg 1986, ch. 26). Others argue that the autonomy “ticket” licenses risky
and reliable patient choices equally (although there may be other reasons for handling these
cases differently).
Hence, the meaning of “autonomous” is contested along at least these two dimensions: both
with regard to what qualifies an individual for the deontic status (both which characteristics and
to what degree) and with regard to the downstream implications of having that status. As a
result, knowing what one is claiming when one says that someone is “autonomous” requires
knowing how one is thereby positioning oneself with regard to these options. It requires, as I
will say, situating one’s utterance within various possible “regimes of autonomy.”

3 Regimes

The term “regime” is intended to refer to an interconnected, socially situated package of

licensing and qualifying relations as well as other factors that fix a particular understanding
of a deontic status and provide backing for it.
The concept can be applied to a wide range of normative statuses, from being a citizen or
being mentally competent to being a family relative or heterosexual. Within different
communities and at different points in history, different regimes are in force, and at any
given time or place, there may be multiple regimes competing with each other for influence

4
I find it useful to distinguish between various packages of autonomy competence: executive, deliberative,
disclosive, and critical capacities related to self-governance (Anderson 2014; on “autonomy-competencies”,
see Meyers 1989). My point here, however, is not to advocate a particular substantive conception of
autonomy.
 J. Anderson

or for being accepted as legitimate. In addition, there are always also alternate, possible
regimes to which critics can appeal in arguing that a current regime should be revised or
replaced.
As I am using the phrase, a ‘regime’ comprises (1) a specification of both what gets you
the deontic status and what it gets you, (2) a scheme of how to implement or institutionalize
the attribution (and contestation) of statuses, and (3) an understanding of what justifies both
the specification and the institutionalization of the deontic status. What will typically be
especially central to characterizing a given regime will be the views and policies regarding
how much of the relevant capacities individuals must have to gain certain entitlements in
particular social practices. To speak of a regime is to speak of this entire, more-or-less
consistent network of normative interrelations and modes of implementing them.5
My methodological proposal, then, is to consider the elaboration and evaluation of
competing regimes of autonomy to be a central task of normative ethical theorizing.
However, before turning to that task, I would like to briefly discuss a more mundane case,
to illustrate how this analysis is supposed to work: the case of being a licensed automobilist.6

4 Regimes of Licensing Drivers

Consider the property, not of “being autonomous,” but of “being able to drive a car” (for
background and details, see Vanderbilt 2008). Clearly, there is no single context-free way of
specifying this property. Driving a car involves extensive knowledge (of the rules of the
road, of risks involved in different situations, etc.) and a variety of learned skills (ability to
execute coordinated tasks simultaneously, capacities for attention and perception, etc.), both
of which come in varying degrees and combinations. Thus, the truth of the assertion, “I can
drive a car” (understood as a claim about being a good-enough driver to warrant being
allowed to drive) will depend on whether one has the right combination of skills to an
adequate degree – where the understanding of “right” and “adequate” are normative,
contestable categories. The accusation, “You have no idea how to drive!” is open to dispute
in a variety of contexts, on the basis of a wide variety of factors and divergent understand-
ings of how good one has to be at the various skills to count as competent. And these
attributions form a crucial part of various social practices involving cooperation, since my
judgment that a friend isn’t a “good-enough” driver (despite his having a driver’s license)
might make me unwilling to loan him my car.
Because unclarity about who is a good-enough driver is particularly dangerous, official
licensing procedures have been established that set criteria for competence (and provide
documentation). They institutionalize, as it were, the disambiguation of how competent one
has to be for what purposes. And markedly different approaches can be taken, depending on
which qualities are taken to be relevant and to what degree, giving rise to different regimes
of driver competence. For example, some regimes might be very demanding and restrictive,
requiring drivers to demonstrate a high level of knowledge and skill; others might be less

