Vulnerability, exploitation and autonomy

Bioethicists who seek to defend commercial transactions that intuitively seem exploitative, such as organ sales and commercial surrogacy, typically pair a liberal analysis of exploitation with a libertarian analysis of autonomy. In this paper, I argue that the liberal analysis of exploitation, which focuses primarily on two party transactions between individuals, occludes the structural dimensions of exploitation. This occlusion then paves the way for the transaction to be understood in terms of libertarian autonomy. I propose that a vulnerability analysis paired with a multidimensional and relational theory of autonomy highlights the structural dimensions of exploitation and exposes the myth-making that underlies claims that these forms of exploitation are autonomy-enhancing.