University of Southampton

Abstract

Virginia Warren proposed that one feature of a sexist ethics would be its neglect of “housekeeping issues” – the often ill-defined, subtle, ongoing questions of how we conduct ourselves in everyday life and shape our relationships and interactions with those around us – in favour of a focus on resolution of the ‘crisis issues’, the discrete, isolated conflicts where one makes a final decision from a limited menu of possible actions. The principle of respect for autonomy is overwhelmingly invoked as a tool for the resolution of crisis issues, protecting the decision-making authority of the individual patient within the context of a given clinical decision. I aim to explore how respect for autonomy might be understood if respect were instead treated as a housekeeping issue, by drawing on three representative cases. A woman’s decision on whether to undergo foetal diagnostic testing highlights, as Rebecca Kukla argues, the ways in which autonomous choice is shaped by the history of the norms of the provider-patient relationship. The decision to opt for cosmetic surgery highlights the ramification of apparently-individual decisions beyond the immediate clinical context, and thus a dimension of ethical concern that is rendered invisible by conventional approaches to respect. And an example offered by Catriona McKenzie of an apparently-competent woman’s refusal of treatment demonstrates the ways in which the provider-patient relationship, beyond non-interference in competent decisions, can serve to shape individuals’ self-conceptions in ways that may support or undermine autonomous agency.

Together, I argue that these cases suggest that respect for autonomy is a principle of ethical housekeeping, not an instrument for crisis resolution. The relevant difference can be elucidated via the intuitive distinction between two common-sense interpretations of ‘respect’. The conventional, crisis-issue framing of respect is akin to that used in ‘respecting borders’ of sovereign states – a paradigm of non-interference in governance of their affairs. The alternative is embodied in our understanding of respect for an interlocutor – the attitude displayed towards a partner in a conversation or debate, where one is attempting not simply to adjudicate the victor of a conflict, but to collaborate in producing a mutually-intelligible space of reasons upon which all participants can agree to act. I propose that the cases discussed above – and the ways in which the conventional, crisis-issue, framing of respect for autonomy fails to capture ethically-significant features within those cases – suggest that respect is best understood as a housekeeping issue, akin to respecting an interlocutor.

Biography

I am a medical student at the University of Sheffield, prior to which I studied Physics and Philosophy at the University of Oxford. I am particularly interested in ethical issues in the medical epistemology, the social and political responsibilities of health workers, and in feminist and communitarian approaches to autonomy and respect.

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