Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous decision-making process? Why make the distinction? Examples are drawn (...) from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed. (shrink)

Since John Locke, regnant conceptions of personhood in Western philosophy have focused on individual capabilities for complex forms of consciousness that involve cognition such as the capability to remember past events and one’s own past actions, to think about and identify oneself as oneself, and/or to reason. Conceptions of personhood such as Locke's qualify as cognition-oriented, and they often fail to acknowledge the role of embodiment for personhood. This article offers an alternative conception of personhood from within the tradition of (...) phenomenology of the body. The article presents a phenomenological analysis of joint musical activity in dementia care and outlines an intercorporeal conception of personhood based on this analysis. It also provides a philosophical basis for the idea that others can hold us in personhood, and it questions a strict one-body-one-person logic that has pertained in much personhood debate. (shrink)

Some have claimed that moral bioenhancement undermines freedom and authenticity – thereby making moral bioenhancement problematic or undesirable – whereas others have said that moral bioenhancement does not undermine freedom and authenticity – thereby salvaging its ethical permissibility. These debates are characterized by a couple of features. First, a positive relationship is assumed to hold between these agency-related concepts and the ethical permissibility of moral bioenhancement. Second, these debates are centered around individualistic conceptions of agency, like free choice and authenticity, (...) which hail from an atomistic tradition of autonomy. My view is that emphasizing individualistic conceptions of autonomy do not provide particularly strong foundations on which to argue about the issue of the permissibility of moral bioenhancement. This is because individualistic autonomy is not the kind of agency-related consideration we ought to value. Instead, I propose that we investigate the relationship between moral bioenhancement and a more relational kind of autonomy. Focusing on this latter relationship, on my view, clarifies the potential for moral bioenhancement to support or enhance people’s autonomy. (shrink)

‘Undermatched’ is the name education researchers have given to the surprisingly large number of students who attend post-secondary institutions which are less selective than their academic credentials would permit, or who simply fail to even apply for college when they are qualified to do so. At first, this might seem like an obviously bad trend, especially as rates of undermatching are much higher among students from low-income backgrounds. This article argues, however, that individual cases of undermatching are sometimes morally acceptable (...) when the choice is made autonomously. Some readers will have trouble calling this situation just, as it is one in which a disadvantaged person has decided on a course of action which will likely perpetuate this disadvantage. To address this, the article considers alternate ways in which we might distinguish between autonomous and non-autonomous choices in undermatching cases. The article concludes with some indications about how this analysis should affect future theory and policy intended to protect against unjust undermatching. (shrink)

This paper gives a new and richer account of open-mindedness as a moral virtue. I argue that the main problem with existing accounts is that they derive the moral value of open-mindedness entirely from the epistemic role it plays in moral thought. This view is overly intellectualist. I argue that open-mindedness as a moral virtue promotes our flourishing alongside others in ways that are quite independent of its role in correcting our beliefs. I close my discussion by distinguishing open-mindedness from (...) what some might consider its equivalent: empathy and tolerance. (shrink)

Ethnic minority status and female gender convey a risk for suicidal behavior, yet research of suicidality of ethnic minority female immigrants is scarce. The authors of this article conducted qualitative interviews with 15 young women in the Netherlands, who either had attempted suicide or contemplated suicide, and analyzed these in a narrative psychology tradition. Suicidality was associated with despair and frustration over the violation of the women’s personal autonomy and self-integrity regarding strategic life choices. Autonomy restrictions and violations followed two (...) patterns, which are interconnected with four criteria regarding the capacity for autonomy. Findings are discussed with referral to Durkheim and feminist theories of autonomy. (shrink)

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to (...) serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation. (shrink)

Many digital technologies, designed and controlled by intensive data-driven corporate platforms, have become ubiquitous for many of our daily activities. This has raised political and ethical concerns over how they might be threatening our personal autonomy. However, not much philosophical attention has been paid to the specific role that their hyper-designed (sensorimotor) interfaces play in this regard. In this paper, we aim to offer a novel framework that can ground personal autonomy on sensorimotor interaction and, from there, directly address how (...) technological design affects personal autonomy. To do this, we will draw from enactive sensorimotor approaches to cognition, focusing on the central notion of habits, understood as sensorimotor schemes that, in networked relations, give rise to sensorimotor agency. Starting from sensorimotor agency as a basis for more complex forms of personal autonomy, our approach gives us grounds to analyse our relationship with technology (in general) and to distinguish between autonomy-enhancing and autonomy-diminishing technologies. We argue that, by favouring/obstructing the enactment of certain (networks of) habits over others, technologies can directly act upon our personal autonomy, locally and globally. With this in mind, we then discuss how current digital technologies are often being designed to be autonomy-diminishing (as is the case of “dark patterns” in design), and sketch some ideas on how to build more autonomy-enhancing digital technologies. (shrink)