5
In characterizing this sort of normative-practical holism, it may help to mention several theorists who,
despite difference with my view (and between them), may usefully be seen as making parallel moves:
Hohfeld’s theory of rights (Hohfeld 1913), Foucault’s archaeology of the human sciences (Foucault 1970),
Garfinkel’s ethnomethodology (Garfinkel 1967), H.L.A. Hart’s ascriptivism (1948), neo-Sellarsians
(Brandom 1994; Lance and White 2007; Kukla and Lance 2009; Fossen in press), and, most generally, in
Hegel’s philosophy (for an excellent elaboration of several relevant parallels, see Quante forthcoming).
6
There are other examples as well, such as competing regimes of childhood (Anderson and Claassen 2012) or
culturally contingent regimes of “being on time.”
Regimes of Autonomy

demanding or even rely on individuals’ own self-assessment. In addition, regimes might

differ in the aspects of competence that are considered relevant, with some giving priority to
knowledge of the traffic rules, and others giving priority to reaction times and hand-eye
coordination. And there might also be differences in the extent to which what one is
authorized to do (drive with a trailer; drive at night; etc.) is conditional on demonstrating
one’s competence along a sliding scale. Taking these factors together, a particular legal
regime of driver competence serves to fix the appropriate sense in which someone “is able to
drive a car” in terms of a conception of which factors ought to be taken to be relevant and
what thresholds should be established (as well as a slew of other factors, such as policies
regarding assessment and enforcement).
At this point, the normative question arises as to which regime is best justified. Given the
contingency of any given driver-licensing regime and the significant impact it has, there are
always alternatives relative to which status quo arrangements must be defended. In evalu-
ating the appropriateness of a given regime, a great deal will depend on the wider context of
implementation and the justification on the basis of core values or societal objectives. For
example, a regime in which drivers expect one another to have mastered complex rules
regarding “right of way” at relatively unstructured intersections will have difficulty being
inclusive of drivers from neighboring countries with different traffic rules. A particularly
demanding set of requirements might introduce issues of equal access to mobility within the
society, depending on the availability of driver’s education as well as public transportation.
Similarly, traffic systems in which roundabouts and traffic-calming structures are widespread
might lower the need for especially quick reaction times, thereby creating a safety buffer
within which aging drivers might be able to retain their automobility, often with greater
opportunities for full participation in society. Other values could also be relevant, from
concerns with environmental impact of widespread car-use to attitudes regarding the role of
teenagers in society.
Again, I am not here arguing in favor of any particular regime. The key point is that, even
in the absence of an account of the core elements of “really being able to drive,” arguments
can and must be given for endorsing a regime.

5 Autonomy, Regimes, and Degrees of Competence

As in the case of being able to drive a car, there are a variety of ways of understanding what it
takes to be able to lead one’s life autonomously – not just theoretically, but in the social practices
within which counting as autonomous plays a pivotal role. In this section, I will focus on two
social contexts whose character is significantly shaped by the presuppositions made about the
autonomy-competence of individuals: physician-assisted suicide and planning for retirement.
Both are cases in which disputes about regulation and public policy – and charges of paternal-
ism – hinge on underlying disputes about what degree and scope of autonomy-competence is
required for being able to be authorized to decide matters for oneself. How clear-headed does
one have to be for a desire for assistance in committing suicide to authorize a physician’s
cooperation? When are patterns of saving for retirement so predictably irrational that regulatory
interference is appropriate? Some regimes of autonomy require only a low threshold of
competence for qualifying for decision-making authority or for culpability, whereas others will
be more demanding. Moreover, this demandingness applies not only to the degree of compe-
tence but also its scope: some will focus on a narrow set of characteristics (such as the ability to
take a stand regarding the desires and inclinations one finds oneself with), whereas others will
opt for a wider range of autonomy-competencies.
 J. Anderson

