Category: Autonomy

The principles of human rights give a central place to the values of autonomy and dignity. Critically discuss the meaning and significance of autonomy and/or dignity with reference to a specific problem dealt with in the course.

1. Introduction

Human rights “recognise the inherent value of every individual, regardless of race, geographical location or gender.” (reference) These rights are based off of concepts of dignity, respect and equality and are present in all aspects of life and society (reference).

More specifically, the right that will be focused on in this essay is the right that all individuals must have the right to have control over an individuals own body, with the right to autonomy. Autonomy in the most common sense of the word depicts that individuals within society should be allowed the right to seek and carry out their lives in line with ones personal beliefs, interpretations and aspirations (reference). It is imperative that all individuals, (in this example more specifically females) within our society and around the rest of the world are provided access to these rights, as they have significant beneficial impacts on individuals emotional and physical wellbeing.

The topic of abortion is a heavily disputed topic within communities and wider society and is also a contested subject in the realm of human rights discussions. This weight associated with this topic is due to the increased number of women around the world that have their right to autonomy violated as a result of their inability to access abortions. Commonly it is groups in power (families, government, medical staff) placing pressure and dominance over women making decisions about termination, impeding on their rights to autonomy. These pressures will affect and ultimately dictate the decision they make about their body and child, that will alter the course of their lives forever. It is because of this that removing a woman’s right to abortion is such an extreme violation of their rights (reference). Throughout the completion of this essay will cover topics of abortion and human rights (specifically for women), autonomy and abortion and discuss why this is so important for women through looking at Judith Thompsons ‘violinist’ example.

2. Abortion and Human rights

“The basic rights to freedoms to which all humans are entitled” (http://wwda.org.au/issues/unhrt/hrchart1/#:~:text=Introduction,and%20equality%20before%20the%20law.) This is legally binding statement put forth to dictate and protect the rights to which all humans within society, including women, are entitled to. More specifically human rights dictate that women have the right to “seek to terminate a pregnancy as often access to safe and legal services is severely limited (http://wwda.org.au/issues/unhrt/hrchart1/#:~:text=Introduction,and%20equality%20before%20the%20law.). Despite this, women around the world are limited in their ability to access this right. The accessibility for women varies from country to country, with states owning primary responsibility for advocating for and protecting their people’s human rights. States ability to enforce and provide access to these human right is what has resulted in many women having their rights violated in relation to their decisions and accessibility surrounding abortion. This is a direct contradiction of the laws put in place by the human rights treaty (reference). The right to autonomy, as mentioned above is a vital aspect of contemporary human rights. The ability of government bodies in power today to dictate a woman’s access to abortion is ultimaatley denying them of their autonomy, or makes their ability to access and benefit from the rights they are entitled to receive completely circumstantial (cook & dickens Indert work)

Negative social constructs engulf the topic of abortion within society, linking to it a stigma of shame and embarrassment, resulting in it often being an avoided (taboo) topic of conversation. This means that often women’s options and experiences in relation to abortion and termination are often silenced, and as a result, other women miss out on being educated about the topic. This lack of education, lack of discussion and lack of social acceptance is what has resulted in the misconception within society that the rates of abortion are low within their society. However in societies around the world, this is not the case. Between the years of 2015 to 2019 across the globe, of ‘121 million unexpected or unwanted pregnancies, 73 million (61%) ended in termination’ (https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide#). In one of the biggest, more progressive countries in the world, the USA, abortion laws and their accessibility differs from state to state. In the USA alone, within this time period, ‘32 of every 1000 unwanted pregnancies ended in abortion’ (reference). Contrasting these numbers, in Australia and New Zealand where access to abortion is more consistent and accessible between states, ‘15 per 1000 unwanted pregnancies resulted in abortion’ within this same time period (https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide#)). When looking at these two countries statistics on terminations for unwanted pregnancies it is telling that women who want or need to access an abortion due to unwanted pregnancy will fight to access the services they need regardless of state laws or legislations where they live.

While these statistics shine a light onto numbers of medically noted abortions it does not account for the number of unmonitored, unsafe illegal abortions. For women living in a state or country where abortion is illegal, and women’s right to autonomy is being denied they are often left with no choice than to access an unsafe form of abortion, putting themselves at risk. The World Health Organisation stated that each year, “approximately 21.6 million unsafe or unauthorised abortions take place every year” (reference WHO) with almost 25% of these abortions leading to “serious illness or complications for the mother” (reference WHO).

3. Autonomy and Abortion

Around the world, women’s right to autonomy is impacted due to issues surrounding

abortion and human rights. Following on from information that has been previously given about American and Australia, some countries have complete bans on abortion. One of these countries is El Salvador, where it is illegal for a woman to access a safe medical termination regardless of the circumstances in which it is required. The consequences of seeking out these terminations are often serious for the mother and for the medical practitioner they see. For example, a person who performs an abortion (medical professional or otherwise) on a consenting woman, or a woman who induces herself into early labour to miscarriage may be imprisoned for up to eight years (reference). Furthermore, if a woman does not consent and receives an abortion from a doctor they may be given an extended sentence (reference). The harsh nature of these laws is what results in women participating in unsafe at home abortions using ““coat-hangers, rods, pills, fertilizers, soapy water and battery acids” (reference) putting themselves at risk as a result of a violation to their human rights and their autonomy. This example clearly dictates the impact that having a non-existent right to autonomy and no control over the right to “ones body and life” (reference UN rights) negatively impacts women’s health and safety, with extreme repercussions on he individual life, in relation to mental and physical health and morality rates (reference). In situations like this it is easy to note the importance autonomy plays in an individual’s life.

Harsh abortion laws, as mentioned previously are not only restricted to countries with lower socio-economic standards. American and Australia both have had previous laws within their constitutions that dictated and restricted women’s right to abortions despite these countries being viewed as more ‘progressive’ around the world. In New South Wales the ‘Abortion Law Reform Act’ that is currently in place was only introduced in 2019, in which it permits “abortions up to 22 weeks and permitting abortions after 22 weeks if two medical practitioners agree” (REFERENCE). Before this was put in place it would be necessary for women to gain the approval of multiple medical practitioners who would access the women’s physical and mental health before allowing them to access a termination (reference); This would in turn, undermine their autonomy by taking the control over the decision away from them. Restrictions to women such as this, is what enforces a negative stigma surrounding abortion in our society; instilling fear in women about their options if they do experience an unwanted pregnancy as doctors and government officials instill in themselves the power to make the decision for women.

“No one shall be subjected to arbitrary or unlawful interference with his privacy, family, home or correspondence” (https://humanrights.gov.au/our-work/rights-and-freedoms/freedom-interference-privacy-family-home-and-correspondence-or). This is what is stated in the international covenant of Civil and Political Rights (ICCPR) in Article 17. This is violated across the world in many circumstances, one of those being in Australia, with the medical abortion pill not being introduced within the country until 2012, despite it being circulated around the world for 20 years earlier (reference). This medication, a vital progression in the completion of abortions for women, is listed on the World Health Organisations list of essential medicine, yet due to the misuse of an Australian Senator’s power being misused and abused the medication was restricted to enter into the Australian health system denying hundreds and thousands of women their right to autonomy and a method of abortion that could increase their health within the process by an astronomical amount (reference). This again supports the ideal that human rights violations are prevalent in all countries.

Ultimately, abortion laws over the years have updated from being virtually not present across the world, to being put in a position of power that leads to individuals trying to overpower and restrict others access to them. While still not at the point of entitling all individuals access to abortions without discrimination globally, progress is being made in an attempt to improve and progress the autonomy of women in relation to abortion.

4. Autonomy for women

The major human rights that relate to abortion include the right to not be forced into pregnancy, and the right to the highest standard of health and reproductive rights (reference). Within the United Nations declaration of Human Rights, it is stated that “every woman has the recognised right to the highest standard of sexual and reproductive health” (reference UN). In order for this to be true for women, access to medically safe and legal abortions within their states is essential. This does not just encompass accessing services, it includes autonomy. Abortion within the realm of human rights, links to the topic of health which means it should be possible for women to access a service that supports and helps their ‘health’. Restricting this is a direct violation of human rights as it is ultimately promoting a platform for unsafe terminations that puts women’s health on the line as they seek out other alternatives due to restrictions. Promoting this negative and unsafe ideology on the topic of abortion, as well as denying women’s right to terminations further denies their autonomy. Moreover, the lack of accurate medical information about abortion is limited due to rulings on the topic which therefore strips women of the ability to make informed decisions about their own bodies and physical health (reference). Conclusively all women have rights to access the highest standard of sexual and reproductive health. In order for women to achieve this abortion laws need to be updated to make sure that resources are widely available to women of all ages.

As mentioned in the start of this essay, autonomy by definition is the “right or condition of self-government” (reference). This concept is imperative to understand when looking at it in relation to abortion and human rights. This is because if autonomy was the basis of the formation of all rules and legislation within our society, there would never be a question if an individual was ‘allowed’ to have an abortion, it would simply be known that women have the power over their own bodies and if they wished to seek out a termination it would be her right to access one. When viewing how abortion would be, should autonomy for women be allowed, it is easy to see how refusing women’s right to autonomy is a direct violation of her human rights. There are many ‘pro-life’ discussions that take place within today’s society, in which it is argued the foetus has the right to life that is greater than the autonomy, health and wellbeing of the mother (reference). Judith Jarvis Thompson in her writing ‘A defence of Abortion’ (1971) contrasts this ‘pro life’ idology, acknowledging that to an extent a woman’s autonomy must come before that of the foetus. Thompson in her work uses the example of being attached to a ‘famous violinist’ against your will. This example is given in an attempt to rationalise and support the idea of the importance of autonomy (reference). Thompson raises the idea that while the foetus does have a right to life, the abortion process is simply “dperiving the foetus of the non-consensual use of the pregnant body” (reference). There have been many disagreements on this topic with the argument being raised that the individual in Thompson’s example would have a moral obligation to keep the violinist they are attached to alive, and therefore have the same moral responsibility to keep their unborn child alive too, regardless of the consequences to the individual (reference singer). Thompsons example ultimately depicts to the reader that to ignore an individuals autonomy, is to cause harm and strip power without consent, ultimately violating their human rights.

