Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which (...) other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law. (shrink)

It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

In der 1785 veröffentlichten Grundlegung zur Metaphysik der Sitten formuliert Kant erstmals die Prinzipien einer universalistischen Ethik der Autonomie, deren Einfluß bis heute ungebrochen ist. Schon beim Übergang von der gemeinen zur philosophischen Vernunfterkenntnis findet man die Hauptgedanken: In der Ethik geht es nicht primär um das gute Leben und das Glück, und es geht auch zunächst nicht darum, welche Handlungserfolge erzielt werden; Gegenstand moralischer Hochschätzung sind vielmehr Intentionen und Maximen. Gut ist, was für alle vernünftigen Wesen gilt, weil es (...) von ihnen als autonomen und vernünftigen Wesen gewollt wird. Die Schrift ist kurz, einfach gegliedert und verständlich geschrieben. Sie eignet sich daher als Einführung in Kants Ethik, enthält aber zugleich als Grundlegung alle wesentlichen Gedanken seiner praktischen Philosophie. Auf der Grundlage der Originalausgabe von 1785/86 wurde der Text völlig neu erstellt. Eines der wichtigsten Bücher der Philosophiegeschichte liegt damit in einer zuverlässigen und preisgünstigen Neuausgabe vor. (shrink)

It is sometimes suggested that the physician should offer the patient “just the facts,” preferably in a “value-free manner,” explain the different options, and then leave it to the patient to make the choice. This paper explores the extent to which this adviser model is realistic. The clinical decision process and the various components of clinical reasoning are discussed, and a distinction is made between the biological, empirical, empathic/hermeneutic and ethical components. The discussion is based on the ethical norms of (...) the public health services in the Nordic countries, and the problems are illustrated by a clinical example. It is concluded that the adviser model is unrealistic. Patient information is important, but the complexity of clinical reasoning makes it impossible to separate facts and value judgments. It is claimed that there is an inherent element of paternalism in clinical decision-making and that clinical practice presupposes a mutual trust between physician and patient. (shrink)

This book follows hard upon Korsgaard's The Sources of Normativity. Both present the author's influential version of a Kantian theory of normative ethics and metaethics. Whereas The Sources of Normativity was a systematic investigation of "normativity" written as a single unit, the present volume is a collection of previously published papers, some of them already well known and much discussed, dating between 1983 and 1993. By the nature of the case, one might expect less thematic unity in this book than (...) in the other one, but the present book is a deeper and more wide ranging presentation of the author's views. Korsgaard's historical focus in The Sources of Normativity is less on Kant and more on the British moralists. Creating the Kingdom of Ends deals quite explicitly with the interpretation of Kant's moral philosophy. The papers in this book contain, in my judgment, the heart of Korsgaard's work: a variety of fresh and illuminating insights into Kant's moral theory and its relation to contemporary ethical theory which have helped to reshape the image of Kant's ethics and to refocus the issues dealt with in current moral philosophy. Or to make claims less grand but of more immediate relevance to this review, there is no question that some of the papers in this book have helped to reshape both the present writer's image of Kant's ethics and his conception of the way questions of ethical theory should be addressed. I hope below to say something both about where I think Korsgaard has gotten these matters right, and where I find her position either unclear or dubious. (shrink)

In the subsequent pages, I want to develop a distinction between wanting and valuing which will enable the familiar view of freedom to make sense of the notion of an unfree action. The contention will be that, in the case of actions that are unfree, the agent is unable to get what he most wants, or values, and this inability is due to his own "motivational system." In this case the obstruction to the action that he most wants to do (...) is his own will. It is in this respect that the action is unfree: the agent is obstructed in and by the very performance of the action. (shrink)

Should the `irrational' refusal to consent to ECT of a depressed patient who knows he is thought to be ill, knows that his doctor believes ECT will help him and knows that he is being asked to decide, be respected or overridden? The author of the first paper, an American bioethicist argues that the refusal should be overridden in the interests of fostering the autonomy of the patient by overcoming the impediment to that autonomy which major depression represents. A philosopher (...) and a psychiatrist respond and an editorial discusses the issues. (shrink)

Ranging over central issues of morals and politics and the nature of freedom and authority, this study examines the role of value-neutrality, rights, equality, ...

