1. 1 Catriona Mackenzie Philosophy Department, Macquarie University, Sydney Rethinking Autonomy: Response to Gerard Hastings

2. 2 Outline Why is the conception of personal autonomy underpinning market rhetoric and ideas of consumer sovereignty impoverished? Is there a more plausible conception of autonomy from the perspective of the aims of public health?

3. 3 The libertarian or ‘maximal choice’ view of autonomy Equates autonomy with the satisfaction of individuals’ preferences Advocates maximal choice and minimal regulation Emphasises personal responsibility for risks De-emphasises corporate and societal responsibilities to marginalised and disadvantaged individuals and communities

4. 4 Philosophical Justifications 1.Liberal neutrality thesis – the state has no business promoting particular values or imposing restrictions on individual choice 2.The freedom necessary for autonomy is negative liberty. Interference can only be justified if the exercise of a person’s liberty threatens harms to others (J.S. Mill’s harm principle) 3.Coercive or paternalistic interference by other persons or the state constitute the main threats to autonomy.

5. 5 Problems The state can and does play a crucial role in shaping our values and fostering autonomy Negative liberty is not sufficient for autonomy. Autonomy requires access to genuine opportunities and the social goods that enable them. These goods depend on a well-functioning state State regulation and public health interventions are crucial for well-being and autonomy

6. 6 An alternative relational approach to autonomy Autonomy is a complex competence requiring extensive interpersonal, social and institutional scaffolding. Relational approach is attentive to the effects of social inequality, injustice and oppression on autonomy the social constrains and influences on individual choice What matters is the range of meaningful choices available to individuals and communities An interest in promoting autonomy entails an interest in promoting social justice

7. 7 Implications for public health Relational approach focuses attention on background conditions shaping individual health choices Is the consumption of junk food an autonomous choice or a constrained choice, given these background conditions? Public health interventions (eg. regulation of junk food marketing) can foster autonomy To address health inequalities we must address the social, economic, environmental etc. inequalities that cause them

8. 8 Additional suggestion To reassert our autonomy we need to reclaim the concept: reject libertarian, maximal choice conception, rethink autonomy as relational