ABSTRACTThis article will examine the claim that personal autonomy is impaired by a paradigmatic instance of serious psychopathology – namely, the condition of being delusional – in light of the hierarchical conception of personal autonomy. This conception of personal autonomy aims at yielding value‐neutral judgements about freedom and self‐governance. I will argue that when viewed from the perspective of this specific conception of autonomy, delusions do not necessarily impair an agent's personal autonomy. In order to establish this claim, I will probe the general idea that delusional subjects are beset by a mental disease that is rationally incapacitating, to which the hierarchical theorist might appeal. I argue that, understood within the parameters set by the commitment to value neutrality, this idea fails to provide support for the claim that delusion necessarily impairs personal autonomy. One contribution this article makes to the effort of understanding how delusion impairs personal autonomy is to help us pinpoint the ways in which our value commitments inform our judgements of impaired personal autonomy in delusional agents.