With regard to any domain of this sort, an almost limitless number of regimes of
autonomy are possible, given that regimes are distinguished only on the basis of so many
factors (including capacities deemed relevant, threshold levels required, context-sensitive
exceptions, diverse practical “licensing” implications, forms of institutionalizing the official
ascription of status and contesting it, and self-understandings of why the approach is
appropriate). To help clarify how normative debates about regimes of autonomy
typically proceed, I will delineate three particularly prominent clusters or constella-
tions of views, as is standardly done in characterizing political viewpoints (such as
“communitarian” or “Green”). I will be distinguishing three such clusters, which I will
label “neoliberal,” “solidaristic,” and “justificationally perfectionistic,” labels that serve
to highlight features that fit together, thereby bringing out related commitments that
provide useful focal points for the discussion of the relative merits of a specific
regime. In this sense, regimes of autonomy differ along various axes, having to do
with the level and kind of autonomy-competence deemed appropriate to expect of
individuals, and with what to do in cases in which individuals meet (or fail to meet)
these standards.

6 Regimes of Autonomy in the Domain of Assisted Suicide

The assessment and ascription of autonomy is particularly decisive in the domain of

significant health care decisions, such as requests to participate in experimental drug
therapies, refusals to have a gangrened foot amputated, or noncompliance with a course of
anti-tuberculosis medication. But the ultimate case here is surely assisted suicide. The issue
is this: when a physician is asked to facilitate a suicide, she must assess whether the person
in question is autonomous. And, again, we have the familiar structure of a “regime”: a
necessary element in determining the normative boundaries of the practice (assuming for the
sake of argument that physician-assisted suicide is, under some circumstances, morally
appropriate) involves the application of a predicate — in this case, “has the autonomy-
competencies necessary for determining whether to end one’s own life” — and this predicate
is open to a wide range of interpretations. At least in the institutionally regulated context of
(quasi-)decriminalized physician-assisted suicide, we have the case that parallels official
driver’s licenses: the indeterminate question of whether someone is “really” able to appre-
ciate the grounds for and against suicide needs to be operationalized. It is a contingent matter
how it gets established (regarding the diversity of modes of implementation, see Battin 1991;
Kuhlmann 1995; Rietjens et al. 2009). The point of my methodological discussion, in the
first part of the paper, was to shift the focus away from finding the “core” elements of
autonomy. The point now is to show that, as in the case of driver’s competence, the
contingency of the criteria doesn’t mean that “anything goes” with regard to the official
implementation of the criteria. There are good reasons that can be offered for various
regimes of autonomy, and to illustrate this I will sketch this for neoliberal, solidaristic, and
perfectionistic conceptions of what regime of autonomy is appropriate in the domain of
physician-assisted suicide.
For a neo-liberal approach, what is central is that what gets you autonomy is minimal and
what autonomy gets you is maximal. Once you have met a low threshold of understanding
your situation and appreciating the effects of the choice, the scope of actions that are licensed
is taken to be rather expansive. The focus is on ensuring that the person requesting suicide is
maximally free from interference. This component is both the decisive factor in determining
whether one counts as autonomous (that one is not subject to manipulation or pressure) and
Regimes of Autonomy

the central component in what medical recommendations one is entitled to ignore.7 Of

