Justifying judgments of inauthenticity
In my proposal, judgments of inauthenticity in others concern their decision-making, or more precisely their desires, as desires are the most basic element in ordinary preference-forming and, thus, in decision-making. I follow Taylor (
2005), Sjöstrand and Juth (
2014), and others in this desire-oriented approach. For reasons of justification, judgments of inauthenticity are delimited to concern only a certain kind of persons, namely those whose medical condition may influence their decision-making so that they hurt themselves or others. Examples of such persons include an anorexia nervosa patient who expresses a wish to die rather than gain weight and someone with a brain tumor that causes him or her to develop pedophilic sexual desires.
2 For those persons and the desires underlying their healthcare decisions, I argue that it is justified to judge that a desire is inauthentic to the extent that it is due to causal factors that are alien to the person and to the extent that it deviates from the person’s practical identity.
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Thus, there are three main elements in my proposal that require some elaboration here; the kind of people and desires included in the analysis, the notion of alien causal factors, and the notion of deviation. For pedagogical reasons, I will go through them in the opposite order. However, first I present some brief notes on the theoretical foundation of my proposal.
In one tradition, the distinguishing feature between authentic and inauthentic desires is whether the desire-holder would endorse her own desires upon critical and informed self-reflection. The tradition is known mainly from Frankfurt (
1971) and Dworkin (
1988) and has been supported more recently by Juth (
2005) and DeGrazia (
2005), among others. It has been noted that the distinguishing feature is difficult to observe in others (see, e.g., Ahlin
2018a; Sjöstrand and Juth
2014; and; Swindell
2009). That is, it is difficult to know whether a person would endorse her own desires upon informed and critical self-reflection, and therefore the theoretical ideal is impractical, at best. However, the distinguishing feature can be reversed, so that a desire is inauthentic if the desire-holder would
disapprove of having it upon critical and informed self-reflection (cf. Juth
2005, p. 153). Then, it is less difficult to observe inauthenticity in others, as empirical factors that indicate that a desire-holder would in fact disapprove accordingly can be identified and articulated in detail. The theory which is presently being spelled out builds on this reversed version of the Frankfurt-Dworkean ideal. The notions of alien causal factors and of deviation are empirical factors indicating that a desire-holder would disapprove of having a desire upon critical and informed self-reflection.
That is the theoretical foundation of my proposal. It is an ideal theory of what distinguishes authenticity from inauthenticity. What follows here, however, does not concern that distinction per se, but the justification of judgments of inauthenticity, i.e., what justifies the judgment that a desire meets the conditions for being inauthentic. That justification is phrased in non-ideal terms, and builds from empirical factors in real persons and contexts.
Consider a person who suddenly displays a desire that is seriously deviating from her practical identity, i.e., the way she usually thinks, behaves, and functions socially (cf. Christman
2009, pp. 149–156). One hypothetical example is Anna, a professional ballet dancer known to love dancing more than anything else, who after being injured refuses to undergo a minor treatment that would enable her to continue dancing (Ahlin
2018a, p. 44). Her refusal builds on desires that are seriously deviating from her practical identity. Therefore, the case invites the thought that Anna’s desires are inauthentic. However, the judgment is not justified. The reasons for why Anna makes the surprising decision to refuse treatment is unknown. Because we do not know the causal history of her desires, we are not justified in making the judgment that they are inauthentic.
Now, consider a 40-year old man who suddenly developed a sexual interest in children that was causally connected to a brain tumor (Burns and Swerdlow
2003). When the tumor was removed the pedophilic symptoms disappeared, and when the symptoms later returned it was found that the brain tumor had grown back. There is no doubt that the tumor caused the man’s sexual interests. Thus, the causal factors of the man’s desires were alien to how he was otherwise construed, which intuitively seems to justify the judgment that they are inauthentic. However, alien causal factors do not suffice to justify that judgment. For instance, sometimes alien empirical factors cause non-alien desires, such as the hypothetical case of a sugar addict who develops a brain tumor causing cravings for sweets. Therefore, it is not justified to make the judgment that an alien desire is inauthentic merely because of its causal history.
