This article examines and refutes the claims that neuroscientific evidence renders autonomy “quixotic” and thus supports a shift toward paternalism in medical and political decision-making. The author argues that the notion of autonomy has been mistakenly associated with the metaphysical concept of free will, and offers a political definition of autonomy to clarify how responsibility is implicitly grounded in the legal and political system: An agent acts autonomously when she/he (a) endorses decisions and acts in accord with internal motivational states, (b) shows commitment to them in the absence of undue coercion and compulsion, and (c) could as a reasonable and rational person continue to do so after a period of informed critical reflection. The author further argues that neuroscientific findings confirm the assumption that humans are fundamentally fallible social creatures and explain the mechanisms of openness to the social world, which can be and sometimes are abused. A naturalistic framework does not dispute autonomy or rights, but it does point toward means of manipulation and toward areas in which further legal protection of rights and autonomous choice is needed. The author concludes by clarifying the ideal-typical degrees of coercion (indirect, direct and total) and compulsion (mild, severe and total) that serve the purpose of qualifying reduction of autonomy and responsibility in certain cases, and elaborating the middle-ground position between the “moral” and “brain disease” model of addiction.
The state-appointed experts who evaluated Hill initially said he did not qualify as mentally disabled. But, according to the Atlantic, all of them have since come around to the opposite conclusion.
Still, the state now argues that, “Hill has not met his burden of proving retardation under an onerous state standard; that the doctors’ new diagnoses are flawed; and that, as a matter of law, they come too late anyway to spare Hill,” according to the Atlantic.
The amount of power that prosecutors have in areas of mental health decision making is substancial, so much so that they are qualified to argue what is a flawed diagnosis and what isn’t, while still using incorrect terminology - when the experts can’t even agree about the diagnosis. Further, in some states, DA’s are able to administer and score risk assessment tests that effect sentencing details (which I find disturbing). To be fair, making a determination of mental state that is supposed to reflect the mental state at the time of the offense is no light task considering the timing, the ongoing psychological impact of prison and at the same time, the experience of the administer, the improvement of tools over time and additional validity for interpretations. But in light of what can be taken away, over a bit of paper shuffling and pricey expert-witness slap fights…a little more time to evaluate wouldn’t kill the state. It would seem some prosecution offices prefer to reflect back on flawed decisions claiming support by archaic information and rationale that barley fit the bill at the time, rather than take precautions when a discrepancy arises that is also accompanied by new and reliable information. In other words, saying we did the best we could at the time, is never good enough when you have the chance to correct it now.