I was invited to join others in contributing a post about love to the Daily Nous in honor of Valentine's Day. Mine is cross-posted below, but you can check them all out here.
It's Valentine's Day, so let's talk about ... death! In the grand tradition of philosophical debate, I'll start with an anecdote:
Kay Sievewright and Ernie Sievewright of British Columbia were married for 55 years, and when their health declined, they hoped to die together. They were each approved for Medical Assistance in Dying, which became legal here in Canada in 2016, but their request to die at the same time was turned down. Instead, they died four days apart, in early 2017.
A spokesperson for the Canadian Medical Protective Association, which provides legal advice to physicians, said they couldn't comment on this case, but they did make a general statement: "The legislation is quite clear that the request has to be voluntary and they are not under any influence ... It may well be that one member of the couple is being influenced by the other member of the couple and the reason why they're agreeing to the pact is not entirely without influence."
You might think this has little to do with Valentine's Day, but I think this case highlights in an interesting way some deep complexities of love and personal autonomy. It's often thought to be in the nature of love that you come to feel the way you do about things partly because of the influence of the other person. In union theories of love, merger can mean curtailing individual decision-making, and in caring concern theories, the fact that something will increase the well-being of the beloved is a reason to do it. Drawing on accounts of shared agency, Andrea Westlund proposes shared egalitarian deliberation, in which each person should be open to guidance by the perspective of the other.
On the face of it, love is thus in tension with autonomy, where there is an emphasis on the importance of doing things for your own reasons, free, as the statement says, even of "influence" from others.
This tension can be resolved in various ways. Some concern theorists point out that if you act for the other person because you love them, this is acting for your own reasons. And as relational theorists of autonomy like have long emphasized, what enables people to be autonomous is not isolation, but relationships. Westlund says that autonomy is about being "answerable" for your commitments, so love means mutual answerability.
These ways of resolving the tension aptly show how autonomy and love are compatible, but as is often pointed out, they may not fully resolve deeper questions of undue influence from our intimates. What makes influence inappropriate? When one person prioritizes the interests of another, this can be because of love, but it can also be because of pressure, coercion, or socialized deference. How should this distinction be understood?
Even when deference is systematic and gendered, a result of feminine socialization, there is debate over how "autonomy" should be conceptualized. On the one hand, a person who is systematically deferential to another in this way seems paradigmatically non-autonomous, since they are not deciding for their own reasons. On the other hand, if a person chooses deference, that's their choice; who are we to say they are not being themselves?
Anita Ho highlights the relevant complexities in bioethical decision-making. Given the vulnerabilities and stresses of illness and treatment, relational perspectives force us to acknowledge that for whose whose family is central to their existence, consideration of family members' "advice, needs, and mutual interests" is part of being autonomous. Still, she says, exploitation, indoctrination and false consciousness are real possibilities. Clinicians should "listen to the family’s concerns and reasoning process, and then explore with them various options that can best respect the interests of all parties." By default, however, Ho says that health care teams should trust the patient's own final expressed wishes -- not because manipulation is impossible, but rather because family relationships are highly complex and typically opaque to clinicians.
This brief investigation highlights some of the limitations of appealing to autonomy to solve complicated ethical problems, especially where love and intimacy are involved. It seems appealingly simple to say that for important decisions, we should prioritize individual autonomy. But autonomy is complicated and contextual, and may not be able to bear all this theoretical weight.
The Sievewrights may have come to their decisions in a context of mutual respect, or one may have felt obliged to go along with the other out of love, or one may have pressured the other. From the outside, we may never know -- and in a deeper sense, there may be no answer to this question, even if we had the transcript of the Sievewrights's intimate thoughts.
The same is true for any difficult and important decision, no matter when or how it takes place. The presence of people we love has a powerful effect on us. Sometimes that shapes us to make us who we are. Sometimes it shapes us in more disturbing ways. We may not ourselves always know how to tell the difference.