Does ‘autonomy’ mean anything any more?

My husband is constantly amused by talk of patient autonomy — for people who want to have a limb lopped off to solve their feeling of body dysmorphia and so on. I suppose he is amused because that is his nature, rather than that these things are inherently funny. In any case, as I have told him more than once, he is himself an example of impatient autonomy.

There was great talk of autonomy in the debate on Lord Falconer’s Assisted Dying Bill. The learned Lord Brennan pointed out that, if it is passed, ‘Litigants will say to the court, “I want to exercise my autonomy and my choice. Why is it restricted to the terminally ill?” ’ Thus the word becomes a banner to wave, like those off-the-peg placards at teachers’ rallies printed with the name of the Socialist Workers Party, which must annoy even some of those teachers by lacking an apostrophe.

What autonomy means is almost anybody’s guess. The etymology suggests ‘making laws oneself’. Not many of us do that, and those that do (MPs) often fall foul of other laws. The rest of us can hardly climb a ladder without permission, and yet when we fall into a really dangerous situation, such as into the clutches of a doctor, it’s Liberty Hall, boys.

The meaning of autonomy was not made any clearer, a couple of centuries into its life, by the intervention of Immanuel Kant, whose ideas on the matter began to reach English-speakers in 1798. A 19th-century expositor of Kant explained that by autonomy he meant ‘that there are in this case no considerations of pleasure or pain influencing the will’. Ever tried that? So rational people like Kant go around with their homespun set of laws, paying taxes and driving the right way down one-way streets because they have decided to add such sensible rules to their personal handbooks.