What He Would Have Wanted If...

"[A] wounded and unconscious victim of an accident may not take the decisions about what is to be done to him, but in so far as the doctor chooses a course which the doctor knows the patient would have preferred had he been conscious, there is no violation of the patient's freedom -- indeed, there is an affirmation of that freedom in the sense of 'effective power', if the doctor's choice is guided by what the patient would have wanted." A. Sen, THE IDEA OF JUSTICE (2009).

For the bibliographically inclined, that's at p. 302, in chapter fourteen, "Equality and Liberty."

Yes. I see the point, but it is bothersome.

We might want to say, intuitively, that I am acting freely if a surrogate of mine (a chosen surrogate ideally) makes the decision I would have made in a time of medical crisis, when I could not have made it. In contrast, I am not free if the decision is made for me by someone who doesn't care what I would have wanted.

For example, perhaps two operations are possible as means to save my life. We'll just cal them A and B.

Operation A has an 80% chance of success. We'll assume "success" here is binary -- either I'll recover or I'll die on the table.

Operation B has a 65% chance of success.

BUT ... Operation A will leave me blind. Operation B, if it is successful, will end not just in my recuperation, but in my sighted recuperation.

So the question I or some surrogate must face is: what value in terms of success likelihood to I assign to the prospect of post-operative vision?

There is of necessity a subjective element here. The prospect of blindness may be more terrifying to me, dear reader, than to some of you. I might thus be more inclined to opt for Operation B.

Is it fair to say in that context that arrangements for surrogates who know or at least who care about my own subjective preferences makes me more free, more a liberty-possessing creature, than I would be at that time? And that this is a good reason, perhaps even the decisive reason, in favor of such arrangements?

I think the answer is "yes," here and that this is what Sen was getting at in that passage. But the situation is logically troubling. Because every pinhead dictator thinks he is a wise compassionate doctor and the unconscious body politics lies before him ready to receive and be made more free by the benefits of his benevolence....

The next two posts will also be inspired by Amartya Sen although by a someone different aspect of his work.