While within this essay only avenues positive benefits of autonomy for the individual in relation to abortion are discussed it is important to briefly state that there are arguments for the negative aspects that autonomy may bring onto the individual in relation to terminations. For example, in a study conducted by blank it was identified that women interviewd often felt increased levels of stress and self-inflicted pressure to make the ‘right’ decision when given the free choice to decide between the termination or birth of their child. While this may be true it is important to note that many women may experience these pressures when discovering that they had conceived, and as a result of choosing abortion further experience negative impacts of their autonomy due to their inability to access what should be their basic human rights (reference).

5. Conclusion

Ultimately, human rights refer to and recognise the value in all individuals, blind to individuals’ race, location, gender and wealth, with central focuses on autonomy and dignity. In relation to the topic of abortion, when women are denied autonomy, their right to make decisions relating to their body and future are taken away, stripping them of their human rights. While it has been stated and discussed within the essay above that human rights violations in relation to abortion are present all around the world, (in some cases more extremely than others) it is important to understand the affects these violations have on the individual both physically and mentally, and why it is that these infringements are allowed to occur in a modern society. Autonomy for women is ultimately the way to guarantee that the basic human rights are being provided and met for the individual. Being autonomous would mean women have the ability to make intense medical decisions, without the interference or opinion of family, friends, government, or medical experts simultaneously freeing them from the social stigma and shame that is often circulated within societies. The works of academics such as Judith Jarvis Thompson support this ideal, and reiterate the concept that for human rights to be met around the world, it is women who must be granted autonomy when considering their options for the outcome of their pregnancy.

Abortion remains at the forefront of public issues, making the headlines in recent labour leadership campaigns, when Rebecca Long-Bailey appeared to suggest that she disagreed with permitting female reproductive autonomy after the standard 24-week limit on the grounds of disability. Jess Phillips hit back, arguing, ‘abortion legislation in this country should be removed from criminal justice laws and placed firmly within the Department of Health’. These arguments give a flavour of the abortion debate and provide a timely invitation to reflect on the degree to which the Abortion Act facilitates female reproductive autonomy. By reproductive autonomy, we mean the right of a woman to make autonomous decisions about her body and decide when, or if, to have children. This essay will argue for the reform of abortion laws to reflect twenty-first century standards and practice, which ultimately demands the decriminalisation of abortion in order to facilitate female reproductive autonomy. Part one of this essay will review autonomy in the context of David Steel’s abortion Bill; it will then move on to review how constructions of women played into the Act. Finally, this essay will look at how the Act continues to fetter reproductive autonomy and what decriminalisation would look like.

It may be useful to contextualise current medical law to help understand how anachronistic the Abortion Act is. In recent years, patient autonomy has assumed central importance in British medical law. It now seems uncontroversial that a patients’ right to make their own decision about medical treatment is protected by law. However, restrictive laws mean this has been slow to translate into support for women’s choices concerning pregnancy. It seems problematic that this increasingly strong commitment to patient autonomy has little resonance in abortion law.

Secondly, it is important to situate the legislation in its historical context to reiterate the act’s aim. The Offences Against the Person Act 1861 (OAPA) is the offence under which a doctor or pregnant woman who unlawfully attempts to procure a miscarriage can be convicted. This law subordinates female reproductive autonomy by undermining women’s ability to control decisions about their bodies.

Despite legislation making it a criminal offence for women to procure terminations and for medical professionals to perform them, abortions still happened, they were simply unsafe. Backstreet abortions were a feature of everyday life. As Diane Munday, a researcher at St Bart’s hospital at the time, reflects, ‘hospitals would keep beds open after payday for women suffering complications from botched procedures’. This quote epitomises the unfair restriction of women’s autonomy, showing illegal abortions, which carried risk of death, as more preferable than an unwanted child. Estimates of how many illegal abortions occurred in England and Wales before 1967 vary from 200,000 to 150,000 annually. The treatment of clandestine abortion accounted for one-fifth of gynaecological admissions within the NHS in this period. Maternal mortality from illegal abortion was acknowledged to be unacceptably high and abortion was seen as a persistent public health problem.

It follows that Parliament’s solution was the reform of abortion law by having doctors managing the problem, also protecting doctors from performing illegal backstreet abortions. However, this form of legal abortion was unashamedly couched in medical management, eclipsing questions of women’s rights, as its purpose did not lie with reproductive autonomy . In part, the medical framing of abortion emerged from the highly polarised pro-life vs. pro-choice debate, compromising that the ‘rational’ male doctor was most capable of deciding whether a woman needed an abortion in his professional opinion.

Literature in the 1960s responded to the pro-life debate and aimed to engage men, in particular, with the ethical arguments for abortion. For instance, Thomson’s seminal article was groundbreaking in terms of getting men to understand women’s experiences and the right to abortion. It was particularly instrumental as ‘the topic of abortion’ was one that ‘had been tainted by people’s assumptions about sex and sexuality, and by their dismissive characterisation of it as a “woman’s problem”. Putting the example in the second person, Thomson made the male reader adopt the perspective of a pregnant woman. Although the abortion debate has since shifted to focus on decriminalisaion, Thomson’s contribition was landmark at the time.

A crucial aspect of understanding the framing of the legislation in 60s Britain was the assumption of maternity as women’s normative role. The Bill was explicitly discussed as a means to minimise the numbers of ‘unfit’ mothers and ‘unfit’ children, immediately subordinating any questions of women’s rights to patriarchal language. A common sentiment in arguing for legal abortion was “over-large families where the mother is so broken… it becomes quite impossible for her to fulfill her real function as a mother”. In framing abortion as a means to help women unable to cope with motherhood, the Government reinforces the notion that the Act’s purpose was not reproductive autonomy.

Instead, the roots of the Abortion Act lie in a series of stereotypes about the type of woman to have an abortion. Those fighting reform painted images of the desperate victim they wished to save, configuring women as ‘passive and in need of protection’. Women were portrayed as ‘physically inadequate’, completely out of control, who would be driven to madness if denied relief. Such oppressive language debases women mentally and physically. This focused the issue on ‘saving’ helpless victims, rather than facilitating women’s choice to make decisions about their pregnancies, an unsatisfactory way to view reproductive autonomy.

M.P.s opposing abortion commonly invoked irresponsibility and recklessness as women’s defining characteristics during the debate. For instance, Mahon purported a woman may abort ‘according to her wishes or whims’, while Jill Knight said ‘[a] mother might want an abortion so that a planned holiday is not postponed.’ Such statements infantilise and dis-empower women, constructing them as frivolous and foolish in their decision-making. These attitudes are inextricably wound up with ideas of female sexuality, highlighted in notions of women recklessly ‘getting themselves pregnant’. Rather than viewing women as autonomous agents actin their own interests, Parliamentary debates constructed pregnant women as unable to make ‘wise’ decisions about their pregnancies. Relying on constructions of women as reckless and irresponsible, Parliament attempted to justify the disenfranchisement of women, dismissing any rational arguments to the contrary. Thus, the task of the law is essentially one of responsibilising. It acts to curb women’s recklessness, blaming women’s ‘slutty’ behaviour for their pregnancy. In doing this, the law ascribes to the notion that women are not capable of making their own choices, placing a firm barrier between women and reproductive autonomy.

Evidently, the law of the United Kingdom has developed towards a more legalised framework than absolute criminalisation. The Abortion Act 1967 offered some relief, providing an offence to the OAPA (until twenty-four weeks) when two doctors agree in good faith that: 1) there is a substantial risk of severe foetal abnormality, 2) the woman, or any existing family, are at grave risk of physical or mental injury, or 3) the woman’s life is in danger. The 1967 Act did not grant women the right to end an unwanted pregnancy. Instead, it gave doctors the power to decide whether there are grounds to support a woman’s request for abortion. However, in 2018, 97.7% of abortions were performed under ground C, 99.9% of which because of a risk to the woman’s mental health. This indicates a dischord between law and its liberal application, reaffriming the need to update the Act in line with modern day medical practise.

The problems with the 1967 Abortion Act are glaringly obvious.

• OAPA was legislated over

Crucially, the Offences Against the Person Act was not repealed but legislated over. This means that despite the Abortion Act, abortion remains to this day a criminal offence. The 1967 Act only made restricted exemptions to the 1861 Act.

• The requirement for two doctors

Despite liberal interpretation and permissive practice, the Abortion Act (as amended by the Human Fertilisation & Embryology Act 1990) remains one of the most restrictive in the developed world. The requirement for two doctors means that a woman who wants an abortion is wholly dependent upon the exercise of medical discretion. While this captures the views that characterised the 1960s practise, it is a sharp contrast to today’s common law protection of patient autonomy. Again, it is problematic that this increasingly strong commitment to patient autonomy is not recognised in a female reproductive capacity. The very exercise of doctor’s examining women’s reasons for seeking abortion assumes a necessary lack of autonomy over the decision of whether to become a mother and that naturally the choice ’not to’ requires authoritatively sanctioned justification. Thereby, the legislation reflects utterly an anachronistic framework that subordinates female reproductive autonomy to patriarchal attitudes about gender norms, female sexuality, and fertility control.

