Is the government in the position to dictate whether or not a woman should be permitted to get an abortion? Is it an infringement of autonomy for the state to prohibit the consumption of drugs, even though they have been proven harmful? Is it ethical for a corpse to abstain from donating its organs to someone in need? Should a terminally ill patient have the right to end his or her own life through euthanasia? Is it the responsibility of the government to step in and restrict dietary practices in order to end the obesity epidemic? Should an individual be mandated to wear a seatbelt or should he or she have the freedom to refuse?
All of these questions are asking the same thing: to what extent should an individual have control over his or her own body? This is the main question that I framed my research around. Should an individual have absolute control over his or her body or is it the duty of external forces to create restrictions in order to protect or guide the individual even if it requires extreme measures?
In this piece I intend to propose one way to approach bodily autonomy, and subsequent policies, based on the conclusions I have drawn from my research.
But first, what does it mean to have bodily autonomy?
Catriona Mackenzie presents one viewpoint in the chapter “On Bodily Autonomy” in Handbook of Phenomenology and Medicine. Traditionally, libertarians and most liberals rely on the “maximal choice conceptions” argument for bodily autonomy, which posits that,
“as long as a person’s choices meet two minimal conditions, she should be free from the undue (paternalistic) interference of others or the state to do with her body as she chooses. These conditions are firstly, that the choice does not cause harm to others; secondly, that the choice is non-coerced and reasonably voluntary” (Mackenzie, 419).
Mackenzie, however, refutes the claim that “a person is entitled to potentially unlimited scope in the range of bodily options available to her and that the more such options she has open to her the better” (Mackenzie, 419). She instead believes that autonomy embodies more than just ownership of one’s body; it is a feeling of agency that is created through lived experiences. Therefore, a multitude of choices cannot enhance autonomy adequately, not without the consideration of normative values as well. Mackenzie explains, “Choice is valuable because it enables us to enact or express our values. But if our choices are not guided by our values, if choice itself is the only value, then our choices are arbitrary and wanton” (Mackenzie, 434). She provides this example, “a schoolgirl who desires breast implants for her sixteenth birthday because she knows that breast size is important to success in show business, would count as making an autonomous choice [according to the maximal choice conceptions theory]” (Mackenzie, 420). Essentially, her argument is that bodily autonomy cannot simply be defined by unlimited and non-coerced choice because decisions related to one’s body are influenced by norms and values. Therefore, norms and values need to be taken into account when framing the definition of bodily autonomy, which Mackenzie believes is an active and self-reflective process that goes beyond inherent ownership of one’s body.
From my research, it became clear that issues regarding bodily autonomy were fraught with controversy because they are grounded so heavily in subjective moral principles. A common argument in favor of expanded bodily autonomy is that an individual should have the right to do whatever he or she wants with his or her own body as long as it does not harm others. While I do believe that it reasonable to argue that since “there is no universal consensus about the good,” individuals should be able to “live according to their own conception of the good life” (Mackenzie, 419); Mackenzie’s argument indicates that there are more factors going into what may ostensibly seem like autonomous decisions than a mere desire for a good life. People are swayed by social pressures and desires that are influenced by external norms more than intrinsic wants. This can lead to decision-making that may be detrimental to an individual’s health and wellbeing, which would prevent him or her from living the “good life” to the fullest extent. To me, this justifies intervention in certain cases because it acts as a tool to remind people of health concerns that they might otherwise overlook. Advocates for unlimited bodily autonomy would argue that no external power should force values on individuals with regards to their own bodies. But since one’s bodily actions are not made in a vacuum and instead take normative values into account, why should intervention not also be shaped with such values in mind?
In my ideal world, individuals would have the freedom of almost unlimited bodily autonomy and would be informed and rational enough to make educated decisions about their bodies. However, I believe that we are a long way from that point and that it is in the best interests of individuals’ wellbeing for external powers to guide the people even if that occasionally requires extreme measures.
What form should this intervention take and when is it applicable?
From my research I have concluded that state intervention (in the form of bans, prohibitions, or restrictions) on an action related to bodily autonomy is required in the following cases:
- Whenever the negative effects on bystanders (any external individuals) outweigh the positive effects on the actor (person doing the action that expresses bodily autonomy).
For example: Smoking in public spaces (e.g. restaurants) because the health damages of second hand smoke on bystanders outweigh the positive sensations experienced by the smoker.
- In cases in which the reverse is true, intervention is required when there are strong negative effects of the action on outside parties, even if the actor benefits immensely.
For example: Taking steroids because it can be argued that the benefits that an athlete, for example, gains over the opposition outweigh the disadvantage to his or her opponents. However, the disadvantage to the opponents is significant enough to warrant intervention.
- In cases in which outside parties are not negatively affected at all but the actor is, intervention is required when the negative impact on the actor is seriously detrimental.
For example: Ingesting toxic chemicals.
- If the impact on the actor is harmful but not severe then the state has the responsibility to educate individuals so they can make informed decisions even if the state does not intervene.
For example: Consuming unhealthy foods, which is detrimental to one’s health but is not severe enough to warrant bans or restrictions.
The difficulty with deciding which actions warrant intervention is that it can be tainted by personal opinions and morals. In “Why the way we consider the body matters–Reflections on four bioethical perspectives on the human body”, Silke Schicktanz argues that, “Moral autonomy…includes the respect for another person’s bodily integrity, even if it conflicts with one’s own preferences and aims of action” (Schicktanz, 8). To tackle this issue I propose that issues of bodily autonomy should be approached in terms of level of negative risk instead of level of freedom. Each action has a different impact on the actor and the bystanders, and therefore, the strength of negative effects of an action should be taken into account when determining the extent to which to regulate it. Instead of determining a blanket level of freedom that each individual should have (for example, each individual should have complete bodily autonomy despite the consequences) we should determine a level of risk that we deem safe for an individual to take on. For example, our current legislation considers unlimited amounts of caffeine to fall below the level of risk but any amount of heroin is above the level of risk. If we were to frame these two examples in terms of freedom, then an individual would be permitted to consume equal amounts of caffeine and heroin even though each the two substances vary drastically in their detriment to one’s health.
To conclude, I believe that bodily autonomy should be considered through the lens of norms and values and should be maximized but not at the expense of people’s health and wellbeing. These views may seem authoritarian to those that advocate for complete bodily autonomy, but perhaps this final example will elucidate my claim. We are presently required by law to wear a seatbelt in a moving car. Now, some might argue that seatbelts are annoying, uncomfortable, and too much of a hassle to deal with; therefore, each individual should be able to determine for his or herself whether or not to wear one. But these people forget that the likelihood of being in a car accident is high and their bodies will be much better protected if they are wearing a seatbelt. Complete freedom is only beneficial as long as it does not compromise one’s life. Buckling up next time you get in a car is a small price to pay to prepare for the worst.
Mackenzie, Catriona. “On bodily autonomy.” Handbook of phenomenology and medicine. Springer Netherlands, 2001. 417-439.
Schicktanz, Silke. “Why the way we consider the body matters–Reflections on four bioethical perspectives on the human body.” Philosophy, Ethics, and Humanities in Medicine 2.1 (2007): 1-12.