course, physicians may have their own reasons for not cooperating, and within a
consistently neoliberal regime, it will also be especially important that physicians are
not forced to obey any and all demands of their patients. But what is distinctive about
the neoliberal regime of autonomy is the particularly strong presumption against
second-guessing the autonomy-competence of others.
For what I am calling a regime that is “solidaristic”, the demands for qualifying are lower
than for the neo-liberals, but what the status “autonomous” gets you is also more limited. For
solidarists, the starting assumption is that people are much more vulnerable than a neo-
liberal approach assumes. Solidarists emphasize the costs and risks of assuming that
everyone is able to handle very complex and difficult decisions well. If we take the
solidaristic regime to be guided by commitments to protecting the vulnerable, promoting
inclusion, and reducing inequality, then it can be expected to focus on ensuring that people
are not overwhelmed by an expanded scope of choice. What this means in the case of
physician-assisted suicide is an opposition to policies that open up room for those with more
autonomy-competencies to fare well but that leave those with less competency more
vulnerable. This lesser autonomy-competency can include, for example, difficulties figuring
out (and paying for) end-of-life alternatives to suicide, or confused emotions about
whether one has any worth as a person, or a diminished sense of agency that gives
one little confidence that one will be able to effectively control decisions that are
made later. A solidaristic regime is committed to minimizing the effects of these
forms of lower autonomy-competence (and the comparative advantage to those with
higher forms of competence), and one likely way of doing this is to limit the
situations of choice that require these forms of competence. Thus, by limiting the
range of options — and perhaps even refusing to license anyone to request physician-
assisted suicide — a solidaristic regime aims to protect the vulnerable and minimize
inequality. In this sense, what autonomy gets you within the solidaristic regime is
much more restricted, relative to the neoliberal model.8
Finally, one can also envision regimes with a “perfectionist” character, in which what
autonomy gets you is quite extensive, but where there is a relatively high threshold for
autonomy-competence. The guiding idea within this regime is that it is valuable for
individuals to have control over their own destiny, but that they only do so when they have
the requisite competence. On this understanding, perfectionists share the solidarists’ concern
with individuals’ autonomy-competencies being insufficient to handle the expanded context
of end-of-life options, particularly when that includes physician-assisted suicide. But per-
fectionist regimes take a different approach to rectifying this, focus not on a restriction of
choice but an expansion of the skills needed to handle the expanded choice. In line with this,
a perfectionist regime of autonomy in the case of physician-assisted suicide would be
focused on optimizing the context of decision-making, the resources available, and the
opportunities for strengthening one’s appreciation for the reasons that one has. (This
is particularly true if one thinks of the form of perfectionism involved as anchored not
on a commitment to realizing substantive ideals of how to live but rather procedural

7
Once the decisive issue has been framed as a matter of voluntariness, the issues of manipulation typically get
framed in terms of a metaphysics of causation (e.g. Ach 2011). As a result, there is a tendency to overlook the
fundamentally normative choices about what forms of causal influence are compatible with the ascription of
autonomy.
8
This is not to say that would guarantee egalitarian results, since some people or more in a position to take
their lives without assistance.
 J. Anderson

understandings of a well-justified choice, a view one might dub “justificational”

perfectionism.”)9 The key challenge for a perfectionist regime, of course, is to develop
an account that allows such a regime to retain a commitment to non-manipulation and
reasonable pluralism about conceptions of the good life (including the degree of
autonomy-competence one finds important to develop). But that is itself part of
working out what it means to respect and value autonomy in the case of physician-
assisted suicide.

7 Regimes of Autonomy in the Domain of Retirement Savings

This analysis of regimes of autonomy applies not only to assessing autonomy-competence in

individual cases but also to wider issues of public policy. Consider governmental policies
regarding retirement savings.
During the past century, governments have developed a variety of approaches to ensuring
that citizens have adequate income after they retire. One way of doing this is by distributing
funds collected through taxation or mandatory pension contributions. For a variety of
reasons, governments have been moving increasingly to pension schemes that make the
provision of adequate retirement income dependent on individual retirement savings. Partly
as a result of this (though also as a general fact of life), planning for old age is, for many, one
of the most important domains of decision-making they face. The skills involved in making
these decisions are key components of the rationality required for autonomy. One must be
able to appreciate the effects of one’s choices on others and oneself. One must be able to
“time travel” prudentially, to consider the significance of effects on oneself far in the future.
One must understand the instrumental relations between means and ends. One must be able
to factor in probabilities and risks regarding changing circumstances. Someone who was
chronically and completely unable to perform these tasks successfully might still make
choices about his or her pension savings, but any success would be the result of luck rather
than instances of self-governance. And if significant numbers of citizens turned out to lack
these autonomy skills regarding their retirement savings, not only would the economic
viability of the system and the retirement guarantees be jeopardized, it would also be the
case that individuals would end up in a situation in which they are not able to successfully
handle the decisions that a policy elects to impose on them – what I have elsewhere criticized
as an “autonomy gap” (Anderson 2009).
Accordingly, the politics of pensions turns significantly on disputes about what level and
scope of autonomy-competence citizens should be expected to have (both predictively and
prescriptively). Should, for example, individual employees be assumed to be sufficiently
competent in handling their financial affairs, or is there a need for safeguards and assistance
in avoiding the usual pitfalls and temptations? Within some regimes of autonomy, the
threshold for qualifying as autonomous is low and the concomitant decision-making author-
ity is high. And in such regimes, there will not appear to be much need for propping up
individuals’ autonomy. By contrast, in regimes of autonomy in which much higher standards
of competence must be met before one counts as having decision-making authority, there