• Only doctors perform abortions

While historically abortion procedure was more high-risk, medical developments such as the Early Medical Abortion (EMA) mean abortions are much safer. In view of this, it makes little sense to restrict abortions to the doctor’s office, and more sense to make EMAs more readily, commerically available, e.g. as an over-the-counter pill, thus returning choosing power to women. This restriction therefore seems redundant in terms of protecting women’s health and instead impinges on female autonomy as it restricts a women’s decision to reject a pregnancy.

• Intersectionality

A further problem with the act is that it assumes all women have equal autonomy. Women from ethnic minority groups or women who are poorly educated may not have the knowledge or confidence to seek a second opinion if their GP is obstructive. Furthermore, women from rural areas faced with an uncooperative doctor may not be able to access an alternative medical practitioner. The Abortion Act then operates to entrench deference to medical opinion with disproportionate practical impact on the choices of disadvantaged women. Access to abortions disproportionally favours women with more social capital, further reducing the autonomy of lower class and non-white women. This supports Fineman’s notion that all our choices are made within the constraints of society . Hence, the criminal law framework as it stands confines female reproductive autonomy into a legal vacuum, shaped primarily by men with no experience of abortion.

Reinforcement of women’s role

A final problem with the Act is that its implicit reliance on assumptions of motherhood as women’s most appropriate social role facilitates the continued oppression of women. Though many women happily engage in motherhood, the institutional exploitation of this act as a justification for excluding women from reproductive discourses is oppressive. Having the freedom to decide whether to bear and nurture children is not merely important for ‘women gaining control of their reproductive lives, an essential prerequisite to women freeing themselves from male dominance’, but ultimately for gaining an identity independent of reproduction. Notions of reproductive autonomy and bodily integrity are not merely significant for affording women the ‘right to choose’, but rather what that choice affords them: equal opportunity to craft their sense of identity, to pursue their talents, and fostering their own sense of a ‘good’ life. More than fifty years on change has stagnated. Patriarchy has not been displaced. It is time for a law that recognises women’s unencumbered ‘right to choose’ whether to be a mother.

Thus, in an important sense, the battle for reproductive autonomy was hindered in 1967 rather than helped. The Act explicitly avoided granting substantive rights to women, and instead was rooted in a paternalistic attitudes. Through critical analysis we might become more aware of the role law plays in facilitating the continued denial of women’s reproductive autonomy.

In 2008 we came close to liberalising the Abortion Act, when reforming MPs proposed a number of amendments to modernise abortion under the Human Fertilisation and Embryology Act 2008. The amendments saw the removal of medial approval for all but late terminations, permitting nurses and other health care providers to carry out abortions, the extension of the range of locations where abortions can take place, and the choice to complete EMA’s at home. However, the government torpedoed any debate of liberalising reform, instead choosing to table a programme motion rather than allowing a vote. In blocking any chance for the amendment to be discussed, the government revealed scant concern for the right of a democratically elected Parliament to debate a matter of importance and significant controversy. The result is the retention of legislation grounded in tired stereotypes of frivolous women unable to make important decisions in a serious or reflective way. The refusal of successive governments to update any law regarding abortion leaves intact the archaic legal framework that suffers from many of the problems that provided for the compelling reform of the OAPA.

It is time we re-framed what modern abortion law should look like. It is time the law reflects contemporary social values and accepts female reproductive autonomy, ending the hypocrisy that pretends abortion is rare. The Abortion Act does not belong in the realm of criminal law. An abortion is a medical procedure. Decriminalising abortion would require a process of parliamentary reform to remove specific criminal penalties such as the destruction of foetal life as an independent justification for criminal sanction under the OAPA and ILPA. However, in doing this it would be necessary to consider cases of men assaulting pregnant women in order to invoke miscarriages. It is recommended that such actions should be chargeable under amendments to general offences relating to actual and grievous bodily harm to ensure the extent of harm caused by the loss of a wanted pregnancy is fully recognised in law. This proposed method of decriminalisation would not only withdraw punitive measures imposed on women, it may also contribute to a society where abortion is destigmatised. It is likely to help erode stereotypes of women as incapable of decision-making by legally framing pregnant women as the ‘active’ social agent. Undoubtedly, this would represent an important move to recognise women’s rights of self-determination or autonomy.

It follows from this that the law should be amended to allow competent adults, and young people, to consent to abortion on the basis of informed consent as with other medical care. There is no logical reason to retain the two doctors’ signatures required by the Abortion Act, instead accurate, appropriate and timely non-directive information from healthcare professionals would enable each individual to fully explore their options and choose freely. Above all, the law does not need a reason for the authorisation of an abortion. It should provide a framework in which abortion can be obtained safely, free of judgement, and characterised by choice. The concept that women should be allowed to decide for themselves, on the basis of informed consent, would facilitate female reproductive autonomy in a healthcare environment respectful of self-determination. While there is not enough room to go into it here, it would be recommendable to keep a statutory public register of conscientious objectors, enabling women to avoid approaching an objecting doctor and risking delay or bias.

If women receive reproductive autonomy there is no reason so suggest that it should not be absolute. The current separation between grounds A and D is unsatisfactory and should be collapsed if the focus is autonomy. Women are currently permitted to exercise their choice after 24 weeks if the foetus is seriously handicapped, yet this in itself is entirely problematic, as it relies on the subjective exercise of medical discretion to determine what constitutes ‘seriously handicapped’. Moreover, if, as many academics argue, female reproductive autonomy is paramount, then why should ‘the right to choose’ be fettered at 24 weeks? One could argue that, without restrictions imposed upon autonomy, women might choose to abort later for personal reasons other than disability. If the goal is to facilitate reproductive preferences, it seems contradictory that a women’s choice stops being respected at what appears to be an arbitrary number with no intrinsic value. In Australia and Iceland it is twenty-two weeks, in France, the Ukraine, Belarus, Spain and Germany fourteen, in Hungary twelve and in Portugal ten. It is oppressive to confine autonomy to a number chosen mostly by white men who confuse abortions with ‘holidays’. This is reinforced by statistics that prove women will abort as soon as possible, grounding the argument that if a woman chooses to abort after twenty-four weeks, her choice should be respected.

Although this argument is logically supportable, it may be pragmatically difficult to get such legislation through. It should be recognised that later abortions raise more ethical concerns, and the retention of criminal law provisions would likely command more popular support in this area.

Finally, there is no reason to retain the legal requirement for the EMA’s first dose of misoprostol to be carried out in a hospital or approved location, as it would limit national capacity to provide early abortions. Instead, the law should model Norway’s legal framework and allow both doses of misoprostol to be self-administered at home. This would help to subvert women’s oppression by enabling the prompt and safe expulsion of the pregnancy in an environment of their choosing, rather than inflicting undignified onsets of bleeding on journeys home from clinics.

In conclusion, it is time law in the United Kingdom decriminalised abortion and handed women back their autonomy over their pregnancy. This could be done by modelling the law in Victoria [Australia], moving abortion from criminal law into GMC guidelines, facilitating reproductive autonomy by providing safe, accessible abortions. Though we discussed some potential issues that may arise from decriminalising aboriton to term, such as the need to legislate in the instance assault-induced miscarriages and acute moral concerns with later terminations, there is no reason to suggest such problems should stand in the way of female reproductive autonomy. Until we see absoloute criminalisation, the most successful short-term strategy may be challenging the construct of the legal subject: the woman. As Carol Smart says, ‘law hears what we have to say about women”. This suggests the law is not going to change until social constructions of women change. Therefore, perhaps the reform of abortion law calls for wider, sociopolitical intervention in order to challenge the base perceptions of women.

Building autonomous teams is an art and thought to be the Holy Grail of an agile enterprise. With that being said, Spotify is one of the best examples of companies, which didn’t undergo a transformation, but was founded with an agile mindset from the very beginning. Over the past years the company has continuously improved its processes and organizational structures to accomplish what is has today – high performing, autonomous teams. And for a good reason. According to research in the area, people working in autonomous teams tend to be more motivated, productive, creative and innovative (Smart, 2017, “The Art of Building Autonomous Teams”).

Organizational culture

One of the fundamental key success factors in reaching autonomy is an explicit organizational culture (Lee, 2017, “Autonomous teams —make learning your competitive advantage”). While small, family-like enterprises with high levels of trust and empathy among employees are more likely to keep their culture implicit, big organizations should define their culture norms in order to make sure that all employees understand and held accountable for no-compliance. Therefore, an explicit organizational culture helps the company to promote and reinforce behaviors it expects from its employees. And this is exactly what Spotify did when setting clear fundamental values in the company’s manuscript “Agile a la Spotify”. It is important to accentuate that writing down a list of norms and principles as well as communicating them to employees does not mean creating a culture. It is the task of the leadership team to adopt these values, believe into them and act as role models. When hiring people, Spotify does not pay attention only to technical skills, but also to the cultural compatibility of the potential employee (Nobl Academy, 2016). Overall, the hiring is a multistep process with strong emphasis on the cultural fit also involving an interview with the future team-members of the candidate.

