Virginia Warren proposed that one feature of a sexist ethics would be its neglect of \u201chousekeeping issues\u201d \u2013 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 \u2013 in favour of a focus on resolution of the \u2018crisis issues\u2019, 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\u2019s 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\u2019s refusal of treatment demonstrates the ways in which the provider-patient relationship, beyond non-interference in competent decisions, can serve to shape individuals\u2019 self-conceptions in ways that may support or undermine autonomous agency.<\/p>\n
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 \u2018respect\u2019. The conventional, crisis-issue framing of respect is akin to that used in \u2018respecting borders\u2019 of sovereign states \u2013 a paradigm of non-interference in governance of their affairs. The alternative is embodied in our understanding of respect for an interlocutor \u2013 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 \u2013 and the ways in which the conventional, crisis-issue, framing of respect for autonomy fails to capture ethically-significant features within those cases \u2013 suggest that respect is best understood as a housekeeping issue, akin to respecting an interlocutor.<\/p>\n
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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. _<\/p>\n
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