Ethical issues in moral and social enhancement

5.3.8. Is autonomy undermined by a shift in causal explanations?
Some points of Illich’s (1978) critique may be restated as a worry about individual 
responsibility and autonomy. Critics of medicalization may argue that since a 
technical fix cannot solve problems when the locus of a problem is not in the body 
but in a particular life situation, we risk entrenching the problem by framing it in a 
way that suggests lack of responsibility. In the context of proposals for wider 
provision of CBT, Summerfield and Veale argue that ‘once a psychiatric 
formulation is deployed as the explanation for a person’s problems, the moral 
economy of the situation alters’ (2008, p. 327)
and that the shift in focus ultimately 
undermines autonomy. The focus on a diagnosed condition for which (it is implied) 
the patient is not responsible, and from which they are not expected to recover 
without professional help, means that the agency and an expectation of finding a 
remedy passes from the patient to the therapist.
Moreover, Read et al. noted that the reason why the general public prefers 
psychosocial explanations of mental illness may be that once a disease model is 
applied to the brain, something definitive and negative appears to have been said 
about the patient’s core qualities: ‘that the person is incapable of judgements, 
reason, autonomy’ (2006, p. 327). Summerfield and Veale (2008) argue that this 
may affect the way people see themselves, results in them giving up sooner, being 
more likely to see themselves not as normally stressed but as ‘suffering from a 
disorder’, and in general playing out the role of a moral patient (a sufferer of 
involuntary circumstances) rather than an autonomous agent, the process reinforced 
by an unequal patient-medical professional power dynamic which further pushes 
patients into passivity.
The conceptual history of addiction is an example of the way attributions of 
responsibility for the problem and for the solution influences the way the problem is 
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Naturally, non-medical solutions have their intangible costs too. The point here is that for 
the full cost-benefit analysis the effects encompassed by the notion of clinical iatrogenesis
 
should be accounted for.

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addressed. Brickman and colleagues’ (1982) classification of the different theories 
of addiction may be of help in thinking about the way in which the conceptual 
background provides an environment which encourages some and discourages other 
approaches to a problem, impacting the milieu in which an individual acts.
Attribution to self of 
responsibility for