Servant leadership

Leadership also played a major role in Spotify’s journey towards autonomy. By abolishing the traditional relationship between leaders and teams as one of superior to subordinate, Spotify improved collaboration by adopting a mindset of partnership. According to McKinzey’s study on leadership and transformation (2018) leaders operating in a network of autonomous teams focus on guiding and mentoring rather than micromanaging and directing (p.11). This fits well with the fact that members of autonomous teams want to be able to make decisions without too much managerial interference (Hess, 2013, “Empowering Autonomous Teams”). As concluded in a research made by Google (2015), creating a sense of psychological safety for the teams improves their effectiveness and motivates the team members to partner, take new roles and bring in individual ideas without being afraid of negative consequences (Rozovsky, 2015, “The five keys to a successful Google team”). Drawing the parallel to Spotify’s success story, the streaming service adapted a servant leadership approach with minimum managerial interference and a culture of a “fail-friendly” environment – both of them facilitating autonomy within teams.

Alignment

Under no circumstances is team autonomy to be associated with anarchy or chaos. Therefore, it is crucial to allocate an appropriate level of autonomy. Failing to provide enough autonomy might be interpreted as lack of trust towards team members and curb their creativity and full potential while too much autonomy could lead to negative outcomes and increased stress levels due to pressure to satisfy leadership expectations (Hess, 2013). In order to give an optimal level of autonomy, Spotify fosters alignment without excessive control. The company invests much time aligning on objectives and goals before launching into work (Mankins & Garton, 2017). The deeper the team’s understanding of the company’s strategy and priorities, the better can it autonomously collaborate in order to find the best solution to the problem communicated by the leadership level. Alignment at Spotify ensures that teams are pushing towards the same goal and all share a common purpose. According to its HR blog, Spotify empathizes that the company’s task is to point out the direction it aspires to go towards and where does it want to be, the way it gets there is solely for the teams to decide. Figure three represents how Henrik Kniberg – a former agile coach at Spotify – graphically represented the relationship between alignment and autonomy. They might seem like two different ends of a scale, as in more autonomy equals less alignment. However, Spotify thinks of it as two different dimensions. Low autonomy and low alignment equal micromanagement culture without a higher purpose. Employees are expected to follow orders without questioning the big picture. In a low autonomy and high alignment situation leaders are good at communicating the problem, at the same time they also prescribe how to proceed.

Figure 3: Spotify’s Alignment & Autonomy diagramm

Source 3: Kniberg, 2013,’Spotify – the unproject culture’

High autonomy and low alignment represent an opposite scenario in which teams can do whatever they want without being given any direction. Spotify’s goal is aligned autonomy, where squads collaborate with each other to find the best solution. Besides these two dimensions, there is another one which maximizes the aligned autonomy – accountability. As an example, Spotify gives a great deal of freedom in innovating. However, employees and teams will be held accountable for the results and they all have to comply with certain established norms and processes (Mankins & Garton, 2017). By providing a high degree of accountability for the teams and across the organization, the company creates a high degree of trust, which is an essential attribute for high performing teams.

According to Smart (2017) – the author of “BDD in Action”, autonomy relies on three essential factors: competence, shared understanding and trust. At a second glance, all these factors are included into Spotify’s autonomy model. Competence is included into Spotify’s cultural value of continuous improvement by sharing know-how, organizing workshops and improving the skills of its teams. Spotify’s counterpart for “shared understanding” is its aligned autonomy, which ensure that teams strive for the same goal. Last, but not least is the factor of trust, which manifests at Spotify through its fail-friendly culture, where team members feel comfortable taking risks and making mistakes as well as being accountable for the results they deliver.

Summary

Within the span of the last 13 years Spotify has grown its engineering and R&D team from ten to 1,800 people, therefore crossing all the evolution stages from a startup to a global enterprise. Despite being born as a company with an agile mindset, Spotify dedicated itself to continuous improvement and transformation towards innovating, experimenting and learning faster than its competitors. Facing the challenge of fast-paced expansion, the company decided to restructure its organization design by scaling its teams into squads, chapter, guild and tribes with the purpose of implementing “minimum viable bureaucracy” and balance between autonomy and high alignment (Kamer, 2018). Throughout the process Spotify came up with its own manuscript of agility internally called “Agile a la Spotify”, which reflected the companies’ culture and agile values together with its core concept of building autonomous teams. Nowadays, Spotify’s culture is well-known for its high levels of empowerment and trust, collaboration and sense of purpose. Following key success factors were identified during the research for this study paper: Spotify’s organizational culture, its servant leadership model and its balance between autonomy, alignment and accountability. Through its explicit culture Spotify supports trust, innovation and experimentation in a fail-friendly environment. By following a servant leadership model, leader focus on guiding and mentoring rather than micromanaging and directing. A local decision-making process increases the productivity of squads and collaboration within the teams. The third key success factor is alignment without excessive control. The basic concept behind it is that alignment enables autonomy, the greater the alignment within the company, the more autonomy it can grant. Following this concept, Spotify invests much time in aligning on objectives and goals. Squads and squad members can find appropriate solutions only when they are aware about the final destination.

Do Spotify’s success factors guarantee autonomous teams for any other company trying to copy the model? Experts are in complete agreement – rather not! There is a vast number of factors that have to be considered: what is the company producing, which business model does it have, which growth ration is it experiencing, what countries is the company operating in and is autonomy generally compatible with its employee’s

Introduction

Working in a public sector requires specific characteristics and behavior to overcome the struggles of delivering services to the masses. Often times, practices that are prevalent and effective to companies doesn’t necessarily applies to the public sector. The schemes of measuring the work done, motivation applied to employees and strategies for performance enhancement are somewhat different. While there are certain instances where practices can be both implemented to both sectors, which is rare, the common scenario would be, practices and theories varies from one sector to another.

Mcclelland’s Need Theory explained that a person’s behavior is specifically based on their needs. There are three (3) basic needs of an employee or worker, the need of achievement, affiliation and power. And one characteristics of the Need of Achievement would be working alone. The need for work-autonomy is the new trend. As the world is constantly changing, workforce is multigenerational draining traditional practices out of the system and being replace with modern ways and strategies.

Companies like Facebook and Google have fully implemented work autonomy in their workforce. Younger generations of workers and employees love their freedom and has manifest on the way they want to work. Nguyen et. al. stated that more autonomy is expected to be associated with greater job satisfaction because workers have more freedom to determine their own effort and work schedule.

While this practice can be fully implemented in the private sector, public sectors are a bit skeptical about it. Public sector employees are bound by their sworn oath of serving the masses and public. Liberty would often pose threats and disadvantages for both the employee and the organization concerned. It was argued that tensions can arise between the promotion of a discourse of autonomy versus the need to control employees to achieve centrally determined objectives efficiently, or by creating expectations that are not fulfilled. (Lin. et. al.)

However, advantages of work autonomy that could compensate the drawbacks are being studied upon. Establishing autonomy and independence in the work force reduces management intervention as well as fully understanding and modifying the way each function of the organization or institution operates. Taiwan Community Health Centers employees’ showed that job autonomy has positive work outcome; greater work satisfaction and less intent to leave. (Lin et. Al.) Other researches had also come up with conclusions that work autonomy has relationship with varying factors like age, work position, years of service and more.

In the local government sector, there are only few researches and studies about the impact and effect of work autonomy on employee’s behavior in work. It is an unknown practice specially in the LGU of rural areas. The culture of work effort is often the traditional way in the location or sites that are not easily penetrated or blended by modernization and change.

Therefore, this study investigates how work-autonomy would affect employee behaviors and motivation. It has its focus on the relationship of work autonomy on varying factors – age, years in service, work classification and job position. Furthermore, it also tries to investigate the levels of work-autonomy that co-relates with the level of job satisfaction and performance of an employee.

Statement of the Problem

This study aims to determine how work autonomy affects job satisfaction and job performance. Specifically, it seeks to answer the following questions:

1. To what level of work autonomy do public employees feel job satisfaction?
2. What level of work autonomy do public employees prefer with respect to the following factors:
   1. Age
   2. Years in service
   3. Job classificationtitle
3. Is there a relationship between work autonomy and job performance of public employees?

Objectives of the Study

This study will be conducted to determine how work autonomy affects job satisfaction and job performance. It specifically aims to:

1. Determine the extent of work autonomy does public employees feel job satisfaction.
2. Determine the level of work autonomy preferred by public employees, with respect to the following factors:
   1. Age
   2. Years of service
   3. Job classificationtitle
   4. Work environment
3. Investigate whether there is a relationship between work autonomy and job performance of public employees.

Scope and Delimitation of the Study

The study will be conducted at the Provincial Capitol of Quirino for the month of March to May, 2021. The research will focus mainly on the three objectives set on this research namely: 1.) level of autonomy affecting job satisfaction, 2.) different level of autonomy preferred by different employees with respect to their age, years in service and job classificationtitle, and lastly 3.) relationship of work autonomy and job performance. 250 employees from the various offices of the Provincial Capitol of Quirino which was the result of cluster sampling done will be the respondents of the study.

However, limitations of the study will be also be observed. Since duration of the study will be between the months of March to May and currently the world is under a pandemic certain health protocols and work guidelines will be taken into consideration. The distribution and dissemination of questionnaires will be send online hence the observance and consideration of respondents’ honesty and integrity will be taken into account.

Significance of the Study

“When employees feel they have the control over their behaviors, or they could engage in certain tasks discretionally, they would be highly motivated and are more willing to work.” (Gong, et. Al.) Employee motivation is always a grey area in an organization. Having the right motivating factor and design for employees can either promote good performance in their work or make them leave and quit work. This can be the case on establishing work autonomy on public employees. Delivering the best motivating scheme to employees is a vital part of achieving organizational goals and simply getting the job done.