Conceptions of individual autonomy and of rational autonomy have played large parts in twentieth century moral philosophy, yet it is hard to see how either could be basic to morality. Kant's conception of autonomy is radically different. He predicated autonomy neither of individual selves nor of processes of choosing, but of principles of action. Principles of action are Kantianly autonomous only if they are law-like in form and could be universal in scope; they are heteronomous if, although law-like in form, (...) they cannot have universal scope. Puzzles about claims linking morality, reason and autonomy are greatly reduced by recognising the distinctiveness of Kantian autonomy. (shrink)

Conceptions of individual autonomy and of rational autonomy have played large parts in twentieth century moral philosophy, yet it is hard to see how either could be basic to morality. Kant's conception of autonomy is radically different. He predicated autonomy neither of individual selves nor of processes of choosing, but of principles of action. Principles of action are Kantianly autonomous only if they are law-like in form and could be universal in scope; they are heteronomous if, although law-like in form, (...) they cannot have universal scope. Puzzles about claims linking morality, reason and autonomy are greatly reduced by recognising the distinctiveness of Kantian autonomy. (shrink)

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he (...) argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper. (shrink)

Perhaps the best way to understand the novelty of Berofsky’s approach is to discuss two prevailing views about autonomy he rejects. On one of these views, we have the following picture: Autonomous agents develop powers to critically reflect upon and evaluate their past and present motivations. Such reflection inevitably leads to conflicts between reflective evaluation and existing motivation. The workaholic judges that he should spend more time with his family; the smoker does not want to have the craving for cigarettes (...) she does have. When such conflicts arise, one exercises autonomy by choosing in favor of the evaluations or higher-order desires over one’s first-order desires. Reason wins out over desire, or the higher self—the “true” or “real” self—wins out over the lower self. (shrink)

In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he is autonomous. (...) In addition this process of identification must itself meet certain procedural constraints. (shrink)

In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he is autonomous. (...) In addition this process of identification must itself meet certain procedural constraints. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

The concept of individual autonomy is one of the most frequently utilized--and perhaps least understood--terms of current moral, political, and legal debate. The first anthology devoted entirely to this philosophical concept, The Inner Citadel includes both extensive discussions of autonomy itself and theoretical applications of autonomy to various areas of philosophical inquiry. John Christman has assembled essays, many appearing in print for the first time, by such eminent philosophers as Gerald Dworkin, Joel Feinberg, Harry Frankfurt, and David A. J. Richards. (...) Together, these essays provide the necessary foundation for the myriad debates and controversies in areas such as bioethics, feminism, and paternalism whose resolution turns on the nature and value of individual autonomy. As the idea of autonomy is central to such a wide range of philosophical issues and impinges on other disciplines as well, The Inner Citadel will be essential for courses in moral, political, social, and legal philosophy, as well as a valuable resource for students of law, political science, and psychology. (shrink)

Virtually any appraisal of a person’s welfare, integrity, or moral status, as well as the moral and political theories built on such appraisals, will rely crucially on the presumption that her preferences and values are in some important sense her own. In particular, the nature and value of political freedom is intimately connected with the presupposition that actions one is left free to do flow from desires and values that are truly an expression of the ‘self-government’ of the agent. However, (...) we all know that no person is self-made in the sense of being a fully formed and intact ‘will’ blossoming out of nowhere. Our values and preferences are explained by essential reference to a variety of influences that have come to bear on our development throughout our personal histories. What is needed, then, is to establish an account of self-determination or autonomy that would help determine just when and if the values and preferences we find ourselves with deserve the centrality that moral and political theories place on them. (shrink)

This discussion paper addresses Ian Wilks’ defence of the risk‐related standard of competence that appears in Bioethics 11. Wilks there argues that the puzzle posed by Mark Wicclair in Bioethics 5 against Dan Brock's argument in favour of a risk‐related standard of competence — namely that Brock’s argument allows for situations of asymmetrical competence — is not a genuine problem for a risk‐related standard of competence. To show this, Wilks presents what he believes to be two examples of real situations (...) in which asymmetrical competence arises. I argue that insofar as Wilks equivocates two senses of competence in his examples — namely, competence to perform a task and competence in performing a task — Wilks is unable to illustrate the existence of real situations of asymmetrical competence. By examining the way in which Wilks equivocates two senses of competence in his examples, and by applying the results of this examination to the problem of patient competency within the medical field, I argue that not only does Wilks fail to show that situations of asymmetrical competence exist, but he is also unable to provide a foundation for understating how the risk‐related standard of competence can strike a balance between an individual’s autonomy and benevolent intervention. I thus conclude that insofar as Wilks fails to answer the objections raised by Wicclair and others against the risk‐related standard of competence, the risk‐related standard of competence continues to be undermined by the problem of asymmetrical competence. (shrink)

