This dissertation argues that as long as we live according to our autonomous
life plan and satisfy relevant procedural conditions, there are few (if any) substantial moral limits to what one may do to one’s own body, since we are living exactly the lives we autonomously want.
The first part of this dissertation shows that a concern for living autonomously outweighs any concern for not violating our autonomy-based self-regarding duties to not (risk) diminish(ing) or destroy(ing) our capacity for autonomy and/or our adequate array of options. Accordingly, if such self-regarding duties exist, they only impose prima facie moral limits to what one may do
to one’s own body. This means that we are not acting morally wrong when we
inflict harm on our body as long as it is part of who we want to be (i.e. an
integral part of our autonomous life plan).
This supports the thesis that there are few (if any) substantial moral limits
to what one may do to one’s own body, which suggests a very permissive view.
Yet there are cases where people inflict very severe and irreversible harm on
themselves in a way that challenges our liberal commitment to such a permissive view. The second part of this dissertation therefore explores whether significant and non-trivial harm should count as a relevant reason for restricting self-harming behaviour. By focusing on the case of living vital organ donation,
this dissertation shows that even when people risk harming themselves in a
significant and non-trivial manner (in this case sacrificing their life to donate
their vital organs), the only way to justify restricting this kind of behaviour is
to accept an objectionable form of paternalism.
The third part of the dissertation explores whether restrictions on selfharming behaviour can be justified in a non-paternalistic way by applying a
liberal strategy of reconciliation. One such strategy is to show that we should
actually be reductionist about personal identity in such a way that it is no
longer certain whether our past, present and future selves are one and the
same person. This means that when we make choices with severe and irreversible consequences, we are not just making them for ourselves but also on behalf of our future potentially numerically different self. The dissertation focuses on two arguments, the shifting identity argument and the personal identity problem, which both seek to justify restrictions on putatively self-regarding behaviour by subscribing to a reductionist view of personal identity.
The shifting identity argument seeks to justify restrictions on putatively
self-harming behaviour by subsuming these under the harm principle. More
precisely, the shifting identity argument shows how putatively self-harming
behaviour is in fact other-regarding harm. That is, when we engage in self-
harm, we are harming our numerically different future self, and by appealing
to the harm principle, we are justified in restricting behaviour involving otherregarding harm. However, by drawing on insights from the debate about the non-identity problem, the dissertation shows that the shifting identity argument cannot withstand scrutiny. I argue that when we accept that our future self might be a numerically different person, we are facing a personal nonidentity situation in the cases in question, since the identity of this future self will inevitably depend on the choices we make now. This means that when I
choose to drive without a helmet and crash, the person (who is a numerically
different person) emerging because of the crash only exists because I chose to
act the way I did. Had I not been driving (and crashed) without a helmet, the
person would never have come into existence. This means that I do not harm
my future self, even when this person is numerically different from me, since
she would not be worse off than she would otherwise have been, assuming that
her life is still worth living. Accordingly, we are not justified in restricting putatively self-harming behaviour.
The personal identity problem challenges the moral authority of advance
directives. By appealing to a reductionist view on personal identity, the personal identity problem implies that when we face advanced cognitive deterioration, such as severe dementia, we cease to exist. This means that the cases where advance directives usually come into play, the person who authored the advance directive no longer exists, so why should we uphold the advance directive? The advance directive seems to have no moral authority over what
should happen to the patient with whom we are now dealing, since this patient
is a numerically different person. By appealing to an argument for the existence of surviving interests, the dissertation shows that advance directives
need not lose their moral authority even when we accept that the author has
ceased to exist. This means, I argue, that if it is important for one what happens to one’s living remains, such interests might actually outweigh the numerically different future self’s potential interests. To some, it may seem counter-intuitive that we would let the surviving interests of a former person outweigh the interests of a living numerically different person; however, this is
exactly what we do in the case of organ donation. If people state that they do
not want their organs to be donated when they die, it seems commonly accepted that we should follow their wishes, even when other living people might have an interest in receiving one or more of the organs. I argue that in order to be consistent, we either need to abandon the idea that people have a right to decide whether they want to donate their organs when they die, or simply accept that advance directives still have moral authority even when the author has ceased to exist.
This dissertation hereby shows that some of the most prominent libertylimiting principles in the literature do not necessarily succeed in justifying restrictions on self-regarding behaviour, which indirectly supports the thesis that there are few (if any) substantial moral limits to what one may do to one’s own body.
life plan and satisfy relevant procedural conditions, there are few (if any) substantial moral limits to what one may do to one’s own body, since we are living exactly the lives we autonomously want.
