Personal autonomy and health policy : some considerations in political theory
This thesis examines some of the implications for social policy of an account of human nature frequently associated with liberal political theory. Taking as its starting point the claim that the objectives of social policy are contested, it seeks to develop an account of autonomy that will serve as a neutral 'organizational principle' around which to construct social policy. A particular version of personal autonomy is developed and defended against both abstract Kantian moral autonomy, and the individualism often associated with liberal theories. This project is pursued first through a discussion of the relationship of autonomous persons to 'social forms', and then through a critique of libertarian and 'intellectualist' accounts of autonomy. It is argued that, since autonomy is not only employed in the making of choices, but also in the implementing of those choices, it follows that the autonomous person must, of necessity, be viewed 'holistically' for the body is the primary means of implementing the choices autonomous persons make. The health of the body, as well as that of the mind, therefore assumes importance for any social policy that takes autonomy to be a fundamental objective. The implications for such an account of social policy are then explored in two ways. First, through a discussion of the phenomenon of 'medicalization'. Second, through a discussion of the Prevention and Health campaign. In the first instance, it is argued that the assumption that medicalization systematically undermines autonomy is ill-founded because theories of medicalization misunderstand what it is to be autonomous. In the second instance, the discussion of preventive health-care policy serves to illustrate the fundamentally erroneous assumptions of individually-focussed health-care programmes. In conclusion, it is argued that a unified account of autonomous persons must inevitably lead to a more integrated social policy.