9
Note also that the perfectionism I have in mind here is not the optimizing form of perfectionism that takes
the greatest degree of autonomy to be a substantive goal of policy-making but rather the satisficing form of
perfectionism that is focused on improvements that give individuals a “leg up,” thereby allowing them to
operate above the necessary threshold of competence. (For a discussion of “autonomy-perfectionism,” see
Gutmann 2011; I am indebted to Gutmann for discussions of this and related points.)
Regimes of Autonomy

will be much more room for governmental regulation. In attempting to defend more laissez-
faire or interventionist policy, it is question-begging to insist that one should simply respect
the autonomy of individuals, for this assumes a single, shared understanding of what
autonomy is, which we don’t have. Thus, what is first needed is an overview of the plausible,
distinct possibilities for regimes of autonomy in this domain. I’ll illustrate this with a sketch
of neoliberal, solidaristic, and perfectionist approaches.
In a regime with “neoliberal” characteristics, full decision-making authority (and respon-
sibility) is accorded on the basis of meeting a low threshold of competence. The guiding idea
is that respecting autonomy is centrally a matter of not second-guessing people’s individual
choices, as long as they meet a minimal threshold of competence and, in particular, are
voluntary. Within this regime, autonomy is closely tied to negative liberty and individual
sovereignty, and relatively little attention is paid to questions of competence, except in
extreme cases. Partly on the basis of suspicions about the limited possibilities for value-
neutral measurements of competence, neoliberals avoid competence-testing except in the
most egregious cases. The focus is instead on threats to autonomy stemming from interfer-
ence with free choice, whether that is the predatory interference of employers aimed at
misleading employees into not taking advantage of certain government mandated pension
plans or the beneficent interference of governments trying to encourage more investment in
long-term interests. A neoliberal regime of autonomy in the domain of pension policy is
focused on getting out of the way, so that individuals can act in accordance with their own
understanding of what their preferences are. In line with this, the competence threshold for
full decision-making authorization is seen as decidedly low and categorical.
A central critique neoliberal approaches, one shared by both solidaristic and perfectionist
approaches, is that giving individuals high levels of decision-making authority on the basis
of a low threshold of competence does not seem wise in the face of growing evidence that
this is an area in which individuals’ decision-making is significantly flawed. Three decades
of research in behavioral economics and cognitive psychology make clear that, especially
when faced with the expansion of options advocated by neo-liberals, our rationality is
bounded, our self-control is patchy, and our predictions regarding what will make us happy
are reliably mistaken (e.g., Ariely 2008; Kahneman 2011). It is especially in light of these
findings that some have argued against recent shifts in some countries from universal
pension schemes to a heavier reliance on voluntary employee contributions (Iyengar et al.
2004; Thaler and Benartzi 2004; Thaler and Sunstein 2008). But the solidaristic and
perfectionist approaches take a different tack on each.
More “solidaristic” regimes focus on how the neoliberal regime fails to protect less-
competent groups in society. From this perspective, the central fact about individual
autonomy is how limited the competence of many individuals is and the ways in which
vulnerable groups are significantly disadvantaged by arrangements in which benefits are
distributed in part on the basis of the autonomy-competence that individuals develop
“naturally.” Particularly salient for solidarists is evidence of how unequally distributed these
shortcoming are – especially for systematic reasons of educational and social background.
Solidarists oppose social arrangements in which those who are better at planning (or can
afford to hire consultants who are) make better use of the (complex) opportunities opened up
by liberalized policies, thereby leaving others behind. And they see the neoliberal regime of
autonomy as playing into this by setting a low and categorical threshold for “what gets you
autonomy,” but then treating differences in above-threshold levels of autonomy-competence
as unproblematic. Given their egalitarianism, defenders of solidaristic regimes are concerned
about the inequality and disadvantage resulting from some people being able to benefit
disproportionately from their greater ability to navigate the difficult task of planning for
 J. Anderson

