(Non) Free Will and Bioethics

May 01, 2017

by Bodnár János Kristóf, MA and PhD (Philosophy), Clarkson University MS (expected 2017, Research Ethics)

(Non)Free Will and Bioethics

Philosophers, religious thinkers, and laymen alike have pondered on the notion of ‘the freedom of the will’ for thousands of years. Over time, the concept underwent various transfigurations – through debates over the source, the function, the purpose, or the extent of it.  Nevertheless, in the so-called Western ethical tradition it seems to have a more or less unequivocal meaning: conscious adult individuals without particular mental illnesses are free in choosing their moral norms and actions. Consequently, they are responsible for those norms and actions as well. Humans meeting these criteria are commonly referred to as autonomous (literally: self-governing or self-determining)subjects.

In Immanuel Kant’s understanding of such autonomous agents, the freedom of the will is postulated. Less technically phrased, this freedom is taken ‘for granted’ as an unquestioned foundation and point of departure in ethics. This serves as a necessary condition of what Kant calls the ‘Kingdom of the Ends’ where humans can practice this freedom of theirs.

Our current liberal and democratic societies, formed in the eras of Modernity and Enlightenment, also grounded their most fundamental values – their ‘identity’ – on this notion, and incarnated this rather abstract ideal into tangible legal means: rights, constitutions, laws, and policies.

From the perspective of medicine and medical ethics, this turn is reflected in the fact that the principle of respect for the autonomous decision of the patient has become a (if not: the) cardinal value and practical concern in modern bioethics. As Paul Root Wolpe puts it in his sociological and historical analysis of the question: “Most human subject regulation and patient-protection policies, as well as most bioethical debate in the United States, center on the idealized value of maximizing individual autonomy.” (“The Triumph of Autonomy in American Bioethics: A Sociological View.” In Bioethics and Society: Constructing the Ethical Enterprise, edited by Raymond DeVries and Janardan Subedi, 1998)

Modern bioethics – as an applied form of ethics – tries to address all ethics problems generally from two ‘vantage points’: On the one hand, from a duty-based (technically speaking: deontological) approach, trying to find and ground those duties that must be respected and never violated in every field of medicine, and on the other, from the perspective that consequences make medical decisions ethical or not.

From a duty-based standpoint, respecting autonomous medical decisions is a ‘must’, since according to this approach, individual self-determination is a value to be recognized and respected in every field of human life, medicine included (In theory, regardless of the consequences it might entail.)

From a consequentialist standpoint, this respect for autonomy in medicine is a much more ‘useful’ way to go than the paternalistic alternative. Patients might experience this autonomous control over therapeutic decisions as a benefit in itself. Also, because the benefits and harms are determined, at least in part, by the perspective of the patient, autonomy might be a more direct way to bring about benefits and ameliorate harms.

So far, so good. But what if all these convictions, legal regulations and ethical frameworks are based on a profoundly faulty foundation – the assumption that the human will is in fact free?This seems to be the main conclusion of several recent neurological and psychological experimentations accurately summarized in a thought-provoking article in The Atlantic entitled: There’s No Such Thing as Free Will.

Focusing on the issue from a strict bioethics angle I now put aside the all too tempting philosophical questions: How freedom of the will (or its lack) could be ‘proven’ with the same level of certainty (if at all) as we, for example, could firmly prove that the Earth is round? And even if one would accept this possibility, what one ‘personally’ should do with such proof if she is still ‘experiencing’ this freedom or wants to live her life as if she were free?

Instead, I take the findings* enumerated in the article for granted, and wonder what consequences this acceptance would entail within the field of bioethics?

Modern bioethics recognition that health care professionals have a duty to respect their patients’ autonomous decisions is grounded as a historical-cultural response to the tragedies of research ethics (Tuskegee Syphilis Study, T-4 ‘euthanasia’ program, clandestine CIA experimentation, only to mention a few of them**) that a paternalistic medical ethics was unable to prevent, let alone address as well as an autonomy-based one can.

But if free will does not exist,how could physicians respect it? Respecting a ‘non-existing’ thing is at least questionable – the more so in such a practical and evidence-based enterprise like medicine. But the threat goes even further. If individuals lack free will, there would be no need to respect their consent or refusal. If there is no free will, there would be no need to ask potential research participants about their willingness to participate. If they meet the criteria for a research study, they should simply be enrolled.

If evidenced based neuroscience has so profoundly proven that free will does not exist the choice on which the autonomy paradigm exists is a fraud and we could not rely on the notion of autonomy to justify the cases of research participant abuse that bioethicists have fought – or at least: seemed so willing to fight – against.


* The article outlines scientific views on the freedom of the will that could be summed up as follows: "All human behavior can be explained through the clockwork laws of cause and effect (...) The conscious experience of deciding to act, which we usually associate with free will, appears to be an add-on, a post hoc reconstruction of events that occurs after the brain has already set the act in motion. (...) In principle, we are therefore completely predictable. If we could understand any individual’s brain architecture and chemistry well enough, we could, in theory, predict that individual’s response to any given stimulus with 100 percent accuracy." Besides, it reviews those recent studies that are after to find out that "if we increasingly see belief in free will as a delusion, what will happen to all those institutions that are based on it?"

** For an overview and ethical analysis of these tragedies, see e.g. the first section of The Oxford Textbook of Clinical Research Ethics’s first section. (Ezekiel et al. (ed.) 1998. The Oxford Textbook of Clinical Research. New York: OUP.

Tags:Bodnár János Kristóffreedom of the willfree willnon-free willautonomy paradigmautonomous medical decisionsbioethics

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