Fictionalism in discussions of autonomy in medical ethics

Fictionalism regarding a particular discourse is the claim that, while the entities discussed do not exist, or the utterances made within that discourse are not true, treating those entities as existing and those utterances as true has value. Put another way, in a particular discourse, we do not, or should not, aim at the truth. An example of a fictionalist position in ethics is described by Joyce in his 2001 book The Myth of Morality. His claim is that, although moral judgements are systematically false, treating those judgements in a fictional spirit, as if true, has practical value.

In discussions around autonomy in medical ethics some participating philosophers may deny the existence of further entities, including the ‘self’ and personal identity over time – both of which are central to autonomy. In this presentation I argue that philosophers with such views need not abandon the discourse. Instead, they should adopt a fictionalist position, and regard the self and personal identity over time as useful fictions. Participants in the discussion may knowingly take a fictionalist position, may deny their position is fictionalist, or may only acknowledge some entities as fictions (despite others’ claim that further entities are fictions).

The value of the fictionalist position in discourses around autonomy does not directly benefit the fictionalist, as is the case in Joyce’s account. Rather, the value is realised indirectly through the project of formulating a coherent strategy in organising medical ethics in a pluralist framework.