retirement (and sticking to that plan). Given their commitment to strong principles of
inclusion, however, they are not inclined to set high thresholds for who counts as autono-
mous. The distinctive solidaristic approach, then, involves a low threshold of competence for
the status of being autonomous, in combination with significant restrictions on the scope of
choice over which one exercises that decision-making authority. A solidaristic approach is
thus an inclusive, low-threshold approach to what gets you autonomy, but a socially
constrained approach to what autonomy gets you.
In line with this, a solidaristic approach to retirement savings would advocate policies,
practices, and institutions that are inclusive by making the tasks more doable and the benefits
from being better at the tasks less significant. Typically, this involves limiting the scope of
what autonomy “gets you” (what the status licenses), by limiting the extent to which being
particularly good at handling numerous, significant, and complex choices puts individuals at
an advantage. For example, simplified, universal forms of guaranteed pensions (or default
investment plans selected by experts) dramatically diminish the relative advantage of those
with high levels of decision-making competence.10 Thus whereas a neoliberal regime
situates autonomy close to individual liberty, a solidaristic regime sees it as dovetailing with
full and equal inclusion in opportunities for full participation in society.
To take a third approach, perfectionists agree with solidarists in viewing neoliberals as
negligent regarding the reality of problematic and prevalent irrationalities, but they see the
solution as lying in increasing individual autonomy rather than decreasing the demands on
individuals. In perfectionist regimes, settling for a low competence-threshold for decision-
making authority reflects a tepid commitment to the value of autonomy, in that opportunities are
passed up for endorsing measures that put individuals in a position to make choices more
autonomously themselves. For perfectionists, valuing autonomy involves facilitating improve-
ments in individuals’ autonomy-competency in general. More specifically, one might take a
“justificationally perfectionist” approach, which focuses on improving the position of individ-
uals to appreciate the reasons they have. Rather than promoting across-the-board “improve-
ments” in the autonomy of individuals, such an approach would merely aim to improve, where
feasible, the possibilities for understanding, reexamining, weighing, and acting on reasons.
In the case of planning for retirement, a (justificationally) perfectionist regime would
focus on improving the conditions of decision-making, including everything from high-
quality information to the time to consider choices to other aids to deliberation. One
argument that perfectionists (and solidarists) could make in favor of government interven-
tion here relates to the “third-party harms” stemming from contributor-based pension
schemes and, more generally, the societal costs of incompetent individual choices. If it turns
out that individuals’ bad choices about retirement savings (or medical insurance, or car
maintenance, or an unhealthy diet, or risky home mortgages) lead to personal crises that
other people are stuck with cleaning up, then this provides non-paternalistic grounds for
taking measures to improve choices (for a discussion, see Shiffrin 2000). Whereas solida-
ristic regimes do this by accepting agents as they are but trying to ensure that the decision-
making tasks are doable, perfectionist regimes address what it takes to be the source of the
problem: lagging development of abilities to handle (increasing) complexity, for example, in
the domain of retirement planning. How to avoid allowing the improvement of decision-
making to slide into rampant paternalism is a major challenge within a perfectionist regime.
But the guiding idea is that a society that values autonomy would be a society that does not
neglect opportunities for increasing the autonomy of individuals.

