Making autonomy an instrument: a pragmatist account of contextualized autonomy

Autonomy is widely regarded as a key concept across ethics, philosophy, psychology, and political theory, but it is contested both descriptively (what autonomy is) and normatively (why it matters and whether it leads to positive experiences). The authors propose to deepen understandings of autonomy via a pragmatist, instrumentalist strategy that clarifies the meaning of ethics concepts by their real-world implications and usability, treating them as tools for moral problem solving and flourishing. They introduce “contextualized autonomy,” envisioning autonomy as a valued ability grounded in experience and composed of multiple component-abilities (voluntariness, information, self-control, deliberation, authenticity, enactment). The paper aims to situate this account among existing individual and relational theories, to argue for autonomy’s transactional, contextual nature, and to illustrate how empirical and experiential knowledge can enrich the concept and support more autonomous agency, with examples primarily from healthcare.

The paper surveys major traditions shaping autonomy. Individualistic accounts (e.g., Kant) conceptualize autonomy as an abstract ability of self-governance defined by freedom and rationality, often abstracted from context. Critics, including Dworkin, Beauchamp and Childress, emphasize that agents are never fully free and introduce second-order desires and threats like coercion and manipulation. Relational autonomy (feminist scholarship: Mackenzie & Stoljar; McLeod & Sherwin) foregrounds the role of relationships, social context, and oppression (e.g., sexism, racism) in shaping or diminishing autonomy, including internalized oppression. This literature reveals tensions between abstract autonomy and lived realization within social webs, the so-called “porosity of autonomy.” Pragmatism (Peirce, Dewey) offers an epistemology connecting theory and practice, proposing that concepts derive meaning from implications and must be empirically tested in real-world situations. Prior bioethics work has focused on information (informed consent) more than other dimensions (e.g., voluntariness). The authors position their contextualized, pragmatist account as integrating insights from individual and relational views while inviting empirical enrichment from fields like psychology, social work, disability studies, and neuroscience.

Conceptual and methodological approach: pragmatist instrumentalist ethics concept analysis. The authors treat autonomy as an instrument whose meaning is clarified by its functions and implications for resolving morally problematic situations and supporting flourishing (growth). The approach requires: (1) providing descriptive and evaluative accounts of the concept; (2) identifying autonomy’s functions and experiential manifestations; (3) iteratively enriching the concept through empirical inquiry (synergetic enrichment) and lived experience; and (4) assessing the usefulness of the enriched concept in real-world contexts, especially healthcare. The analysis operationalizes autonomy as a contextualized, composite ability constituted by multiple non-competing component-abilities (voluntariness, self-control, information, deliberation, authenticity, enactment). The paper illustrates enrichment using interdisciplinary evidence about agent-related factors, context-related factors, and their interactions for three components (self-control, information, authenticity), and derives preliminary practical implications (e.g., shared decision-making, contextualized informed consent, situational strategies for self-control). This is a programmatic, theory-building methodology rather than empirical data collection.

• Proposal of contextualized autonomy: autonomy is an experientially grounded, transactional, and contextual ability, best conceived as a composite of multiple component-abilities (voluntariness, self-control, information, deliberation, authenticity, enactment) whose relevance and degree vary by situation.
• Synergetic enrichment: empirical and experiential knowledge can refine understanding of each component-ability and identify facilitators/barriers, enabling interventions to support autonomy without undermining its value.
• Self-control: Agent-related factors (e.g., delay of gratification, frontostriatal circuitry, mindfulness, sleep) and context-related factors (e.g., social norms, deterministic beliefs, social support, parenting, digital nudges) influence self-control. Situational strategies (e.g., studying in a library) can reduce self-control demands. Implications include avoiding major decisions under sleep deprivation and using technologies to scaffold goal pursuit.
• Information: Autonomy entails abilities to understand and use information; cognitive biases (framing, anchoring) affect decisions. Contextual supports include shared decision-making and supported decision-making tools to align information exchange with values and capacities. “Contextualized informed consent” is proposed to balance disclosure with non-maleficence (nocebo concerns) and to educate clinicians and patients about biases.
• Authenticity: Autonomy’s value is tied to actions reflecting identity, values, and temporal continuity. Authenticity can be supported or threatened by factors such as age, gendered contexts, mental health conditions/treatments, coercion, financial incentives, and culture. External supports can foster intrinsic motivation and value-congruent choices.
• Valuation of autonomy: Grounded in lived experience and empirical psychology (e.g., self-determination theory), autonomy contributes to well-being and flourishing across cultures; heteronomy relates to diminishment and apathy.
• Practical relevance: The account reconciles abstract and relational traditions, reframes empirical findings as empowering rather than threatening to autonomy, and motivates development of measurement tools and interventions to enhance autonomy in practice.

By reframing autonomy as a contextualized composite ability, the paper addresses longstanding tensions between abstract individualistic accounts and relational critiques. The pragmatist, instrumentalist stance treats autonomy as a hypothesis to be tested in lived situations, allowing empirical findings on cognition, neuroscience, and social context to inform and strengthen autonomy rather than undermine it. This approach clarifies why autonomy remains valuable—because it reliably contributes to flourishing—and how it can be supported through targeted strategies at both agent and environmental levels. The synergetic enrichment examples (self-control, information, authenticity) demonstrate actionable pathways: mitigating cognitive biases, structuring decisions collaboratively, and fostering authenticity through value-concordant processes. Thus, the account advances ethical theory toward practical usability in healthcare and beyond, emphasizing empowerment of agents and sensitivity to situational variability.

Autonomy is a highly esteemed value recognized in ethical principles and law, yet often treated either as an abstract individual trait or as a purely relational property. The authors advance a pragmatist account of contextualized autonomy: a dynamic, experiential, and transactional composite ability comprising voluntariness, self-control, information, deliberation, authenticity, and enactment. Through instrumentalist, synergetic enrichment, interdisciplinary empirical insights illuminate facilitators and barriers for these components, encouraging ethically grounded, practical strategies to bolster autonomy. The approach avoids false dichotomies between theory and experience and treats empirical knowledge as empowering. The authors call for further methodological work on instrumentalist analyses, richer interdisciplinary dialogues, development of multidimensional measures of autonomy as an ethics construct, and evaluation of interventions for their impact on autonomy in real-world contexts.

• Programmatic scope: The paper offers a broad conceptual framework without fine-grained argumentation for all claims.
• Selective enrichment: Illustrations focus on three component-abilities (self-control, information, authenticity); a comprehensive enrichment of all components exceeds the scope and would require extended treatment.
• Context focus: Examples primarily from healthcare due to authors’ backgrounds; applicability to other domains is suggested but not empirically demonstrated here.
• No empirical data: The article presents no original datasets; recommendations rely on synthesis of existing literature and conceptual analysis.
• Measurement gap: Calls for multidimensional scales to assess autonomy indicate current lack of validated measures aligned with the proposed construct.