The two notions seem to do well when combined, so that desires that are both deviating from the desire-holder’s practical identity and are due to alien causes indicate inauthenticity. However, there is one major flaw in the suggestion that the combination would justify judgments of inauthenticity. Consider a person who displays a deviating and alien desire which is good, in some sense. For instance, in one case, a 90-year old woman who was otherwise quiet and shy suddenly started to make jokes and flirt with young men (Sacks
1985, chap. 11). Her “frisky behavior” was found to be due to untreated syphilis, i.e., an alien cause of deviating desires. But, the woman enjoyed her new self and did not want it to go away. It appears to be unjustified to judge that her desires are inauthentic, in spite of the fact that they are both deviating and due to alien causes.
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Therefore, in my proposal, judgments of inauthenticity should be delimited to persons whose medical condition may influence their decision-making so that they hurt themselves or others. Then, it is justified to make the judgment that, for instance, the 40-year old man who developed a sexual interest in children had inauthentic desires while it is not justified to make the judgment that the 90-year old woman who developed a new way of life had inauthentic desires.
Thus, to summarize my proposal:
For persons whose medical condition may influence their decision-making so that they hurt themselves or others, it is justified to judge that an underlying desire is inauthentic to the extent that it is due to causal factors that are alien to the person and to the extent that it deviates from the person’s practical identity.
In the next subsection, I will incorporate it in Beauchamp and Childress’s account of personal autonomy.
A non-ideal authenticity-based conceptualization of autonomy
The basic premise in the theory is that everyday choices of generally competent persons are autonomous. Call such persons “normal.” A second basic premise is now added: choices made by otherwise normal persons who suffer from some medical condition that may influence their decisions so that they hurt themselves or others are sometimes inauthentic.
Thus, the theory has two basic premises with different functions. The first premise is directly connected to the autonomy of persons; a person who is not generally competent according to the standards of incompetence elaborated on above is less autonomous than a person who is generally competent. However, a person who suffers from some medical condition of the kind discussed here is not necessarily less autonomous than one who does not suffer from such conditions; for instance, the medical condition may not actually influence her decisions merely because it can potentially do so. Thus, the second premise is only indirectly connected to the autonomy of persons; it enables judgments of inauthenticity through conditions that will be spelled out shortly.
The fourth condition of authenticity may now be added to Beauchamp and Childress’s list, for stylistic reasons between the first and second condition. Thus, autonomous choice can be analyzed in terms of normal persons who act (1) intentionally, (2) from authentic desires, (3) with understanding, and (4) without controlling influences that determine their action. Each condition is assumed to apply until there is reason to believe otherwise. That is, normal persons are assumed to act, e.g., intentionally or with understanding unless something indicates the opposite. It remains here to spell out in practically usable terms factors that indicate that an otherwise normal person acts from inauthentic desires.
Two factors indicate inauthenticity. Both must be present for a judgment of inauthenticity to be justified. In practically useful terms, they read:
The factor of deviation It is a factor indicating inauthenticity that the desire under scrutiny does not cohere with how the desire-holder’s identity has developed over time and is presently being sustained.
The factor of alien causes It is a factor indicating inauthenticity that the desire under scrutiny is due to causes that are not normal to how the desire-holder is otherwise construed, taking both physical and mental dispositions into consideration.
It should be noted that the factors come in degrees and are sensitive to judgment. For instance, a desire may deviate from a person’s practical identity, but only insignificantly. To illustrate, Anna, the hypothetical professional ballet dancer, may have a desire to drink beer on the evening before an important show. The desire conflicts with her desires to stay focused and do everything that is in her power to perform well on the show, although the deviation from Anna’s desire-set is not significant enough to indicate inauthenticity. That is, Anna may have the authentic desire to drink beer on the evening before an important show. Deviations should be more serious than that to merit the judgment that a desire is inauthentic. Had Anna instead had the desire to try heroin, the judgment may have been different due to the seriousness of the deviation.
