Autonomy has a central place in contemporary bioethics, though there is much debate about how it should be valued and the conditions under which a person can act autonomously. It is often defined as ‘self-rule’, yet discussion of autonomy is rarely linked to an account of what the self is or what self-rule involves. The common convention is that being autonomous involves the operation of certain rational processes, and this is reflected in the standard cognitivist approach to assessing decision-making capacity. On this view, the capacity to act autonomously is separated from the effects of a person’s actions, such that a person can be regarded as autonomous irrespective of how self-destructive their actions may be.
In this presentation I will outline an alternative understanding of self-rule based on Spinoza’s conception of freedom. In Spinoza’s ontological system, persons are finite composite individuals striving to actualise their nature. Their nature is determined by the coordination of their parts and by the relation of these parts to other agencies. A person increases in freedom as they learn to integrate the powers available through their body and through interaction with other agencies. On this understanding, ‘self-rule’ is the power to self-actualise enabled through self-knowledge. A person can be regarded as having ‘decision-making capacity’ to the extent that they have this power. I will illustrate this understanding with reference to cases where decision-making capacity might be in question, and indicate how – on this view – autonomy should be respected in such cases.