Losing Control: Why Absence of Controlling Influences Should be Replaced by Absence of Alienating Influences as a Criterion for Autonomous Action in Bioethics

ABSTRACT According to Faden and Beauchamp's influential model, an action is autonomous when it is done intentionally with understanding and in the absence of controlling influences. Recent debates concerning nudges have shown, however, that this last condition gives limited ethical guidance for assessing the ethical permissibility of manipulative influences—that is, influences that are neither fully controlling nor fully noncontrolling. While multiple authors have developed frameworks to determine the ethical permissibility of nudges, the implications for the concept of autonomous action have not been addressed yet. This is problematic, as the concept of autonomous action informs the practice of informed consent and the concept of voluntariness. In this paper, I defend a revised conceptualization of autonomous action in light of these developments. I will first consider and reject two proposed interpretations of “noncontrol“: easy resistibility and the absence of illegitimate control. Building on the work of Christman and Blumenthal‐Barby, I then argue that “the absence of controlling influences” should be replaced by “the absence of alienating influences”. On this view, influences are compatible with respecting an autonomous choice to the extent that persons would not feel alienated from their choice were they to reflect on that decision in light of those influences. This condition, I argue, can better capture the nature of autonomy and provide better guidance as to which influences are compatible with respecting a person's autonomy. I end by responding to the objection that non‐alienation is too demanding and spell out some practical and conceptual implications of this revised concept.