In this paper I discuss the view that the appropriate concept of competence is a decision‐relative one: that a person may be competent to make one decision but not another. The argument that I present is that neither of the two competing theories supporting the decision‐relative approach, internalism and externalism, can provide a coherent explanation of why a person’s competence should be thought to be relative to a particular decision. On the one hand, internalism, which regards competence as exhaustively a (...) matter of the person’s understanding, fails to identify the specific skills or content that would warrant linking a specific decision with competence, and thus cannot provide an account of decision‐relative that parallels task‐relative. On the other hand, externalism, which regards competence as a matter of the person’s understanding in relation to external elements such as risk, cannot adequately defend why a person’s competence to make a decision should ‘track’ the level of probable harm that results from the decision. (shrink)

Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation of the personal relevance of this information, and logical reasoning, may be insufficient to address this question. This is so because major depression may not impair these (...) four abilities while it may disrupt coherence of personal preferences by changing them. Such change may be evaluated by comparing the treatment preferences of the individual during the depression to his or her treatment preferences during normal periods. If these preferences are consistent, they should be respected. If they are not consistent, or past treatment preferences that were arrived at competently cannot be established, treatment refusal may have to be overridden or ignored so as to alleviate the depression and then determine the competent treatment decision of the individual. Further study of the relation between depression and competence to refuse or consent to psychiatric treatment is required. (shrink)

Psychopathology is the study of the signs and symptoms of psychiatric disorders - delusions, hallucinations, phobias, depression, for example. This book gives an account of the terms currently in use and attempts an in-depth analysis of the nature of each. The matter is examined both from a philosophical perspective and from the point of view of what is known about the function of the hemispheres of the brain.

Christine Korsgaard has become one of the leading interpreters of Kant's moral philosophy. She is identified with a small group of philosophers who are intent on producing a version of Kant's moral philosophy that is at once sensitive to its historical roots while revealing its particular relevance to contemporary problems. She rejects the traditional picture of Kant's ethics as a cold vision of the moral life which emphasises duty at the expense of love and value. Rather, Kant's work is seen (...) as providing a resource for addressing not only the metaphysics of morals, but also for tackling practical questions about personal relations, politics, and everyday human interaction. This collection contains some of the finest current work on Kant's ethics and will command the attention of all those involved in teaching and studying moral theory. (shrink)

In 1910, Karl Jaspers wrote a seminal essay on morbid jealousy in which he laid the foundation for the psychopathological phenomenology that through his work and the work of Hans Gruhle and Kurt Schneider, among others, would become the ...

Meyers examines the question of personal autonomy. She observes the effects of childrearing practices and sexual biases, and reflects upon the results in women. Annotation copyrighted by Book News, Inc., Portland, OR.

Autonomy has recently become one of the central concepts in contemporary moral philosophy and has generated much debate over its nature and value. This 2005 volume brings together essays that address the theoretical foundations of the concept of autonomy, as well as essays that investigate the relationship between autonomy and moral responsibility, freedom, political philosophy, and medical ethics. Written by some of the most prominent philosophers working in these areas, this book represents research on the nature and value of autonomy (...) that will be essential reading for a broad swathe of philosophers as well as many psychologists. (shrink)

This is a collection of published and unpublished essays by distinguished philosopher Michael E. Bratman of Stanford University. They revolve around his influential theory, know as the "planning theory of intention and agency." Bratman's primary concern is with what he calls "strong" forms of human agency--including forms of human agency that are the target of our talk about self-determination, self-government, and autonomy. These essays are unified and cohesive in theme, and will be of interest to philosophers in ethics and metaphysics.

A volume of philosophical studies, centred on problems of personal identity and extending to related topics in the philosophy of mind and moral philosophy.

One of the most influential of contemporary philosophers, Harry Frankfurt has made major contributions to the philosophy of action, moral psychology, and the study of Descartes. This collection of essays complements an earlier collection published by Cambridge, The Importance of What We Care About. Some of the essays develop lines of thought found in the earlier volume. They deal in general with foundational metaphysical and epistemological issues concerning Descartes, moral philosophy, and philosophical anthropology. Some bear upon topics in political philosophy (...) and religion. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.