Furthermore, as explained above, in this framework judgments of inauthenticity are only justified regarding a certain kind of persons. Therefore, justification of such judgments requires knowledge of the person’s medical condition and substantive deliberation on whether the person may hurt themselves or others. Thus, judgments of inauthenticity are a matter of practical and context-sensitive deliberation in particular cases. Thereby, the present proposal—as Beauchamp and Childress’s original account of autonomy—is conceptually underdetermined. It is a structure for rational deliberation on the authenticity of decisions made by otherwise normal persons, but it does not include complete specifications of how the involved concepts apply in particular cases and contexts. As such, the proposal should be understood not in terms of, e.g., necessary and sufficient conditions, but as generally reason-giving in a framework of reflective equilibrium.
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Objections
In this subsection, I respond to three (internally independent) objections to my proposal; the threshold for making a judgment of inauthenticity appears to be too high, the condition of authenticity brings normative content into an otherwise value-neutral conceptualization of autonomy, and, finally, my suggested addition to Beauchamp and Childress’s concept of autonomy is superfluous.
Because both factors that indicate inauthenticity must be met for a judgment of inauthenticity to be justified, it appears that few actions would ever be judged as inauthentic. This is not a bad thing; the conceptualization of autonomy which is defended here is ultimately anti-paternalist. From an anti-paternalist perspective, it is good that most actions are treated as autonomous and that factors that indicate the opposite are few. What is important is instead that the conceptualization is accurate.
Furthermore, the factors do in fact support judgments of inauthenticity in real cases (see the next section). Consider, for instance, patients suffering from borderline personality disorder (BPD). Some BPD patients are characterized by unstable “selves” and may, for instance, display sudden and dramatic shifts in goals, values, vocational aspirations, types of friends, and so on (Lester
2009). In generic cases, both factors indicating inauthenticity are thus present; BPD patients are otherwise normal persons with seriously deviating desires that are due to alien causes. Their actions and healthcare decisions are non-autonomous, and the present non-ideal conceptualization of autonomy enables the reliable judgment that they are non-autonomous for authenticity-related reasons.
Proceeding with the second objection, it is true that the condition of authenticity brings normative content into the conceptualization of autonomy through the second basic premise, i.e., that choices made by otherwise normal persons who suffer from some medical condition that may influence their decisions so that they hurt themselves or others are sometimes inauthentic. But, the concept was never value-neutral. Most importantly, Beauchamp and Childress’s standards of incompetence are value-laden (
2013, pp. 114–20). To paraphrase Buchanan and Brock, the proper standard of incompetence must be chosen; it cannot be discovered (
1990, p. 47). Choosing such standards involves moral assessment and deliberation. Thus, any judgement that a person is incompetent to make a certain healthcare decision is moralizing, because the standards of incompetence are morally loaded.
Finally, the third objection is that my suggested addition to Beauchamp and Childress’ concept of autonomy is superfluous; their concept already accounts for concerns of inauthenticity through the condition of controlling influences.
6 As explained above, Beauchamp and Childress analyze autonomous actions in terms of normal choosers who act “without controlling influences that determine their action” (
2013, p. 104). Some controlling influences are internal to the agent, such as, e.g., psychiatric disorders and drug addiction (p. 138). Therefore, the argument goes, as my suggestion builds on the notion of alien causal factors—understood as internally controlling influences—it adds nothing substantial to Beauchamp and Childress’s concept.
However, although they mention the possibility of internally controlling influences, Beauchamp and Childress do not focus on them in their conceptualization of autonomy (pp. 104–105, 138). In fact, internally controlling influences are almost completely left out of the discussion of the condition of non-control. Thus, I see my suggested addition as a contribution to Beauchamp and Childress’s concept as it explicates one kind of internally controlling influence. It enables analysis in one instance of non-control that was previously theoretically underdeveloped. Furthermore, the addition suggests that this kind of internally controlling influence should be understood in terms of authenticity specifically, and not in other terms. Thereby, the addition also connects one kind of internally controlling influences to an already established theoretical school of thought, namely the Frankfurt-Dworkean.
Thus, the three objections that the threshold for making a judgment of inauthenticity is too high, that the condition of authenticity brings normative content into an otherwise value-neutral concept, and that my suggested addition is superfluous do not overthrow my proposed authenticity-based conceptualization of autonomy.