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of informed consent (...) from the perspective of ethics of care which is here called relational autonomy-in-informed consent. Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism. (shrink)

It has been recommended that parents should monitor their children’s Internet use, including what sites their children visit, what messages they receive, and what they post. In this paper, I claim that parents ought not to follow this advice, because to do so would violate children’s right to privacy over their on-line information exchanges. In defense of this claim, I argue that children have a right to privacy from their parents, because such a right respects their current capacities and fosters (...) their future capacities for autonomy and relationships. (shrink)

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to date. I critically (...) review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates. (shrink)

Ascribing autonomous status to agents is a valuable practice. As such, we ought to care about how we engage in practices of autonomy ascription. However, disagreement between first-personal experiences of an agent's autonomy and third-personal determinations of their autonomy presents challenges of ethical and epistemic concern. My view is that insights from a dialogical rather than nondialogical account of autonomy give us the resources to combat the challenges associated with autonomy ascription. I draw on Andrea Westlund's account of dialogical autonomy—on (...) which autonomy requires a dialogical disposition to hold oneself answerable to external critical perspectives—to make my case. (shrink)

Two key themes structure the work of French philosopher of science Gilbert Simondon: the processes of individuation and the nature of technical objects. Moreover, these two themes are also at the heart of contemporary debates within Ethics and Bioethics. Indeed, the question of the individual is a key concern in both Virtue Ethics and Feminist Ethics of Care, while the hyper-technical reality of the present stage of medical technology is a key reason for both the urgency for and the success (...) of the field of Bioethics. And yet, despite its potential for thinking about these issues, Simondon’s philosophy remains largely unknown. Rather than exploring Simondon’s complex ontology for itself, the aim of this paper is to establish what contribution his work can make in Ethics and Bioethics on two essential questions: the relational structure of the self and the nature of the human-technology relation. I argue that Simondon’s re-conceptualization of the individual harmonizes with perspectives in Feminist Bioethics and points toward what I call an “open” Virtue Ethics that takes relations to be essential. In order to establish this connection, I explore at length the relational approach to Feminist Bioethics offered by Susan Sherwin’s work. I argue that a Simondonian account of technology and of the individual furthers the relational understanding of the self, offers a characterization of Virtue Ethics that is in harmony with the Ethics of Care, and clarifies a notion of responsibility that is implicated in the complex reality of the modern technological milieu. (shrink)

As in other areas of medical practice, relatives accompany patients to genetic consultations. However, unlike in other areas, the consultations may be relevant to the relatives’ health because they may be at risk of developing the same genetic condition as the patient. The presence of relatives in genetic consultation may affect the decision‐making process and it raises questions about the perception of patient autonomy and the way it is practiced in genetics. However, these issues have not been examined in previous (...) empirical studies. This article aims to fill this gap by reporting findings from a qualitative study with clinicians working in the area of inherited breast cancer. The findings indicate that family presence has an impact on the patient's decisions to undergo genetic testing and preventative operations when she is diagnosed as a carrier. The findings further indicate that, unlike in other areas of medical practice, blood relatives who are present in consultations are perceived by clinicians as patients or potential patients, and this in turn increases their involvement in discussions in the consultation room. Finally, the findings indicate that in genetics, a relational approach to autonomy is applied. Decisions are made in a social context, where the relatives’ views are heard and taken into account. The findings suggest that the conventional bioethical approach to autonomy, which perceives the decision‐making unit as comprising a clinician and an individual patient, is challenged in genetics. The findings thus suggest that bioethicists, lawyers and policy‐makers should consider whether this individualistic approach is still valid and applicable. (shrink)

Despite extensive theoretical debate, concrete efforts to overcome paternalism and unbalanced power relations between patients and doctors have produced limited results. In this article, I examine...