10
There are interesting parallels here with the recent United Nations Convention on the Rights of Persons
with Disabilities; for a discussion, see Graumann 2011; Anderson and Philips 2012.
Regimes of Autonomy

8 Justifying Regimes

I began this essay by contrasting my social pragmatic approach with standard ap-
proaches that focus on identifying a core set of elements that are necessary and
sufficient for being autonomous. What I have tried to show is that one can usefully
shift the question from “What is autonomy really?” to “What regime of autonomy is
best for us in this context?” The discussion of the previous section is intended to
illustrate how that second question could be formulated, in the context of physician-
assisted suicide and retirement planning, as well as what some candidates for different
regimes might look like.
Providing an answer to that question of justification, however, is a complex matter.
It raises complex issues regarding the relative merits of different regimes. A wide
range of considerations will be relevant to such a discussion. Some of those consid-
erations will have to do with the internal coherence and consistency of a candidate
regime. Do the value commitments and policy solutions fit together? Is the under-
standing of autonomy consistent across different domains? Other considerations will
have to do with the practical implications of adopting one or another regime. Are the
social conditions such that these commitments can be institutionalized in a way that
accords with the underlying principles? In particular, will modes of assessing individ-
uals’ competence already constitute insulting forms of second-guessing? Perhaps most
significantly, there will be important considerations to be taken into account regarding
the complex implications of regimes of autonomy for other domains, where regimes
are centered on other values, such as freedom or efficiency. For it might turn out that
some regimes of autonomy are much more compatible with the most compelling
candidate regimes in other domains, and this would give us reasons to prefer it.
Moving beyond these abstract claims about how the debate could proceed would require
engaging with the details of actual debates in which detailed reconstructions of regimes are
evaluated relative to one another and in light of their wider implications. My aim here
has only been to articulate a way of engaging the issues on which the debates actually
hinge, rather than getting stuck in debates about what the necessary and sufficient
conditions for autonomy really are. There is a family resemblance among the issues
that arise in debates about the competence thresholds at which paternalism is justified,
about the scope of governmental obligations, or about the appropriateness of prohibi-
tions. It’s not a coincidence that these debates are filled with references to “autono-
my”. But these debates are most fruitfully pursued, not via proxy wars over the
correct definition of “autonomy”, but as ethical and political debates about the kind of
society that is best for us. Those broader debates are a good deal messier than debates
over the necessary and sufficient conditions for autonomy, but the progress that is
made in them is also more real.

Acknowledgments This essay was written while I was a Fellow at the Centre for Advanced Study in
Bioethics at the Westfälische Wilhems-University, Münster, and I am especially grateful for the supportive and
stimulating environment it provided. Earlier versions of this essay were presented to audiences in Amsterdam,
Münster, Colchester, Bielefeld, Tilburg, and Utrecht, and I benefitted enormously from the discussions there.
For comments on earlier versions of this essay, I am particularly grateful to Rüdiger Bittner, Frank Hinrichs,
Thomas Fossen, Wayne Martin, John Christman, Margaret Gilbert, Thomas Schmidt, Thomas Schramme,
Dominik Düber, Arnd Pollman, Ludwig Siep, Marina Oshana, Robin Celikates, Beate Rössler, Johann Ach,
Michael Quante, Pauline Kleingeld, Deryck Beyleveld, Gerhard Bos, Ineke Bolt, Rutger Claassen (also for
earlier joint work on “regimes”), and an anonymous referee for this journal. Annette Dufner and Michael
Kühler deserve special mention for their encouragement and particularly detailed comments at various stages
of this essay’s development.
 J. Anderson

