November 29, 2023

Re-examining autonomy

The buzzword cutting through the noisy controversy over the US Supreme Court’s repeal of Roe v. Wade is “reproductive autonomy”. This is raised on a pedestal as the liberal ideal for which American women should strive.

But there are other, more nuanced, views of autonomy, viewed especially through a feminist lens. In a European journal called Medicine, Health Care and Philosophy, Ji Young Lee, of the University of Copenhagen, argues that “this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and third-party reproduction.”

She goes on to state:

Plausibly, then, reproductive autonomy is a good thing – something it would be entirely reasonable, if not ideal, to aspire to in reproductive decision-making. Yet, the oppressive and inegalitarian social environments that make up our non-ideal world complicates the ethically explanatory power of a liberal framework of reproductive autonomy. This is because the liberal framework on its own does not fully capture the question of who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. I take these factors to constitute three major limitations of the liberal framework. This should provide us with enough reasons to doubt the status of liberal reproductive autonomy as the prevailing ethical ideal for reproductive decision-making.

The liberal model of autonomy, she contends, privileges free decision-making. But a healthier view, which she calls “relational autonomy”, takes into account the costs of the decision and the reasons for which the decision is made. It is not enough merely to have “options”; one must examine the content and limitations of the options as well.

She uses the example of egg-freezing, a reproductive method which allows women to have a career and also experience motherhood. Companies like Facebook and Apple are offering it as an employment benefit. But who really benefits – the women or the company?

She concludes that bioethicists need:

to take relational views of autonomy as a starting foundation for further discussion, and from there to ask critical questions about the nature and content of the reproductive decision-making which do not simply rely on the liberal conditions of choice.