Studying the impact of this unfamiliar concept of motivating public employees is important for it will not only help the organization achieve their goal through motivating employees, but more of, it will help the employees understand their working techniques and strategies of making doing the job effectively and efficiently, thus this research. The result of this study will be deemed beneficial to the following groups of people:

Employees. With the findings of this research, employees will understand the work scheme best fit to each one of them. As well as, it will help promote accountability and commitment to the work assigned. The findings on this study will also be able to help in achieving and maintaining a good work and life balance.

Organization. It is uncommon for public offices to promote work autonomy yet, with the result of this study, public organizations or institutions will understand the behavior of their employees, thus creating an effective enhancement and satisfying work motivational package for each type of employee. A happy employee is an effective and efficient worker. Combining both would likely result to achieving organizational goals as well as successfully delivering service to the public without invalidating the needs of employees. This creates a system of trust between employees and organization.

Definition of Terms

The following terms are defined operationally to help the readers understand the context and purpose of the study:

Effectiveness. The capability of an employee to accomplish the task correctly and accurately.

Efficiency. The ability of an employee to accomplish the work the fastest possible way with the least effort or performance.

Job Performance. The degree or level of an employee’s effort to accomplish the assigned job or work.

Job Satisfaction. The degree or level of an employee’s confidence and contentment with his or her work.

Motivation. A package of benefits, strategies or schemes that push an employee to perform at their best, achieving the goal of the organization.

Organization. A system or network of people that works together to achieve a desired goal and deliver service to the end users.

Public Employee. A person who applied and get hired to work for a public office.

Public Office. An organization or institution that is devoted to delivering services to the masses or the public.

Work Autonomy. The liberty given to an employee to decide the phase of the work and how to accomplish the same.

Review of related Literature

This part presents the literature and studies that guided the research and helped the researcher organized the study. These literature and studies supplied the information and data that enlightened the study about work autonomy as motivation and its impact on job performance and job satisfaction.

Motivation

Over the decades, motivation plays an important role in the way a person behaves and performs. This has been one of the most important yet one of the most difficult part in running an organization. Several traditional strategies are less effective because of the challenging new trends in terms of work environment, norms, and employee’s behavior.

According to Al Jasmi (2012), employees are the main contributor and effective factor of an organization’s success. Researches and studies often revealed that a motivated employee is an efficient and effective worker. This type of worker will contribute greatly in the organization’s goals and objectives.

Crafting a motivation scheme for one employee to another can be complicated. Motivation is commonly patterned with employee’s behaviors, wants, and needs. There are two types of motivation. It is common knowledge that there is an intrinsic motivation, as well as extrinsic motivation.

Intrinsic Motivations are the ones that come from ‘internal’ factors to meet personal needs. (Cebollero, 2014). This is simply doing the job because it is Inherently interesting and fun. This means that employees accomplishes task because they’re enjoying the work, and are feeling comfortable with the way it is done and as well as the phasing and timeline. Extrinsic Motivation are those things that originates form ‘external’ factors and are can be controlled by the organization. (Cebollero, 2014) This motivates employees because of the outcome after the work has been accomplished. Normally, salary and recognition are the common samples of this type of motivation. It is debated whether which of the two types can be more promising and more effective for both the employee and organization in the short and long periods of time. Nonetheless, employees need one or the other, or they need both extrinsic and intrinsic motivations.

There are also different theories concerning motivation. These theories generally relate employee behaviors to motivational levels or classifications. Though time and as the world evolves and changes, with the occurrence of trends, theories and concepts are formed and adds up to the list. But traditionally and commonly, there are three (3) founded theories of motivation.

The first and most popular would be the Maslow’s Hierarchy of Needs Theory. This theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid. From the bottom of the hierarchy upwards, the needs are: physiological (food and clothing), safety (job security), love and belonging needs (friendship), esteem, and self-actualization. (McLeod, 2020) Maslow also states that lower level needs to be satisfied before progressing to the next one. But it was further elaborated that, it is not an ‘all-or-none’ phenomenon.

Another theory of motivation is the Hezberg’s Motivation-Hygiene Theory also known as the two-factor theory. This is a practical approach to motivating employees. According to Herzberg, there are factors that results to satisfaction, as well as factors that results to dissatisfaction. (Juneja, 2018) The implication for organizations to use this theory is that satisfying employee’s extrinsic factors will only stop them from feeling dissatisfied but the motivation to put an additional effort for better performance with work is not enough or rather not met. (Wan Fauziah Wan Yusoff, 2013)

The last familiar theory of motivation would be the McClellands uman Motivation Theory. The theory explains the process of motivation by breaking down the what and how’s of needs and the right way of approaching different needs. The three important aspects of the theory would be Achievement, Power and Affiliation. These three aspects greatly affect and influence a person’s behavior. Classifying first the individual’s ultimate need and approaching it one by one depending on the classification is the way for this theory.

Work Autonomy, Job Satisfaction and Job Performance

Autonomy in the workplace simply means that employees have the liberty or freedom to choose how, when and strategies to accomplish the work. Work autonomy can be also defined as the practice of delegating authority, responsibility and accountability from the top level command down to the lower level employees giving liberty in decision-making with respect to the assigned task or work. (Leach et. al., 2003 p.28) This is viewed in the sense that, through the establishment of work autonomy in the workplace, layers of management are slowly remove. Moreover, it involves a shift in the operation of fundamental functions of the organization. (Boyne, 1999)

The concept of autonomy in the workplace is the new trend of businesses and organizations. Most large companies like Google and Facebook have fully implemented autonomy in their working arrangements of employees. These companies encourage autonomy for it is believed that a happier employee fosters productivity and creativity. Employees are not restricted with the working environment and with strict policies, schedules and work arrangements.

Public employees are more restricted than those working in a corporate and business world, thus making it hard to implement work autonomy in this field. But researches and studies proved that schemes seeking to empower employees and reducing hierarchies in the operation and management improves productivity and performance.

A study of Taiwan Public Health Center employees showed that work autonomy definitely helps in the productivity and efficiency in the work. Furthermore, different levels of autonomy are preferred by different types and classification of public employees. The study found that permanent staff in the community health centers have more job autonomy than the fixed-term staff have. This result is similar to the study of Han, et. al., 2009, showing higher level of autonomy on permanent nurses than those temporary nurses.

While it is evident that autonomy affects job satisfaction and job performance, organizations are a bit skeptical in promoting and encouraging the implementation in the public offices. Employees should have the capability and skills development to handle autonomy in working effectively. Organizations need also to invest in empowering workshops, trainings and employee development to take advantage of the benefits of autonomy.

Job satisfaction and performance are two interrelating concept of management. Job satisfaction can directly affect job performance. But in rare instances, wen job satisfaction is abuse there would be loss of effort to perform. Employee tends to be complacent and do mediocre works when there is comfortability. Balance for these three concepts is the key to achieve the optimum benefits and opportunities to the employee’s progress and organization’s success.

Written by Scott Y.H. Kim, this academic article concentrates on bioethics and the particular ethical philosophies that are prominent within the provision of healthcare. The article was written for the philosophy, psychiatry and psychology journal published by John Hopkins University Press in 2013. Through this article, Kim expands on the notion of autonomy and its application within medicine. The presence of autonomy in healthcare stems from the principlism theory, most famously advocated for by Beauchamp and Childress. This dominant approach to bioethics highlights 4 principles that facilitate a means for resolving any bioethical concern; autonomy; non-maleficence; beneficence and justice. Although it is acknowledged that all four are of equal value, autonomy holds significant importance. Flowing from Beauchamp and Childress’ theory of principlism, autonomy is widely regarded as an individual’s right to make their own independent decisions concerning their life and how to live it. Scott Y.H. Kim recognises that the principle of autonomy plays a significant role in the application of bioethics however, throughout this article he considers whether the concept is too individualistic. The basis of his argument centres on the traditional understanding of autonomy and whether it is too restrictive/confined; neglecting to acknowledge the wider context in which the principle is applied. Instead, Kim promotes autonomy understood in broader terms, known as relational autonomy. This takes account for a wider community in which an individual develops, not just consideration for their own individual decisions. He suggests that the relational character of autonomy is intrinsic to its very nature.

Autonomy has been deep-rooted within society for some time. We (as a community) give this freedom such high regard because the decisions we make and the values which we hold close are inherently important to us. It is a means through which we can achieve our goals and values. Despite the longstanding acceptance of the significance of autonomy (particularly within the provision of healthcare), there has been an ongoing dispute regarding how it should be understood. Kim aims to thwart the traditional understanding of the principle, suggesting that relational autonomy should prevail; placing greater emphasis on one’s wider relationships within society. He begins by critiquing the narrowly defined autonomy and why it is problematic. Following this he discusses why this understanding of the principle risks autonomy being abused, particularly in a healthcare setting. Finally, Kim finishes by laying down relational autonomy and why this understanding is favourable.

