Abstract

In lieu of an abstract, here is a brief excerpt of the content:Accurate Self-Assessment, Autonomous Ignorance, and the Appreciation of DisabilityJoel Anderson (bio) and Warren Lux (bio)In their thoughtful commentaries on our essay, "Knowing your own strength: Accurate self-assessment as a requirement for personal autonomy," George Agich, Ruth Chadwick, and Dominic Murphy (2004) provide both criticisms and insights that give us a context in which to clarify further our claim that one's autonomy is impaired when one is unable to appreciate whether one has the capacities required for tasks one is undertaking. We focus on two issues: the extent to which our account of autonomy suggests a problematically "externalist" or "objective" approach and the issue of whether our talk of accurate self-assessment entails an overdemanding requirement that one know numerous facts about oneself to count as autonomous.The External Point of ViewFor many, the idea that specific regions of the brain might be relevant to a person's autonomy evokes nightmarish, startlingly reductionist visions of a world in which informed consent is decided on the basis of neuroimaging. In arguing that a capacity for self-assessment is essential for autonomy and also presupposes executive function that is often impaired by prefrontal damage, we do not wish to engage in such reductionism by suggesting that there is any straightforward, one-to-one mapping comparable to that presupposed by the nightmare scenarios. Given what we know about the brain's plasticity, the prospects (although limited at present) for neurorehabilitation, the multiplicity of the instantiation of autonomy-related capacities, and, especially, the constitutively moral/normative dimensions of these capacity concepts, such mappings are clearly problematic. This is true even in the easy cases, which, as Murphy points out, include our case of "John." This is all the more true with regard to the more complicated psychiatric cases, including disorders such as depression where the normative dimensions and the greater interpretive leeway in diagnosis preclude reductionist solutions (See Anderson 2004). For these reasons and for independent philosophical reasons, we are uncomfortable with the label "externalist," [End Page 309] although we acknowledge and confirm our view that externally applied neuroscientific notions—and evidence—can inform these matters. Nonetheless, we do not wish to argue for a fully externalist point of view, especially when paired with the idea that we are advocating a "smooth naturalistic picture of the cognitive basis of autonomy" (Murphy 2004, 303). Murphy puts us in some terrific company with the likes of John Doris, Shaun Nichols, and—we would add—himself, and this is welcome and flattering. But, to avoid any misunderstanding of an issue that we do not actually take up in our essay, we should caution that we do not endorse a program of naturalizing the normativity on which many of central autonomy-related concepts are based. The notion, for example, of what it is to assess competently one's chances of success cannot be replaced with a set of nomological regularities or a self-applying list of necessary and sufficient conditions.Appreciating Disability and Knowing the FactsOne of the central challenges we face in presenting our approach is to distinguish our requirement of "accurate self-assessment" from an implausible requirement that one have no false beliefs about one's capacities. In different ways, all three commentaries make it clear that our argument would benefit from further clarification of this distinction.In her commentary, Chadwick suggests that our approach may commit us to requiring too much self-knowledge, specifically, that it seems to require accurate knowledge of things like our genetic makeup as a requirement for autonomy. To begin with, it is worth underscoring again that the requirement we have introduced is explicitly task specific: we are focused here on whether an agent has an understanding of things that are relevant for undertaking an intended task, and declarative knowledge of facts, genetic or otherwise, about oneself is relevant only insofar as they bear on that understanding.But Chadwick's point clearly goes deeper. In that regard, it is particularly important to underscore that ours is actually a requirement that has less to do with knowing facts—even task-specific ones—about oneself and much more to do with having the ability to incorporate available...