Abstract This paper examines a convergence between Heidegger's reconceptualization of subjectivity and intersubjectivity and some recent work in feminist philosophy on relational autonomy. Both view the concept of autonomy to be misguided, given that our capacity to be self-directed is dependent upon our ability to enter into and sustain meaningful relationships. Both attempt to overturn the notion of a subject as an isolated, atomistic individual and to show that selfhood requires, and is based upon, one's relation to and dependence upon (...) others. The paper argues that Heidegger's notion of authentic Mitsein (being-with) rejects traditional notions of autonomy and subjectivity in favor of a relational model of selfhood. Ultimately, it provides a new point of entry into contemporary debates within feminist philosophy on Heidegger's thinking and defends Heidegger from certain feminist critiques. (shrink)

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, (...) the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities. (shrink)

This paper argues that environmental virtue ethics requires the adoption of an ethical ideal in order to guide the identification and practice of virtues. I recommend friendship as one such ideal due to emphasis such an ideal places upon the quality of the relationship with nature rather than the evaluation of individual actions. After describing the value of friendship as an ethical ideal, I respond to some of the objections that have been raised against it in the context of environmental (...) virtue. (shrink)

This article develops a model of informed consent for fresh oöcyte donation for stem cell research, during in vitro fertilisation (IVF), by building on the importance of patients’ embodied experience. Informed consent typically focuses on the disclosure of material information. Yet this approach does not incorporate the embodied knowledge that patients acquire through lived experience. Drawing on interview data from 35 patients and health professionals in an IVF clinic in Australia, our study demonstrates the uncertainty of IVF treatment, and the (...) tendency for patients to overestimate their chances of success prior to the experience of treatment. Once in active treatment, however, patients identify their oöcytes as both precious and precarious. We argue that it is necessary to formally include embodied experience as a source of knowledge in informed consent procedures, both for gratuitous donation and for egg-sharing regimes. We recommend that at least one full cycle of IVF be completed before approaching women to divert eggs away from their own fertility treatment. (shrink)

How can black feminist and women of color feminist theoretical interventions help create frameworks for discerning agentic action in the context of power, oppression, and violence? In this paper, I explore the social dimension of agency and argue that intention is not just authored by the agent as a function of practical reasoning, but is also socially authored through others' discernment and translation of her action. Further, when facilitated by reasoning designed to reinforce and rationalize systems of domination, social authoring (...) systematically distorts the intentions of some agents. Although some theorists have argued that those agents whose intentions are not recognized by others are forced to exercise a diminished agency, I contend that this account obscures agency that is practiced despite or through conditions of oppression. As an alternative, I propose that feminist of color theory that examines the structural and existential erasures of women of color maps a conceptual space to help us better discern agentic action that is practiced by those subjects whose acts are defined away from them. (shrink)

Some philosophers object that Kant's respect cannot express mutual recognition because it is an attitude owed to persons in virtue of an abstract notion of autonomy and invite us to integrate the vocabulary of respect with other persons-concepts or to replace it with a social conception of recognition. This paper argues for a dialogical interpretation of respect as the key-mode of recognition of membership in the moral community. This interpretation highlights the relational and practical nature of respect, and accounts for (...) its governing role over other persons-regarding concepts. (shrink)

It has been argued - most prominently in Harry Frankfurt's recent work - that the normative authority of personal commitments derives not from their intrinsic worth but from the way in which one's will is invested in what one cares about. In this essay, I argue that even if this approach is construed broadly and supplemented in various ways, its intrasubjective character leaves it ill-prepared to explain the normative grip of commitments in cases of purported self-betrayal. As an alternative, I (...) sketch a view that focuses on intersubjective constraints of intelligibility built into social practices and on the pragmatics of how those norms are contested in an ongoing fashion. (shrink)

This article asks how people come to interpret themselves and others as autonomous given their multiple dependencies. We draw on a cross-case comparison of ethnographic studies with two populations for whom autonomy is both central and problematic: elderly patients in post-acute care, and young adults with disabilities in an independent living program. Analyzing the institutional efforts to make their clients “as independent as possible,” we find that staff members at each organization formulate autonomy as a temporal project through an ongoing (...) calibration of open futures, ideal pasts, and situational competence. Constantly adjusting and fine-tuning where in time autonomy “really” is, workers arrange present dependence so that the contours of the future remain open for their clients. In other words, they make use of temporal markers to produce recognizable autonomous subjects whose dependencies are momentary. Theorizing this temporal project enables us to see more clearly how all of us engage in the constant business of “doing” autonomy, and to better understand the role of institutions in producing autonomous selves. (shrink)