Firstly, Kim explains that those who have long advocated for the principle of autonomy are sceptical of its application in medicine, owing to it being understood in an isolated manner. In particular, Kant, famous for his support of autonomy, has recognised that it ought not to be considered as a detached principle but instead it should be viewed as “the source of all morality”. Kim interprets Kant’s theory as viewing society as an end that cannot be achieved through absolute autonomy i.e. individuals having total free will to pursue whichever endeavours they desire. That is not to say that their wishes should be restricted but rather that individuals must be aware that they are existing within a community that involves mutual relationships and respect for one another. However, his perception of Kantian autonomy as a “theory of human relationships” is slightly erroneous; Kim has to some extent misconstrued Kant’s understanding of autonomy. While recognising that every individual has the right to be respected as well as having a corresponding duty to respect others, Kant’s theory is predominantly focused on the moral law which an individual prescribes himself. We are governed by our own moral law and from this law arises a responsibility to pursue behaviours which are “universally favourable”. On the other hand, relational autonomy is centred on the basis that an individual’s personhood develops in a social environment consisting of relationships and social determinants. Flowing from this, an individual’s values and decisions can be influenced by/defined in terms of these social norms and relationships. Kant does not disregard this …….. we as human beings have an obligation but what differentiates his theory from one of relational autonomy is that he recognises that obligation arises from being governed by one’s own moral law, not simply because we live in a society and must have respect for others. On the sliding scale of autonomy, Kant’s theory lies in the middle, with “isolated” autonomy at one end and relational autonomy at the other. Kim has failed to recognise this distinction, ultimately causing this particular argument in favour of relational autonomy to be flawed.

Furthermore, Kim’s argument is poorly elucidated in the context of healthcare. He introduces the argument by referencing bioethics and the problematic application of the isolated interpretation of autonomy within it. However, he fails to expand on why autonomy understood in relational terms is favourable in a healthcare setting. Kim’s failure to support his stance with practical examples within medicine weakens his argument in favour of the application of relational autonomy in healthcare.

Where relational autonomy fits into the provision of healthcare and why it is favourable (as opposed to the narrow definition) in a healthcare setting.

We impose a moral law on ourselves and from this law emerges a responsibility to act in a particular way.

Autonomy is an issue. Is it morally wrong for a doctor to deceive their patient about the true nature of a treatment, which the patient would otherwise refuse, even if it means improving that patient’s prognosis? Consider the case:

An adult male presenting with aplastic anaemia requires a bone marrow transplant. Without the transplant he will almost certainly die, but with the transplant, he has a good chance of recovery. The patient is a long-time committed Jehovah’s Witness and will not accept any treatments that contain blood; he tells his doctor that he would rather die than act against his faith. The doctor knows that bone marrow will always contain some blood, but instead of telling the truth, he assures his patient that bone marrow contains no blood whatsoever. The transplant proceeds.

In this paper, I will argue that the doctor’s actions were morally wrong. To establish my argument, I will first discuss how the doctor harmed his patient in disregarding his autonomy. Then, I will explore the counterpoint that perhaps his actions could be justified, before dismissing the self-refuting logic. Finally, I will return to the claim that the doctor acted against his patient’s intrinsic and instrumental values while not bringing about any greater good in the process; therefore, from a utilitarian perspective, the doctor was morally wrong.

I will begin with the presumptions that autonomy is intrinsically valuable and to inhibit autonomy is wrong. Autonomy is intrinsically valuable, according to Richards, because it is a central characteristic of personhood, and if personhood is seen as intrinsically valuable, then autonomy must be seen as intrinsically valuable as well (to debate whether or not personhood has intrinsic value would be reductionist, so for the purposes of this paper, I will presume that it does). I will add that the notion of respect for autonomy fosters social equality; when people feel that their own choices are being respected, they are more likely to be respectful of others’ choices. Moreover, utilitarianism is concerned with maximising good; and, by definition, intrinsic values are good in and of themselves. If it is true that autonomy is intrinsically valuable, and such values ought to be maximised, then autonomy ought to be maximised.

Beauchamp’s theory of autonomy requires that individuals have intentionality (i.e. foresight), understanding (i.e. comprehension), and voluntariness (i.e. willingness) when making decisions, if they are to give ‘informed consent’. The only situation where it is acceptable to not obtain informed consent from an individual (on issues solely regarding their own wellbeing) is if the individual in question lacks the capacity to meet those requirements (e.g. children, people with mentally illness, people who are unconscious, etc.). However, the default is to assume an individual does have capacity and the burden of proof (morally as well as legally) rests on whoever is responsible for restricting the autonomy of that individual. In this case, the patient had the capacity to make medical decisions for himself, in the absence of any indication to the contrary, so the doctor ought to have obtained his informed consent. Because the patient was misinformed, he was unable to act on autonomy. And because he was unjustifiably misinformed as a result of the doctor’s actions, the doctor was responsible for his inability to act on autonomy. Autonomy is good and ought to be maximised. Therefore, the doctor’s actions were wrong.

Or were they? An act which restricts an individual’s autonomy with the intent to help (or prevent harm to) that individual, is ‘paternalistic’. By Dworkin’s analysis of paternalism, the doctor was acting paternalistically: he obstructed his patient’s autonomy, without his patient’s consent, in efforts to improve his patient’s welfare. Paternalism, without reasonable justification, is wrong because it limits autonomy. But what if the doctor was justified in acting paternalistically? Perhaps, if autonomy is good, then it would be morally wrong not to maximise a person’s lifetime potential for autonomy. A classical utilitarian approach to maximising autonomy will emphasise that what really matters is how much autonomy I am able to exercise over my whole life, rather than how much autonomy I am able to exercise at one point in time. Maybe, by restricting his autonomy temporarily, the doctor gave his patient future in which he has greater opportunity to be autonomous. Lifelong autonomy. More autonomy over a lifetime. Lifetime sum of autonomy.

While there seems to be a valid argument for overriding an individual’s present right to autonomy in order to protect their future right to autonomy, it adheres to a self-refuting idea of autonomy. What is the point of being recognised as an autonomous person if, when it really matters (e.g. in life or death situations), some authority is going to restrict my right to be autonomous? I would not actually be autonomous then. Furthermore, if we were to accept this counterpoint, we would also have to accept that autonomy is an empty value.

In this paper, I have argued that it was morally wrong for a doctor to intentionally deceive their patient even if it means improving that patient’s prognosis.

Introduction:

Autonomy is a Greek word which autos- mean (self) and nomos means (rule of law) (Merriam-webster, 2019). The Piagetian view defines autonomy in moral is a right or wrong decision making (Raya, 2007). In general, it is means self-determination or self-rule. However, professional is related to the profession which means work with potential (Walter, and Lopez, 2008). Broadly, professional autonomy means autonomy principles application whereby professional people serve independently to make a decision by using their knowledge and experience (Csp.org.uk, 2011).

Word professional autonomy appeared in Madrid in October 1987 by World Medical Association WMA when professional autonomy and self-regulation pick out some basic principles during 39th World Medication Association held in Madrid, Spain (Med.or.jp, 2019).

In fact, clinically use professional autonomy while practicing with patients and they define it as when a physician’s employ his ethical and moral standers to provide all the best to the patients (Stoddard, 2001).

Many of professions in whole word hospitals use term professional autonomy such as physicians, nurses, physiotherapists and more.

Professional autonomy is an issue has impacts on physiotherapists, patients, and the profession. Furthermore, this report includes the professional autonomy evidence in issue impact and analyses it.

Body:

In clinical situations significantly decision making depended on the trust between patients and their medical staff. In multiple hospitals, patients have the confidence to the doctors, other professions and their families to make a decision in their health state. In Korea, 42.4% of patients give medical staff and their families a responsibility in decision-making. However, 21.7% of Korean patient make a decision on their own (Mo, 2012). Maybe those patients who did not give the green light to others to make a decision have no trust of others or have enough knowledge to decide on their health care. Another view, in some hospitals patients decision almost depended on doctors due to lack of patients’ right on information and knowledge, neglect of taking permission to do daily exercises, staffs not listen to patient complain clearly or some staff do not respect patients’ privacy and make a noise in the round while patients sleep. All of that affects inpatient decisions and choose their treatment and patient feels valueless (Ebrahimi et al. 2016).

Professional autonomy issue has an impact on physiotherapists, patients, and professions. First of all, professional autonomy has a clear picture effect with patients. Kleffens et al. said that medical information about the patient’s health state and treatment choices are the basics of patient’s autonomy. There are internal and external factors effects on patients in the decision making process. Often patients’ knowledge and awareness such as self-understanding, perception of care, desire in decision making, and patients’ belief in decision making as internal factors to patients. On the other hand, the external factors that affect patients’ autonomy are medical staff like doctors, nurses, physiotherapists, and others. Moreover, patient’s families, social environment consider as external factors. Whereas in a qualitative study done by Rahmani et al. found significant statistics of patients autonomy connected with an understanding of their health state and medical staff needs. Also, Proot et al. study showed that the patient’s family and health care provider has a big role in the decision making process with patients. Those two studies prove the importance of factors which affect in patient’s autonomy. In the opposite side, Cullati et al.’s study in Switzerland in 2010 show up that increasing in autonomy rate with people who live alone. This study proves the opposite of two previous studies mentioned which those patients who living alone did not have information and life experiences. Negative society and the patient’s body and mind always affect negatively in patient decisions.

The second thing which as how professional autonomy affect the profession? The duration between 2001-2004 Gellatly et al. found there is affirmative effects appear with professional autonomy in the workplace which an increase in job performance and outcomes. In general, some organizations give the employees a chance to choose their schedule. Also, other organizations allow employees to select their job. Those employees have the ability to overlap any job stress by organizing their work and arrive at job satisfaction. In addition, when the employees apply a good professional autonomy and order his or her job correctly, they easily can manage their responsibility and that will affect inappropriate way their effectiveness and behavior reaction. Cohrs et al. (2006) were checked the relationship between using professional autonomy and job satisfaction, the result found the positive association (Saragih, 2015). Furthermore, the trust in the organization increases the productivity of work and the responsibility of work will improve with the organization’ employees, but an observation must be present there to control and monitor the work and increase the professional autonomy Gur and Bjornskov in 2016; Van Hoorn in 2017 said that (Hoorn, 2018). The professional autonomy with increases of job performs, satisfaction and the trust on the profession is effect and studies were mentioned above proved that.

