The Claims of Anorexic Patients: a Relational Account of Autonomy
Jacopo Condo is a PhD doctoral student whose area of research is moral and political philosophy (with a distinct focus on questions of identity, pluralism, multiculturalism, oppression and vulnerability), epistemology, philosophy of language, and psychiatric disorders (especially anorexia). He is particularly interested in the application of late Wittgenstein in ethics and in Charles Taylor's expressivist conception of language. He is supervised by Bob Brecher, Arianne Shavisi, and Michael Neu.
The functional approach to capacities usually evaluates anorexics competent to refuse treatment, but in English law force-feeding can be used even if anorexic patients prove to be competent in decision-making. The priority accorded by Mental Capacity Act (2005) to patient’ capacities is overridden by the diagnosis of anorexia: who has an eating disorder is incapable to deciding on nutrition, and therefore to refuse force-feeding. This solution is ethically problematic because it presumes that anorexics lack capacities to refuse treatment. This measure also conflicts with the UN Convention on the Rights of People with Disabilities and de facto discriminate anorexic patients overstepping their right to choose. This does not mean that anorexics should be always considered competent to refuse treatment on the base of the functional test, but that the value-neutral framework of the very functional test is not able to grasp the status of anorexic’s autonomy.
The idea of personal autonomy endorsed by the current Acts refers to a human agent who is constitutively private. According to this conception, no one can truly understand if the reasons governing a person’s choices are authentic except the “owner” of those reasons. One of my aims is to show that this conception is mistaken, since the very idea of “owner” of the reason cannot be sustained without running into hopeless ontological, phenomenological and epistemological problems. Furthermore, it is quite common that one’s own reasons are, especially in times of upheaval, obscure to oneself. In cases like these we try to clarify the reasons that motivate us in dialogue, interaction and struggle with others. Moreover, we have not developed and shaped our own reasons alone, but in relation with others. Even our most private aspects such as our identity and what really matters to us are dialogically linked to others. The inner world of individuals is not structurally inaccessible to others, as the defenders of normative neutrality maintain: people develop their “privacy” relationally, in dialogue with others.
The relational dimension of human agents is constitutive of their existence, furthermore. Thus, in order to be in a position to identify the peculiar kind of hindrance in which the anorexic is embroiled, it is necessary to overcome the purely “neutral” current conception of autonomy. My purpose is to construct a relational account of autonomy that is able to do this without recourse to a normative model of good reasons. If successful, this would serve to undermine the liberal framework on which the standard conception of personal autonomy is based.