One of the most difficult aspects of caring for ill or very aged animals is determining how they are doing, and whether they are suffering from pain or distress. Our judgments are very often life or death matters for the animal: our assessments of whether they are in pain, or whether they are suffering from loss of mobility of incontinence or diminished quality of life, will often trigger a decision to euthanize.
In conversations about quality of life in animals, I often hear people say things like this: “Well, animals can’t say what they want, so we have to decide for them.” “Animals obviously don’t have autonomy, so we are in absolute charge of their care decisions.” Statements of this kind are usually made with a confidence and assurance that I find a bit unsettling. After all, don’t animals have some opinions of their own on the matter of their continued existence? And don’t animals actually tell us quite a bit about how they are doing, if we learn to pay close attention to their communications?
Within human medical ethics, the concept of autonomy is extraordinarily powerful. It is considered one of the cornerstones of the doctor-patient relationship and one of the core guiding principles within research ethics. It is also exceedingly complex. Volumes have been written about the meaning of autonomy, and even after decades of philosophical debate, there is considerable disagreement about how to understand the concept and about exactly which practices best respect patient autonomy within the medical setting.
The autonomy of animals hasn’t really been explored in any depth within veterinary medicine, perhaps because people are so quick to assume that animals don’t and can’t have something as complex and uniquely human as autonomy. But I believe we might benefit from an open-minded exploration of several questions: can the concept of autonomy meaningfully be applied to animals? If so, how exactly would be understand animal autonomy? Finally, if animals can be said to have some form of autonomy, what does this suggest about our interactions with them, particularly within the context of veterinary care?
We have a responsibility—as caregivers, pet owners, veterinarians—to recognize that each animal has unique preferences and that we can, in fact, go at least some way toward figuring out what these are and how to respect them. The concept of animal autonomy might help us think through how best to understand and respect our companions, particularly as we navigate hard decisions about end of life care.
We might look, for some guidance, at how the concept of autonomy functions within the realm of human ethics. In its most general sense, autonomy refers to self-governance (auto, self + nomos, rule). Within the context of biomedical ethics, autonomy refers to the ability of patients to make decisions for themselves, free from both explicit and subtle forms of coercion that lead to diminished freedom of choice. One of the central guiding principles within medical ethics is that people who are autonomous must be allowed to make their own free choices, based on complete and accurate information. Difficult issues arise when a patient has diminished autonomy—when, for example, the capacity to make autonomous choices is compromised by mental illness, or by delirium, or by heavy doses of opioid medications. We also face tough situations when dealing with children or adolescents, whose opinions most certainly matter but who may not yet have a fully developed capacity for decision-making (particularly when it comes to significant medical decisions, such as whether to pursue risky treatment for a disease). And then there are situations in which people are cannot make their preferences known to us: infants, the unconscious, the severely brain damaged. In these cases, we make what are called “proxy” judgments about what they would likely want, were they able to communicate.
Is animal autonomy analogous to any of these human cases? Are animals most like fully autonomous humans? Or are animals like humans with diminished autonomy, whose preferences we can try to respect, but only within limits? Are animals analogous to children? Infants? The comatose? None of these comparisons have been explored in depth—and they need to be. My own sense is that none of these really do justice to animal autonomy. And I particularly dislike the use of language of proxy decision-making: I often hear people talk about animals as if they were parallel to humans for whom we have to make proxy judgments—people who are comatose or very young infants. Animals may lack “decision-making capacity” in the robust human sense that they can explicitly tell us “I choose x and y but not z.” But this doesn’t mean they don’t have preferences and can’t help guide our choices.
What exactly would “animal autonomy” mean? The answer to this will be very complex and involved, and obviously beyond the scope of this essay. It is worth noting that within the human bioethics literature, there is very little consensus about what exactly autonomy is, how we should understand autonomy, and how we should understand autonomy in the context of medical care. So, there will likely need to be a lengthy and involved dialogue.
Here I would simply suggest that “animal autonomy” is worthy of careful attention from philosophers and scientists and veterinarians. Animals are self-governing and make meaningful choices, in ways very similar to humans. As with our fellow humans, we should strive to understand and respect the preferences of other creatures. Research in ethology is continuing to explore how to understand animal preferences and how these preferences are expressed in observable behaviors. It is worth noting, too, that although the language of “autonomy” has not yet been strongly present in the veterinary literature, the concept has been important in the animal ethics literature more broadly. Tom Regan, for example, talked in his ground-breaking The Case for Animal Rights (1983) about animals as autonomous beings, with their own interests and desires. Regan even includes a very interesting discussion of what he calls “preference autonomy” and explores some of the ways in which autonomy in animals is different from autonomy in humans.
Autonomy is poised to become an important concept in many facets of our interactions with animals, from our care of companion animals, to zoos, to research labs to shelters, to sanctuaries, and beyond.