The third and the final point are the professional autonomy issue impacts on physiotherapists. The nature of physiotherapists work is direct with patients. They assess, diagnose and provide appropriate treatment and rehabilitation sessions by teaching the patient suitable exercises related to their diagnosis. In Sweden, the patient can meet the physio staff without referral even in public sectors. In fact, Swedish physiotherapists have high independent that is mean they have an ability to deal with patients without physicians referrals (Dannapfel et al., 2013). The professional autonomy has a good influence on physio which increases confidence and motivation. In addition, when physiotherapists apply autonomy, they may learn and gain new skills which that improve his or her knowledge and experiences. The World Confederation for Physical Therapy (WCPT) supported that professional autonomy gives physiotherapy staff freedom to practice and decision making to patients, which that will lead to develop and promote the knowledge and practice (Wcpt.org, 2019).

Finally, experimental results showed that professional autonomy has a great work effect on the patient, physiotherapist, and general professions. Preliminary experiments with patients lead them to get a good result while they make a decision with others such as health care providers, families, and friends opposite to who decide alone. However, should the health care provider notify the patient the risk and the benefits of their health state which to allow them to decide correctly and avoid any risks. That is means; in some cases, the patient state may harm others. Also, maybe patient state needs to other resources of the money to treat them. For that, some physicians in the world advise patient to discuss their condition with others and ask for help from them (Zolkefli, 2017). As a result of that, Lord Diplock announced that “it is my right to decide whether any particular thing is done to my body, and I want to be fully informed of any risks there may be” (Coggon, and Miola, 2011).

In the other hand, clearly indicated the profession impacts positive points. Which as should give the employees a chance to organize their work and schedule to practice their work with confidence and trust. In addition, managers and employees must build a good relationship. Furthermore, in the clinical situation should the health care provider like a doctor, physio and nurses make a good relationship with patients. Further research is recommended to determine the maximum achievable enhancement from the ministry of health to use professional autonomy in all hospitals because it has good impacts.

Conclusion:

This report summarizes the professional autonomy impacts on patients first, then on the profession and at the end the impacts on physiotherapists.

One study done in Iranian hospitals proved that younger patients, patients who freelance and in-depended lifestyle, patients who had previous in hospitalizations, and patients with high education had a good autonomy and decision making.

In these cases, patients’ decisions and health state depended on patients’ environments support like families and friends. Whereas, Dooley and Swords study showed and proved that family has a significant influence on patients (Ebrahimi et al. 2016).

On the other hand, professional autonomy has great work and influence on the profession itself which improve the outcome of the job and job productivity.

However, physiotherapists who use professional autonomy have an ability to improve their skills, knowledge, and experiences.

In the end, the application of professional autonomy on patients, physiotherapists, and any other profession lead to increase the communication skills and promote the confidence between the staff and their patients. In addition, increase in other values between the manager and their employees (Murray et al., 2018).

A fundamental debate in the field of medical ethics and English medical law has been finding the right balance between the principles of medical paternalism and patient autonomy. While there are commonly used definitions of medical paternalism, such as “treating of others in their best interests, regardless of their own view of what their best interests are”, as well as a wider societal consensus that it generally refers to the idea of ‘doctor knows best’, there is less agreement on the definitions of patient autonomy. There are, however, a common aspect between current definitions all define autonomy with respect to distinct characteristics, such as “being free from external influence, able to decide given sufficient information, and possessed of the capacity to reason”. Despite the lack of a clear definition, it has not hindered the societal move to recognise the primacy of autonomy over paternalism, as recognised by Steyn LJ in the landmark case of Chester v Afshar, where he noted that “In modern law medical paternalism no longer rules”. However, this essay posits that current arguments around the subject are only valid when simply considering autonomy as the combination of discrete elements, which despite raising undoubtedly valid arguments, is fundamentally based on a limited view of autonomy that can be expanded. This expansion relies on the interaction between an internal perspective regarding the individual’s ability to make decisions, and an external perspective concerning the degree that the individual can exercise that decision. Analysing medical law trends under this expanded two-part model shows that the current law has only focused on promoting the internal perspective, which implies that the pendulum has not only not ‘swung too far’, but arguably has not swung far enough in promoting an expanded, holistic and complete view of patient autonomy.

Contemporary debates around the issues between paternalism and autonomy have rested on modelling autonomy as the combination and interactions between discrete elements or identifiable characteristics, such as in the definition proposed by Smith et al mentioned earlier. While contemporary debates based around the element-based model of autonomy have resulted in valid arguments that carry significant weight in the current discourse around paternalism and autonomy, as propounded by influential academics like Onora O’Neill, academics such as John Coggan have advanced an argument that the debate may have been too narrow in focus, and as a result has failed to promote a holistic model of patient autonomy that truly respects the underlying principles behind autonomy, such as human rights – for example Art 8 of the European Convention on Human Rights which emphasises the right to respect private and family life. A guiding principle for drawing a new model of autonomy that can possibly address such critique relies on the distinction found in Isaiah Berlin’s concepts of two forms of autonomy: a ‘positive’ form which concerns a desire to “be moved by reasons, by conscious purposes, which are my own, not by causes which affect me, as it were, from outside”, and a ‘negative’ form which concerns “the degree to which no man or body of men interferes with my activity”. Extrapolating these two forms of autonomy into current views of patient autonomy, the ‘positive’ form of autonomy can be seen as a broad concept that is closely related to the current characteristic-based conceptions of patient autonomy, with clear parallels to the characteristic of reaching decisions “free of external influences”. Meanwhile, the ‘negative’ form of autonomy would add a new aspect to current views of patient autonomy – the degree to which patients are able to exercise their decisions, without restrictions placed by medical guidelines or laws. As Coggan argues, the importance of this new aspect arises from the fact that “to respect the value of autonomous agents, we must permit people to act freely, not merely to reason freely”. It should be apparent that in a vacuum, simply being able to make a decision about one’s body and health does not by itself translate into any outcome, as a decision is simply a justification to undertake a particular medical action. Therefore, without the ability to translate decisions to corresponding real-world medical actions, it cannot be said that the patient’s holistic autonomy, as a combination of the adapted ‘positive’ and ‘negative’ forms of autonomy, were meaningfully respected. As a natural result, should English medical law be deemed to have failed to create holistic advances under this broader, extended definition of autonomy, it can only reasonably be argued that the ‘pendulum’ has failed to swing too far, instead there are more steps needed to ensure the law moves closer towards achieving the right balance.

The disconnect between the two forms of autonomy, which Coggan rephrased as “autonomy relates to free will… and liberty relates to freedom to act without the interference of a third party”, where ‘autonomy’ referring to the internal perspective and ‘liberty’ referring to the external perspective, became apparent in the case of Pretty v UK. In this case, the ‘autonomy’ aspect was clearly present as Mrs. Pretty was by all measures mentally competent to reach the decision that she wanted to end her life with what she considered was dignity as a result of her painful and tragic battle against motor neurone disease. However, she lacked the ‘liberty’ to translate her decision into medical action as she was both unable to commit suicide herself due to not having control of her muscles, while the law also prevented her husband from assisting her suicide as that was illegal. This is not to comment on the merits of the decision or that that both concepts must be given equal weight, but merely serves as an illustration of how the two concepts can come into conflict with another, thus forcing the courts and the law to promote only the that they deem more important to uphold in their relevant social environments.

Through this lens, the developments of English medical law have shown that it has predominantly chosen to uphold ‘autonomy’ over ‘liberty’, actively and continually promoting discussion on methods of identifying and measuring when the decisions of patients are legally recognised, with very little discussion engaging with the premise of how to also promote legally recognised decisions being exercised and translated into medical actions. This view is emphasised strongly through judicial judgments such as Lord Donaldson’s well-known dicta in Re T:

“An adult patient who…suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment… This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.”

However, taking such an uncompromising position on the importance of autonomy creates the risk that English medical law “reflects a view that sees autonomy as isolational independence. However… autonomy is meaningless in the absence of a social context”. Such a view would suffer the established issues of viewing patient autonomy simply as a vacuum within the confines of the internal perspective of the extended model, and would not promote a holistic and balanced approach that tackles not just individual decisions and mental capacities, but also the wider ‘social context’ of any decisions applications and ramifications in the real world. The current leading laws, such as the Mental Capacity Act 2005, have continued this trend by continuing to promote and a view of patient autonomy defined purely by the internal perspective of how patients reach a decision and whether their decision is legally recognised, as shown by section 4 of the Act referencing various factors which are very personal (such as “the person’s past and present wishes and feelings”) but do not engage with how the law should aim to strike a balance of giving patients the right to translate their decisions into medical actions that do not infringe upon the rights of others, as shown in cases like Pretty. Similarly, Montgomery also helped develop patient autonomy by promoting informational symmetry through considering the patient’s internal perspective, relying on phrases such as the “reasonable person in the patient’s position”. While it aimed to tackle a prevalent and legitimate issue regarding the standards for disseminating information, it did not touch on the external perspective of whether the information needs to be understood by the patient. This creates the problem that Maclean described as a system that “prejudices the vulnerable and less well-educated without providing any significant additional protection for the more capable”. However, attempts to actively engage in the external perspective of patient autonomy is made harder by institutional factors inherent in the English conception of law, since discussions around ‘liberty’ requires legitimate limits to ensure that one’s decisions does not negatively influence the ability for others to decide and act within their rights, emphasising the importance of the ‘social context’, with Coggan going on to add that ‘liberty’ would “work from a presumption that people should be free to act autonomously provided they do not breach well grounded external laws”. Nonetheless, the overall focus on ‘autonomy’, regardless of it merely being a part of a wider, extended view of patient autonomy propounded by this essay, has still tangibly resulted in English medical law promoting the principle of patient autonomy over medical paternalism. However, under the proposed extended model of patient autonomy, the current law has not developed to the extent where one can convincingly argue that patient autonomy has been promoted sufficiently or holistically.

