Introduction
What does it mean to have authority over oneself or over another? When is it appropriate to defer one’s judgment to another, and what kinds of justification are sufficient or necessary for relinquishing one’s own authority or decision-making power? These questions are often critical in the context of clinical decision-making. Patients are sometimes faced with high-stakes choices which can involve or otherwise implicate various authority figures, be they cultural, religious, clinical, or domestic.
Given that patient autonomy is a central value enshrined in modern clinical ethics and practice, the concern surrounding the role of deference can be understood as a concern over undue influence on a person’s self-governance and self-directedness in their medical care. The kind of epistemic deference by which a patient prudentially submits to the expertise of a physician concerning what treatment is most effective seems unobjectionable, but what about deferring to an authority over what one ought to value or seek from treatment? As a separate matter, is the influence of an authority figure truly a threat to autonomy if the patient in question wholeheartedly endorses and volunteers their own deference? Taking these questions seriously requires not only careful theoretical work, but also a careful study of the historical and contemporary contexts within which cultural, religious, gendered, and other deferential dynamics emerge.
Assigned Readings
Thesis: Westlund argues that “self-abnegating deference” compromises autonomy by rendering the agent “insusceptible to a special sort of dialogical reflectiveness about her action guiding commitments” (Westlund, 2003). Westlund describes the case of a wife who is pathologically deferential towards her spouse. The deferential wife systematically subordinates her own interests and preferences to those of her husband and cedes all decisional authority to him. The deferential wife is perfectly satisfied with this arrangement, and even finds deep and abiding fulfillment embodying what she considers her spousal duties (I.e., anticipating and carrying out the will of her husband), but Westlund contends that her autonomy is nonetheless imperiled; while the deferential wife may endorse and identify with her deference, that endorsement has no basis that is not itself deferential. When asked about what justifies her deference, she has no recourse but to reassert her preexisting commitment to deference. Westlund concludes that “blind devotion” to any person or ideology can devolve into self-abnegating deference. In order to preserve autonomy, then, a person exercising deference must be able to engage in justificatory dialogue concerning the deference given.
Discussion Questions
- Does being willing and able to engage in open-ended, justificatory dialogue about one’s deference seem sufficient to satisfy a responsibility to self? Is it, instead, too demanding? Does autonomy require, as Westlund contends, receptivity to external critique?
- Westlund’s argument presupposes the primacy and privileged status of autonomy as something intrinsically worthwhile, but unlike Woolf, who finds the concept of serving as a “vessel” for others disturbing, some, like the deferential wife, ostensibly embrace this disposition as virtuous and place less or little value on autonomy for its own sake. Would Westlund’s argument, then, be unpersuasive to a person who actually exercises self-abnegating deference?
- How might Westlund’s theory apply to religio-medical conflicts, I.e., where a patient defers to a religious authority concerning whether to receive life-saving treatment, or whether to vaccinate one’s children?
- Is deferring directly to the dictates of religious belief or scripture (so interpreted by the person themselves) different from deferring to a religious practitioner or leader? Moreover, is deferring to a clinical authority for their clinical expertise meaningfully distinct from deferring to a religious authority for their theological expertise?