[Update 2: Do scroll to the comments for further arguments, and contribute if you have any thoughts].
John Magruder writes:
Anorexia is not a mere conviction as the author suggests, it is a delusion. It is a false belief that is impervious to rational discussion. That is why the anorexic in question does not have autonomy.
[S]omeone who’s in the firm grip of anorexia nervosa is unlikely to have “convictions” in the sense that most people do. Extreme food restriction is a cause of irrational thought as well as a consequence of it.
‘MacGuffin’ is blunt:
For goodness sake, is this question really so difficult? Anorexia is the manifestation of a mental illness that undermines autonomy. The woman is not in a condition to make sound judgements.
So I had previously defined autonomy very broadly as being about ‘letting those able to make decisions, make decisions’, where being able amounted to being a mentally developed adult.
Now, by ‘mentally developed’ I didn’t mean anything fancy, picking out an IQ threshold that people had to pass or a certain proportion of true beliefs. I really did mean nothing more than: not a child. And the objection that runs through the three comments above is that, yes, autonomy requires the ability to make decisions which requires mental development, but that in turn requires a sound mind, absent of delusion, capable of rational thought. So what to make of this?
First, we can note immediately another definitional problem. Autonomy itself was a sufficiently elusive concept, but now it is being tied up with rationality, making the picture even murkier. What is meant by rationality? I take it that none of the commenters mean something simple and Humean like ‘an ability to pick out the appropriate means towards one’s ends’. The anorexic woman has an end – not to experience pain – and she resists force-feeding treatment accordingly. If that’s all rationality was, she’s got it. So presumably by labelling her irrational, what is supposed to be conveyed is that her end, which entails death, is irrational. Maybe she fails to see the value of life because her mind is so clouded by physiological problems? To which I would say two things:
First; how, exactly, is this irrational? What conception are we working with here?
And second, if this counts as irrational, where does this leave our attitude to euthanasia? Here, by definition, a person wills to end their life because they judge it to no longer be worth living. So if you define rationality as appreciating the value of life irrespective of pain and you insist that autonomy requires rationality, then if someone denies this and thereby expresses irrationality, they cannot be autonomous. And this leaves us in a situation where those seeking euthanasia can never be judged to have made an autonomous decision. Why? Because it would, allegedly, be necessarily irrational.
If I mischaracterise what ‘rationality’ is meant to mean here, please correct me. But if I don’t, consider one more implication:
This type of argument is quick to infer that if someone is irrational and thereby not autonomous, intervention is justified. But do we really think that? Would we really want external force blocking a person’s choices to be, in principle, legitimate whenever their logic falls short of Einsteinian standards? Who sets those standards? And how is anybody going to meet them?
Which returns me to my recommended rule: the state will do best to respect the wishes of its citizens, where their wishes are exactly what they say they wish.
As always, comments would be much appreciated.
[Update] I just realised there is a simple and obvious way in which the woman could be labelled irrational: she is simply inconsistent. An interesting scenario indeed, but not the one at hand. Allow me to refer back to Foster’s original post:
If she is not admitted against her will to hospital, detained there for not less than a year, and forcibly fed under physical or chemical restraint, she will die. She understands this perfectly well. She doesn’t actively seek death, but doesn’t want to be force fed.
This doesn’t look inconsistent to me. I take this to mean that if she could live without being force-fed, she wouldn’t go out of her way to finish herself off by committing suicide. But, given this is the inevitable consequence of refusing force-feeding, she’d accept it. It seems highly contentious to claim there’s anything obviously contradictory here that justifies the overruling of another person. In fact, it looks like an accidental, quasi-employment of the widely-backed Doctrine of Double Effect.