one can only enjoy full autonomy if the choices one makes are completely
unaffected by others. However, this is not the only way to think about autonomy,
and more recently theorists have attempted to offer definitions which do not
commit them to the substantive independence seen as necessary by many of the
philosophers quoted above.
Gerald Dworkin, who quotes all the preceding definitions in his own work,
characterises autonomy as `the capacity of a person critically to reflect upon, and
then attempt to accept or change his or her preferences, desires, values and ideals.'
[13]. To explain himself more fully he states:
`Putting the various pieces together, autonomy is conceived of as a second-order
capacity of persons to reflect critically upon their first-order preferences, desires,
wishes, and so forth and the capacity to accept or attempt to change these in the
light of higher-order preferences and values. By exercising such a capacity,
persons define their nature, give meaning to their lives and take responsibility
for the kind of person they are.' 6p. 20)Despite the variety in these definitions it is possible to glean the essence of the
concept, and it is obvious that valuing and respecting autonomy entails respecting
the person's right to give or withhold their consent to interventions which will
affect them. By participating in the consenting process the autonomous person has
the opportunity to judge the choice within the larger context of their life, goals and
projects and make a decision consistent with the values they hold and the path
they wish to pursue.
7.7.1 Sufficient autonomy to consent
By making the criteria `sufficiently autonomous' Gillon demands that we judge the
capacity of an individual to act autonomously in a given situation, rather than label
groups and individuals capable of giving consent or otherwise. This is consistent
with the approach advocated in law. Instead of making stereotypical assumptions
which might lead us to classify some types of people as non-autonomous, we have
to judge the capacity of individuals to make particular decisions and choices. This
is not to deny that some human beings fall outside the category of autonomous
being, examples being the fetus, the neonate, and the person in persistent vege-
tative state [14].
However, groups such as children [15] and the cognitively impaired might
benefit from closer attention and careful discrimination between individuals, and
it would be incumbent upon those dealing with these groups to judge each indi-
vidual in relation to the capacity required in a particular situation [16]. People with
quite severe learning disabilities or mental health problems could be seen as
autonomous in certain respects and circumstances, and therefore able to give or
withhold their consent.
In some types of case there will be heated debate over the extent to which people
can be autonomous and thereby capable of consenting. Examples differ in kind
but might include people with eating disorders or people with non-mainstream
religious views such as the Jehovah's Witness cited in part A of this chapter. In the
first case there may be a real difficulty in ascertaining the extent to which the
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