In concluding, it is important to first emphasise that the thesis presented in this essay did not intend to detract from the strength or validity of any established arguments on the debates and issues surrounding medical paternalism and patient autonomy in any way. Instead, it aimed to offer a justification for expanding our currently accepted definitions of autonomy from beyond a mere focus on an internal perspective of the individual’s capability to reach decisions, to include a new external perspective of the individual’s ability to translate decisions to corresponding real-world medical actions. Under this expanded model of autonomy, of which existing definitions of patient autonomy forms one part of a bigger whole, it becomes apparent that English medical law has indeed shifted towards autonomy, but only in a limited sense that does not truly respect the wider values of an “autonomous agent”, i.e. merely focusing on the internal perspective of decision-making. Without English medical law engaging in more meaningful and nuanced discussions on the external perspective of translating decisions into actions, it cannot be argued that the pendulum has ‘swung too far’ towards true patient autonomy. Instead, it is only reasonable to conclude that the pendulum has swung in the right direction, but the magnitude of the swing has, to date, been insufficient in promoting and ensuring a holistic and complete model of patient autonomy that fully respects the underlying values behind autonomy.

Selling sexual service is morally worse than selling massages as the prostitute (1) damages bodily integrity by treating her body as a commodity (2) damages sexual autonomy by relinquishing her body sovereignty, and (3) reinforces discriminatory beliefs of female sexuality. Selling massages, on the other hand, (1) does not involve objectification of the female body, (2) does not involve surrendering of body sovereignty, and (3) has significant less effect in reinforcing sexist beliefs.

This essay will only discuss the case of female prostitutes and female masseuses with male customers.

By definition of prostitution (the exchange of sexual acts for money), some cases of sugar babies could be counted as prostitution if sex is the primary aim. It is a more selective form of prostitution where the prostitute has greater control over whom she has sex with. Prostitution involving sugar daddy still damages bodily integrity, but damages sexual autonomy and reinforces discriminatory beliefs to smaller extents than traditional prostitution practices. It is still morally worse than selling massage, but due to word limit, this essay will focus on the traditional prostitution industry.

Selling mere services vs (selling services + a lease of a commodity)

First, I would like to draw a distinction between selling mere services and selling a service that inextricably tied with a short “lease” of a commodity under certain conditions.

When a masseuse sells the massage, the customer is not allowed to use, i.e., touch, squeeze, kiss, etc, the masseuse’s hands. The customer is thus only buying the service without the “lease” the masseuse’s hand.

The selling of sexual service generally comes with the “lease” of the prostitute’s body. The customer is allowed to use—i.e., to touch and penetrate the prostitute’s body. The lease of course comes with some conditions that limit the degree of violence that could be used. I don’t think any selling of sex can be severed from the “lease”. Practically speaking, few will pay

The masseuse is selling the massage, while the prostitute is selling the sex and renting her body temporarily.

By “renting” one’s body for use, the prostitute is treating her body as a commodity, and relinquishing the sovereign of her body. In comparison, a masseuse does not treat her hands as a commodity, still retains her body sovereignty.

Treating one’s body as a commodity damages the body integrity. And the relinquishment of one’s body sovereignty, even partially, undermines her sexual autonomy, thus making prostitution morally worse than selling massage. I will explore the definition of sexual autonomy later.

Counter-arguments

Defenders of prostitution argue that choosing to sell sexual service is a form of expression of their sexuality and thus should be supported as it enhances sexual autonomy (Nussbaum 1999, p288), and that since it is the prostitute’s own choice to sell sexual service, her sexual autonomy remains intact (Schwarzenbach, 1990–1991, p123). I will address these arguments step by step. In order to offer the strongest arguments, I will focus on cases where prostitutes enter the contract voluntarily.

Sexual Autonomy: the dispute in its definition

With regard to the defense that an exercise of free will to enter into the prostitution contract is an enhancement of autonomy, I agree with Gauthier that while the willingness to exchange sexual self-governance for economic benefits may be an exercise of economic autonomy, this is damaging to one’s sexual autonomy (Gauthier, 2011).

Gauthier noted the disagreement on the relationship of sexual autonomy and prostitution can be attributed to the disagreement on the definition of sexual autonomy (Gauthier, 2011). The different definitions (as explained later) reflect the different valuation of female sexual satisfaction in sexual acts. This is crucial as the moral difference between selling prostitution and massages depends on how much moral weight sexual autonomy carries in that definition.

A broad definition assumed by writers such as St. James, Richards, and Schulhofer is that if the sexual acts are “self-determined”, i.e., originated in some desire of the agent performing them, they can be said to be sexually autonomous. In this case, a desire for economic gain suffices to make prostitution in line with sexual autonomy. On this account, the line between economic autonomy and sexual autonomy is blurred, if not non-existent, since the presence of any desire would render an act sexually autonomous. This corresponds with the view that autonomy is normatively content-neutral, thus one can still be autonomous when she agrees to be a slave (Friedman, 2003). This conception of autonomy is rivalled by another account which holds that one must value autonomy in order to be truly autonomous (Oshana, 2003). For the sake of this discussion, I will not go in depth into this dispute.

On the other hand, a narrower definition adopted by Elizabeth Anderson and Scott Anderson states that an act qualifies as sexually autonomous only if it is sexually self-expressive, engaging the sexual desire of the agent (Anderson, 2002, p763). By this definition, the signing of contractual agreement to satisfy another’s sexual desire at the expense of one’s own sexual desires in exchange for a non-sexual good is not sexually autonomous (Morgan, 1987, p26). And the sexual autonomy is distinctively separated from economic autonomy by engaging the element of sexual desire. On this definition, in cases where the purpose of marriage primarily is to secure the exclusive access to sex provided by the wife, and where the wives are not sexually satisfied but keeping serving their husband sexually in exchange for financial security, they could be labelled as not sexually autonomous. But I think most marriages cannot be reduced to a means to exchange sex for money as much more factors such as family, reputation, emotional bond, etc, are entangled.

The difference in definitions highlights the different perceptions of the value of female sexual satisfaction in sexual autonomy: The broad definition places little importance on it as female sexual satisfaction could be left out of the equation of sexual autonomy; while in the narrower definition it is vital. I will use the narrower definition as it is morally significant to put female sexual satisfaction in the image of female agency, the reasons of which I will explain later.

Is Prostitution self-expression of sexuality?

Even in ideal situations where prostitution is entirely voluntary, it is far from a self-expression of sexuality that demonstrates sexual autonomy in my opinion.

As observed by Elizabeth Anderson, the prostitution’s actions governed under the voluntarily-signed prostitution contract express not the prostitute’s own valuations but the will of her customers (Anderson, 1993, p156). She has little say in how she wants to have sex, whom she wants to have sex to, and she has to do it even if she finds the customer repulsive. Even if the prostitute may not generally represent sexual submission to men, the contract to have sex with someone for whom she has no sexual desire conflates women’s sexual freedom with being a willing object of male desire” (Gauthier, 2011). Identifying the subjection of oneself to conditions where one’s own desires could be rightfully ignored with free sexual expression is harmful (which will be explained later).

One may argue that the masseuse’s contract is similar in the sense that both involve the surrendering of some freedom, as explained earlier, the extent and nature of exploitation differ immensely in terms of mere service and service that involves the violation of bodily integrity and sexual autonomy.

Female sexual desires in images of female sexuality⸺How morally important is it?

As argued earlier, prostitution is not a free self-expression of sexuality as the prostitutes become mere object of male desires. To portrait prostitution as a display of sexual freedom advances the notorious “false representation of female sexual agency”, where the sexualization of women is disconnected with actual female sexual pleasure (Gauthier, 2011).

Such false representation resembles the historical and modern regional cultural erasure of female sexual pleasure in the images of female sexuality. Such disconnection is damaging. Researches show that young women’s disregard for their own sexual satisfaction in heterosexual relationships is correlated with their reluctance to frame sexual violence as rape or sexual assault (Tolman 2002, p6). Because they take their sexual role as to satisfy male partner rather than themselves, sexual transgressions are more likely to be deemed as “bad sex or sex gone awry “rather than sexual violence. Thus, false representation of female agency reinforces discriminatory sexist beliefs about female sexuality which is harmful to females.

Even when outsiders stop defending prostitution as a display of freedom, the prostitute’s decision to sell sexual services voluntarily, when they have alternatives to make money, could reinforces the discriminatory beliefs, which in my opinion is part of the reasons why prostitution is stigmatized.

Summary

In light of the importance of putting female sexual satisfaction in the image of female sexuality, the narrower definition of sexual autonomy is more appropriate. Prostitution is morally worse than selling massages as it (1) damage bodily integrity by treating her body as a commodity (2) damages sexual autonomy by relinquishing her body sovereignty, and (3) reinforces discriminatory beliefs of female sexuality