Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting (...) patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

Public health involves the use of power to change institutions and redistribute resources and deliberately to shape individual thought and behavior. This requires normative legitimation and demands ethical critique. This article explores concepts that are vital to public health ethics, but have been relatively neglected. These are membership, solidarity and the concept of place. The article argues that the practice of public health should recognize the equal rights of membership in communities of health justice. Public health should also rely on (...) a sense of obligation and mutual aid in a world of shared vulnerability and reciprocal recognition. Finally, public health achieves its goals not merely—and perhaps not most fundamentally—through information and altering the logical ratiocination of individuals or groups, but rather through the reformation of sense and sensibility. (shrink)

Although the principle of respect for personal autonomy has been the subject of debate for almost 40 years, the conversation has often suffered from lack of clarity regarding the philosophical traditions underlying this principle. In this article, I trace a genealogy of autonomy, first contrasting Kant’s autonomy as moral obligation and Mill’s teleological political liberty. I then show development from Mill’s concept to Beauchamp and Childress’ principle and to Julian Savulescu’s non-teleological autonomy sketch. I argue that, although the reach for (...) a new principle to guide choices in physician–patient relationships can rightfully be seen as important, the notion that is now called autonomy within bioethics has corollaries that undermine critical aspects of medical care. As such, there is need for a richer account of the interplay between the free choice of patients and the informed recommendations of doctors. (shrink)

One of the issues with which bioethics is concerned is defining the limits of the organism’s transformations by technology in order for humanity to avoid evil. Kant’s teleological power of judgment enables us to identify an organism and it allows nature to be transformed only insofar as it affirms a moral subject acting on the basis of autonomy as reason. I propose a new way of utilizing Kantian philosophy in bioethical knowledge. I ask: can we make judgments about nature via (...) the principle of purposiveness? In answering this question, I clarify the following points. The first is Kant’s research into the foundations and reasons for using the teleological power of judgment. The second is the role of digital technology and how it complicates the use of the teleological power of judgment within the framework of bioethical knowledge. And the third is the preservation of the foundations for using the teleological power of judgment. (shrink)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

Transmodern ethics establishes moral norms on liberal, pluralist and pragmatic principles. We see a comeback of the negation morals, however not of ontology-anchored morals, as is the case of the God who picks favourites or of the jealous God paradigm, and not even of morals anchored in a contractualist perspective, as is the case in the modern period. The preferred focus is on the value of positivism, of cooperation as a source of efficiency, of personal enrichment, be it cultural, spiritual, (...) or moral, derived from the access to alterity. Tolerance as an ethical value is legitimised by a new, utilitarian humanism. The ethical construction of identity revolves around the value of loyalty to a tradition, a dogma, a mentality, and by extension to any coherent system liable to generate a sense of belonging. Postindustrial ethics uses for instance the value of loyalty as a strategy in marketing, organisational development, political propaganda etc. The policies used in order to increase the loyalty of a shop's customers, the employee's loyalty for the company she works for, the supporter's loyalty to his team, are the translation in layman terms of the loyalty ethics that in spiritual terms was one of the foundations of orthodoxy as loyalty to the tradition of the holy fathers. The values of equality, liberty and fraternity have been more than that, as they have laid the foundations of the modern society. (shrink)