Abstract

People with disabilities often report enjoying a much higher quality of life than people without disabilities would expect. For instance, many people believe that their lives would be much worse if they were to become paraplegic. Indeed, some people believe that life with paraplegia would be barely worth living. Yet many paraplegics report being roughly as happy as able-bodied people. This conflict in attitudes has come to be known as “the disability paradox.” Many psychologists claim that the disability paradox is at least partly explained by affective forecasting errors. Someone makes an affective forecasting error when she makes a mistaken prediction about the effect of some event on her experiential quality of life. Such affective forecasting errors raise moral problems that are especially pressing in the context of medical decision-making. For instance, when a recommended treatment would leave someone disabled, she may refuse on the grounds that she would rather live a shorter life without the disability than a longer life with the disability. Yet it may be that she would feel very differently after adapting to the condition in question. What should we say about such cases? On the one hand, some ethicists have argued that affective forecasting errors compromise autonomy, so that decision-makers should take account of the likelihood that they will adapt. On the other, it may appear that decision-makers should have no regard for adaptive preferences they may form in the future. My central goal in this paper is to argue that both of these views are mistaken. If sound, my arguments suggest that legitimate moral concerns about a subject’s well-being are sometimes misrepresented as concerns about her autonomy.