References

Ach JS (2011) “Autonomer Suizid?” Preprints of the Centre for Advanced Study in Bioethics Münster no. 20
Anderson J (2008) Disputing autonomy: second-order desires and the dynamics of ascribing autonomy. Sats
Nord J Philos 9:7–26
Anderson J (2009) Autonomielücken als soziale Pathologie. Ideologiekritik jenseits des Paternalismus. In: Forst
R, Hartmann M, Jaeggi R, Saar M (eds) Sozialphilosophie und Kritik. Suhrkamp, Frankfurt, pp 433–453
Anderson J (2013) Autonomy. In: LaFollette H (ed) International encyclopedia of ethics. Wiley-Blackwell,
Oxford, pp 442 –458
Anderson J (2014) “Autonomy and vulnerability entwined.” In: Mackenzie C, Rogers W, Dodds S (eds)
Vulnerability: new essays in ethics and feminist philosophy. Oxford University Press, Oxford
Anderson J, Claassen R (2012) Sailing alone: teenage autonomy and legal regimes of childhood. Law Philos
31:495–522
Anderson J, Philips J (eds) (2012) Disability and universal human rights: legal, ethical, and conceptual
implications of the convention on the rights of persons with disabilities. SIM, Utrecht
Ariely D (2008) Predictably irrational: the hidden forces that shape our decisions. HarperCollins, New York
Battin MP (1991) Euthanasia: the way we do it, the way they do it. J Pain Symptom Manag 6:298–305
Brandom R (1994) Making it explicit: reasoning representing, and discursive commitment. Harvard Univer-
sity Press, Cambridge
Christman JC (1989) The inner citadel: essays on individual autonomy. Oxford University Press, New York
Dworkin G (1988) The theory and practice of autonomy. Cambridge University Press, New York
Feinberg J (1986) Harm to self. Oxford University Press, New York
Fossen T (in press) “Politicizing Brandom’s pragmatism: normativity and the agonal character of social
practice.” Eur J Philos. doi:10.1111/j.1468-0378.2011.00504.x
Foucault M (1970) The order of things: an archaeology of the human sciences. Vintage, New York
Garfinkel H (1967) Studies in ethnomethodology. Prentice-Hall, Englewood Cliffs
Graumann S (2011) Assistierte Freiheit: Von einer Behindertenpolitik der Wohltätigkeit zu einer Politik der
Menschenrechte. Campus, Frankfurt a. M
Gutmann T (2011) “Paternalismus und Konsequentialismus,” Preprints of the Centre for Advanced Study in
Bioethics Münster no. 17
Hart HLA (1948) The ascription of responsibility and rights. Proc Aristot Soc 49:171–194
Hohfeld WN (1913) Some fundamental legal conceptions as applied in judicial reasoning. Yale Law J 23:16–59
Iyengar SS, Jiang W, Huberman G, Mitchell OS, Utkus S (2004) “How much choice is too much: determi-
nants of individual contributions in 401k retirement plans,” In: Pension design and structure: new lessons
from behavioral finance. Oxford University Press, Oxford
Kahneman D (2011) Thinking, fast and slow. Farrar Straus & Giroux, New York
Kuhlmann A (1995) Sterbehilfe. Rohwolt, Reinbek bei Hamburg
Kukla R, Lance M (2009) “Yo!” and “Lo!”: the pragmatic topography of the space of reasons. Harvard
University Press, Cambridge
Lance M, White WH (2007) Stereoscopic vision: persons, freedom, and two spaces of material inference.
Philos Imprint 7:1–21
Meyers DT (1989) Self, society, and personal choice. Columbia University Press, New York
Oshana M (2006) Personal autonomy in society. Ashgate, Burlington
Quante M (forthcoming) “Hegels kognitivistischer Askriptivismus.” In: Beiträge zum Internationalen
Hegelkongress 2011
Richardson HS (2001) Autonomy’s many normative presuppositions. Am Philos Q 38:287–303
Rietjens JAC, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJM, van der Heide A (2009) Two
decades of research on euthanasia from the Netherlands. What have we learnt and what questions remain?
J Bioeth Inq 6:271–283
Shiffrin SV (2000) Paternalism, unconscionability doctrine, and accomodation. Philos Public Aff 29:205–250
Taylor C (1985) “Theories of meaning.” In: Philosophical papers, vol. 1: human agency and language.
Cambridge University Press, Cambridge, pp 248–292
Taylor JS (2005) Personal autonomy: new essays on personal autonomy and its role in contemporary moral
philosophy. Cambridge University Press, New York
Thaler R, Benartzi S (2004) Save more tomorrow: using behavioral economics to increase employee saving. J
Polit Econ 112:164–187
Thaler R, Sunstein C (2008) Nudge: improving decisions about health, wealth, and happiness. Yale University
Press, New Haven
Vanderbilt T (2008) Traffic: why we drive the way we do. Knopf, New York