Rethinking autonomy: Is it a norm-constituted property?

Abstract: Much debate in bioethics has focused on determining what psychological and environmental characteristics undermine decision-making autonomy (aka, decision-making capacity). For instance, the literature has asked whether autonomy is compromised by financial incentives for research participation, nudges, various mental disorders, addiction, and structural injustice, among others. These efforts often use such cases to articulate criteria for autonomy.
I argue that this approach reflects a fundamental misunderstanding. They assume, implausibly, that autonomous agency is a morally-independent property of persons that itself determines the moral terrain, such that questions about moral obligations (like whether paternalism is permissible) can be settled by determining whether a person is autonomous, which depends itself on their non-normative, psychological and environmental characteristics.
I’ll claim instead that autonomy is norm-constituted: an individual is autonomous if they satisfy criteria that are themselves determined by multiple, overlapping, sometimes inconsistent normative considerations. The difference between these two ways of thinking is analogous to two ways of thinking about, say, tennis: bioethicists have thought they are discovering when a person counts as really playing tennis, but have really been asking, implicitly, whether a person is playing tennis well.
I review several pieces of evidence for this claim, including sharp difficulties in defining various elements of autonomy in value-neutral ways, the fact that autonomy itself appears to be decision-relevant, and the fact that many conditions that seem to undermine autonomy, like coercion, addiction, or mental illness, are implicitly normative. I end with practical recommendations for thinking about autonomy in clinical and research settings.