ABSTRACT
It is widely recognized among both autonomy theorists and bioethicists that the term “autonomy” is used in many different ways.1 This gives rise to what can be called the Gertrude Stein Problem: that when it comes to autonomy, “there is no there there.”2 That is, there seems to be no shared understanding of autonomy that is suffi ciently thick to serve as the basis for any analysis of this concept that is widely accepted. This Problem has not gone unrecognized by bioethicists; indeed, three prominent bioethicists (Harry Yeide Jr., Susan J. Dwyer, and, most recently, H. Tristam Engelhardt Jr.) have independently published papers whose titles refl ect their concerns with “The Many Faces of Autonomy” in bioethics.3 This concern on the part of bioethicists to address the Gertrude Stein Problem is understandable, for the prominence of autonomy within bioethics is implicitly based upon the view that the participants in the discussions that draw upon it have a shared understanding of this concept, and that this shared understanding will remain after the concept has been analyzed. If, however, it transpires that there is no shared understanding of autonomy that is widely accepted, then things will look bleak for many discussions within contemporary bioethics. At best, the discussions of the bioethical issues in which autonomy was thought to play a central role will become fractured, with their participants turning only to discuss the issues at hand with others who turn out to share their understanding of autonomy. At worst, it could be that the participants in the bioethical debates in which autonomy plays a central role have simply been talking past each other and turn out not to have any common ground concerning their respective uses of the term “autonomy” from which to continue their discussions.
