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Regimes of Autonomy

Article in Ethical Theory and Moral Practice June 2013

DOI: 10.1007/s10677-013-9448-x

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 Regimes of Autonomy

Joel Anderson (Dept. of Philosophy, Utrecht University)

Forthcoming in Ethical Theory and Moral Practice, in a special issue on "Private Autonomy,
Public Paternalism?" ed. Annette Dufner and Michael Khler (with essays by Diana T. Meyers, John
Christman, John Kultgen, Amy Mullin, Thomas Gutmann, and Bijan Fateh-Moghadam) -- April 19, 2013

1. A Methodological Shift

Claiming that one is 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 autonomous 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 persons status is determined properly that those who
really are autonomous end up counting as autonomous and that those who arent really
autonomous dont. 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 manipulation does one have to be to count as autonomous? It
is usually thought that if a theory of 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
 Anderson, Regimes of Autonomy p. 2

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 justi-
fying 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 Dworkins
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

1 Note that the point I am making here is different from the objection raised by those, like Henry
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 approaches 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.
 Anderson, Regimes of Autonomy p. 3

use these rich, contextualized characterizations 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 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 first contrast a consistently 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 dont wish to deny the benefits of clear, unambiguous definitions (of particularly
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 dont know
what rights and obligations follow from appropriately attributing autonomy to someone,
you dont 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 & White 2007; see
also Anderson 2008). But once it becomes clear that such approaches postpone the task
of working out what the practical implications are 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,

3On 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.
 Anderson, Regimes of Autonomy p. 4

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
proceeding 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 dont really know what they are agreeing to when they accept a
particular definition. This is related to the point just made: if we dont understand what
the practical implications are of endorsing autonomy, we havent 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 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, Im 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 contextualization, 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. Im interested,
second of all, in proposing a way of framing that normative debate in terms of several
 Anderson, Regimes of Autonomy p. 5

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 appropriately 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).
Ill take them in turn.

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 ones 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 ones
life. Or one could focus on the importance of having a range of worthwhile options
 Anderson, Regimes of Autonomy p. 6

available, or of being able to actually live in accordance with ones 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 between views of autonomy and my focus here has to do with the
relative demandingness of the threshold.

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 responsibilities 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. Others argue that the autonomy ticket licenses
risky and reliable patient choices equally (although there may be other reasons for
handling this 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

4I myself find it useful to distinguish between various packages of autonomy competence: executive,
deliberative, disclosive, and critical capacities related to self-governance (Anderson 2012; on
autonomy-competencies, see Meyers 1989). My point here, however, is not to advocate a particular
substantive conception of autonomy.
 Anderson, Regimes of Autonomy p. 7

oneself with regard to these options. It requires, as I will say, situating ones 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 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

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: Hohfelds theory of rights (Hohfeld 1913), Foucaults archaeology of the human sciences
(Foucault 1970), H.L.A. Harts ascriptivism (1948), neo-Sellarsians (Brandom 1994; Lance and
White 2007; Kukla and Lance 2009; Fossen in press), and, most generally, in Hegels 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.

 Anderson, Regimes of Autonomy p. 8

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 understandings 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 isnt a good-enough driver (despite his having a drivers 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 demanding or even rely on individuals own self-
assessment. In addition, regimes might be different 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 ones 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
 Anderson, Regimes of Autonomy p. 9

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 against which status quo arrangements must be
defended. In evaluating 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 drivers
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 ones 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 paternalism 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
 Anderson, Regimes of Autonomy p. 10

does one have to be for a desire for assistance in committing suicide to authorize a
physicians 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 competence 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.
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 constellations 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
 Anderson, Regimes of Autonomy p. 11

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 ones
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 drivers licenses: the indeterminate question of
whether someone is really able to appreciate 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 drivers competence, the contingency of the criteria doesnt
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 the central component in what one is
authorized 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 accommodate to the wishes 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.

7Once 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.
 Anderson, Regimes of Autonomy p. 12

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 perfectionist 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
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.
 Anderson, Regimes of Autonomy p. 13

decision-making, the resources available, and the opportunities for strengthening ones
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 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 in cases of 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 ones 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

9Note 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.)
 Anderson, Regimes of Autonomy p. 14

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 able 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 authority 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 will be much more room
for governmental regulation. In attempting to defend more laissez-faire or
interventionist policy, it doesnt advance the discussion to insist that one should respect
the autonomy of individuals, for this assumes a single, shared understanding of what
autonomy is, which we dont have. Thus, what is first needed is an overview of the
plausible, distinct possibilities for regimes of autonomy in this domain, Ill illustrate this
with a sketch of neoliberal, solidaristic, and perfectionist approaches.
In a regime with neoliberal characteristics, full decision-making authority (and
responsibility) 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
peoples 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 interference with free choice, whether
that is the predatory interference of employers aimed at misleading employees into not
 Anderson, Regimes of Autonomy p. 15

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 focuse 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 how
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
 Anderson, Regimes of Autonomy p. 16

their greater ability to navigate the difficult task of planning for 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 autonomous. 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 improvements in individuals
autonomy-competency in general. More specifically, one might take a justificationally
perfectionist approach, which focuses on improving the position of individuals to
appreciate the reasons they have. Rather than promoting across-the-board
improvements in the autonomy of individuals, such an approach would merely aim to
improve, where feasible, the possibilities for understanding, reexamining, and weighing
reasons.
10There 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.
 Anderson, Regimes of Autonomy p. 17

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
intervention 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 solidaristic 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.

8. Justifying Regimes

I began this essay by contrasting my pragmatic approach with standard

approaches 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 considerations 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 understanding of autonomy
 Anderson, Regimes of Autonomy p. 18

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 individuals 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 regimes that 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
prohibitions. Its not a coincidence that these debates are filled with references to
autonomy. 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.11

References

11This essay was written while I was a Fellow at the Centre for Advanced Study in Bioethics at the
Westflische Wilhems-University, Mnster, and I am especially grateful for the supportive and
stimulating environment it provided. Earlier versions of this essay were presented to audiences in
Amsterdam, Mnster, 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
Rdiger Bittner, Frank Hindriks, Thomas Fossen, Margaret Gilbert, Thomas Schmidt, Thomas
Schramme, Dominik Dber, Arnd Pollman, Ludwig Siep, Marina Oshana, Robin Celikates, Beate
Rssler, 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 Khler deserve special mention for their encouragement and
particularly detailed comments at various stages of this essays development.
 Anderson, Regimes of Autonomy p. 19

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