In this project, I argue that the conventional view of personal autonomy that is operational in contemporary American culture, bioethics and medical practice places undue emphasis on individualism and a limited range of personal qualities and attributes (such as self-sufficiency). Instead, I argue in favor of a relational approach to autonomy which recognizes that each person that exists has certain minimal connections or relations to others, and these connections/relations are identity-forming. Unfortunately, current medical practices have tended to overemphasize individuality and (...) choice (consistent with the conventional view) while minimizing or excluding these relational aspects. As a result, informed consent and patient choice have taken the place of a more robust, relational sense of autonomy in these contexts. But this approach fails to appreciate the ways that illness, uncertainty, and suffering may threaten identity and make it more difficult to meaningfully exercise autonomy—especially when construed in such narrow terms. Through an exploration of the nature of suffering and its effects on the person, I argue that to effectively treat ailments and alleviate suffering, patients must be cared for in ways that respect and restore identity, which also promotes autonomy. This kind of respect derives in part from acknowledging and nurturing relationality, especially in medical decision-making contexts. (shrink)

In political philosophy, the concept of autonomy is often associated with liberalism: it serves as a justification for the liberal values of state neutrality and value pluralism, and seems coherent with the liberal definition of freedom as the absence of interference. Neo-republicans have pointed out that freedom as non-interference fails to acknowledge the fact that one may be unfree while non-interfered with, while on the other hand, not all forms of interference are freedom-limiting. They have proposed to replace the concept (...) by freedom as non-domination, which they define as the absence of actual or possible arbitrary interference. Although their definition is promising, neo-republicans tend to neglect the concept of self-government and therefore, are vulnerable to the same accusations of incompleteness faced by liberals. By focusing on the negative part of freedom as non-domination, they have omitted two aspects: first, that there are other ways to be unfree than to be the subject of mere arbitrary interference, and second, that the real value of non-domination is the capacity to act as a non-dominated being, which requires a level of self-mastery. To fix this problem, I propose an extension of the concept of non-domination and argue that the theory would benefit from including autonomy in the list of its conditions for freedom. Following the republican idea that one is only free in a free state, I propose a definition of republican autonomy that is political in nature, and depends on globalized nondomination. (shrink)

Kirjoituksessa argumentoin, että metafysiikka on ollut valistusta, vaikka se edelleen kaipaa lisää valistumista, kun valistus ymmärretään avoimena prosessina, joka ei ole ajasta ja paikasta riippuvaista. Käsittelen ensin sitä, mitä metafysiikka ja valistus ovat. Sitten lausun länsimaisen metafysiikan historiasta hyvin lyhyesti. Päätän esseen argumentoimalla, että metafysiikka on valistunutta siinä mielessä, että klassisen substanssi-ominaisuus-skeeman sokeasta seuraamisesta on pitkälti päästy eroon. Metafysiikka kaipaa kuitenkin lisää valistusta ja kriittistä tarkastelua, jotta vapaudumme täysin kyseisen skeeman ja modernin predikaatti-logiikan johdatuksen aiheuttamasta kolmesta ongelmallisesta suositusta (tausta)oletuksesta: (1) (...) perustavat partikulaariset yksilöoliot ovat (periaatteessa) laskettavia, (2) ne eivät ole relationaalisia ja (3) ominaisuudet ovat ontologisesti riippuvaisia kantajistaan. (shrink)

In this dissertation, I respond to the feminist critique of traditional theories of autonomy, which revolves around the charge that such theories are too individualistic. Feminists argue against the liberal atomism that they see at the center of traditional autonomy theories. Their resulting theory of relational autonomy is meant to remedy that traditional theories of autonomy posit an individualistic conception of both the self and autonomy. Instead, feminists have argued for a theory of autonomy that takes account of the ways (...) in which persons are irreducibly social, and the ways in which autonomy itself is only possible within certain types of social relationships. I separate the feminist charges against liberalism from the feminist charges against traditional autonomy, since it is at least prima facie possible to consider personal autonomy separately from political autonomy. I thus isolate the feminist critique of liberal atomism from the feminist critique of individualistic autonomy. The first chapter examines the feminist critique of liberalism to determine why it is that the charge of liberal atomism continues to stick, even though it has been clearly established by both feminist and mainstream liberals that liberalism is not guilty of such a charge. While I do not provide a full defense of liberalism, I do argue that such a defense is possible, and possible in a way that upholds feminist goals. Having separated the critiques of liberalism from the critiques of traditional autonomy, the rest of the dissertation focuses exclusively on the autonomy debate. I present an argument against the most robustly relational feminist accounts of autonomy those which accept a relational account of both the self and autonomy. I argue that, although such theories are explicitly designed to vindicate the normative commitments of feminism, their implications yield unwelcome results from this very same feminist perspective. I then present my own procedural account of autonomy. Because it is not constitutively social, it is unlikely to be characterized as a relational account at all. I argue, however, that it is this very feature which allows my account to vindicate the feminist normative commitments espoused by constitutively relational accounts. (shrink)