The first part of this dissertation shows that a concern for living autonomously outweighs any concern for not violating our autonomy-based self-regarding duties to not (risk) diminish(ing) or destroy(ing) our capacity for autonomy and/or our adequate array of options. Accordingly, if such self-regarding duties exist, they only impose prima facie moral limits to what one may do
to one’s own body. This means that we are not acting morally wrong when we
inflict harm on our body as long as it is part of who we want to be (i.e. an
integral part of our autonomous life plan).
This supports the thesis that there are few (if any) substantial moral limits
to what one may do to one’s own body, which suggests a very permissive view.
Yet there are cases where people inflict very severe and irreversible harm on
themselves in a way that challenges our liberal commitment to such a permissive view. The second part of this dissertation therefore explores whether significant and non-trivial harm should count as a relevant reason for restricting self-harming behaviour. By focusing on the case of living vital organ donation,
this dissertation shows that even when people risk harming themselves in a
significant and non-trivial manner (in this case sacrificing their life to donate
their vital organs), the only way to justify restricting this kind of behaviour is
to accept an objectionable form of paternalism.
The third part of the dissertation explores whether restrictions on selfharming behaviour can be justified in a non-paternalistic way by applying a
liberal strategy of reconciliation. One such strategy is to show that we should
actually be reductionist about personal identity in such a way that it is no
longer certain whether our past, present and future selves are one and the
same person. This means that when we make choices with severe and irreversible consequences, we are not just making them for ourselves but also on behalf of our future potentially numerically different self. The dissertation focuses on two arguments, the shifting identity argument and the personal identity problem, which both seek to justify restrictions on putatively self-regarding behaviour by subscribing to a reductionist view of personal identity.
The shifting identity argument seeks to justify restrictions on putatively
self-harming behaviour by subsuming these under the harm principle. More
precisely, the shifting identity argument shows how putatively self-harming
behaviour is in fact other-regarding harm. That is, when we engage in self-
harm, we are harming our numerically different future self, and by appealing
to the harm principle, we are justified in restricting behaviour involving otherregarding harm. However, by drawing on insights from the debate about the non-identity problem, the dissertation shows that the shifting identity argument cannot withstand scrutiny. I argue that when we accept that our future self might be a numerically different person, we are facing a personal nonidentity situation in the cases in question, since the identity of this future self will inevitably depend on the choices we make now. This means that when I
choose to drive without a helmet and crash, the person (who is a numerically
different person) emerging because of the crash only exists because I chose to
act the way I did. Had I not been driving (and crashed) without a helmet, the
person would never have come into existence. This means that I do not harm
my future self, even when this person is numerically different from me, since
she would not be worse off than she would otherwise have been, assuming that
her life is still worth living. Accordingly, we are not justified in restricting putatively self-harming behaviour.
The personal identity problem challenges the moral authority of advance
directives. By appealing to a reductionist view on personal identity, the personal identity problem implies that when we face advanced cognitive deterioration, such as severe dementia, we cease to exist. This means that the cases where advance directives usually come into play, the person who authored the advance directive no longer exists, so why should we uphold the advance directive? The advance directive seems to have no moral authority over what
should happen to the patient with whom we are now dealing, since this patient
is a numerically different person. By appealing to an argument for the existence of surviving interests, the dissertation shows that advance directives
need not lose their moral authority even when we accept that the author has
ceased to exist. This means, I argue, that if it is important for one what happens to one’s living remains, such interests might actually outweigh the numerically different future self’s potential interests. To some, it may seem counter-intuitive that we would let the surviving interests of a former person outweigh the interests of a living numerically different person; however, this is
exactly what we do in the case of organ donation. If people state that they do
not want their organs to be donated when they die, it seems commonly accepted that we should follow their wishes, even when other living people might have an interest in receiving one or more of the organs. I argue that in order to be consistent, we either need to abandon the idea that people have a right to decide whether they want to donate their organs when they die, or simply accept that advance directives still have moral authority even when the author has ceased to exist.
This dissertation hereby shows that some of the most prominent libertylimiting principles in the literature do not necessarily succeed in justifying restrictions on self-regarding behaviour, which indirectly supports the thesis that there are few (if any) substantial moral limits to what one may do to one’s own body.
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Forlaget Politica
