Jeremy Waldron has recently raised the question of whether there is anything approximating the creative self-authorship of personalautonomy in the writings of Immanuel Kant. After considering the possibility that Kantian prudential reasoning might serve as a conception of personalautonomy, I argue that the elements of a more suitable conception can be found in Kant’s Tugendlehre or Doctrine of Virtue--specifically, in the imperfect duties of self-perfection and the practical love of others. This discovery is important (...) for at least three reasons: first, it elucidates the relationship among the various conceptions of autonomy employed by personal-autonomy theorists and contemporary Kantians; second, it brings to the surface previously unnoticed or undernoticed features of Kant's moral theory; and third, it provides an essential line of defense against certain critiques of contemporary Kantian theories, especially that of John Rawls. (shrink)
Part I. The book begins with literary, cinematic, and historical scenarios that exemplify personalautonomy. Meyers uses these vignettes to distinguish personalautonomy from other, variously related types of autonomy and to show that other kinds of autonomy cannot adequately address the concern people have with their own personal decisions. Noting how profoundly social experience impinges on self-discovery, self-definition, and self-direction, Meyers characterizes autonomous individuals as persons who do what they really want, and (...) she undertakes to supply an account of an authentic self that acknowledges people's enmeshment in social relations as well as their psychological complexity. (shrink)
Should a growing market for genetic self-tests be welcomed or feared? From the point of view of personalautonomy the increasing availability of predictive health information seems promising. Yet it is frequently pointed out that genetic information about future health may cause anxiety, distress and even loss of life-hopes. In this article the argument that genetic self-tests undermine personalautonomy is assessed and criticized. I contend that opportunities for autonomous choice are not reduced by genetic information (...) but by misperceptions and misunderstandings of the results of genetic tests. Since the interpretation of genetic information is sometimes distorted by the information provided about the genetic products, more attention should be given to deceitful marketing that overblows the utility of genetic products. Yet personalautonomy is reduced neither by genetic tests nor by genetic information and there is consequently no compelling case for the conclusion that genetic self-tests should be prohibited. (shrink)
This paper explores the value of respect for personalautonomy in relation to clearly immoral and irrational acts committed freely and intentionally by competent people. Following Berlin's distinction between two kinds of liberty and Darwall's two kinds of respect, it is argued that coercive suppression of nonautonomous, irrational, and self-harming acts of competent persons is offensive to their human dignity, but not disrespectful of personalautonomy. Irrational and immoral choices made by competent people may claim only (...) the negative liberty to be left alone. Lives disposed to autonomy are worthy of solidarity and active support in addition to the right of free choice and action. Autonomous premeditated desires (distinguished from mere consent) may embody transcendental choices, which transcend consideration of physical and psychological well-being. Choices made by incompetent persons (e.g., children and the mentally disabled) are not related to autonomy, but to self-directedness. The value of human dignity confers protection to self-directedness, but not at the expense of other vital interests. (shrink)
The value and importance accorded to personalautonomy within liberalism would seem to suggest that cultural practices that severely constrain the choices of individuals through heavyhanded role socialization and restriction ought to be strongly discouraged in liberal societies. In this paper, I explore this claim in connection with the custom of arranged marriage, which has recently come under fire in some liberal democratic states, notably Britain. My aim is to try to complicate the liberal understanding of the relationship (...) between cultural traditions and personalautonomy. In the course of this discussion, I analyze and offer some criticisms of autonomy as a substantive ideal and requirement for flourishing. In revisiting and evaluating arguments in favor of a thick or substantive ideal of autonomy criticisms, I hope to show that a substantive ideal of autonomy as independence is culturally bounded in ways that are often overlooked by liberal philosophers. (shrink)
I argue in this paper that the development and convergence of information and communication technologies (ICT) is creating a global network of surveillance capabilities which affect the traveler. These surveillance capabilities are reminiscent of 18th century philosopher Jeremy Bentham’s panopticon, and as such the emerging global surveillance network has been referred to as the travel panopticon. I argue that the travel panopticon is corrosive of personalautonomy, and in doing so I describe and analyse various philosophical approaches to (...)personalautonomy. (shrink)
In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the (...) context of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)
I once heard a colleague opine that we would be better off if there were a 50-year moratorium on philosophers using the word 'autonomy'. He went on to argue that we could get along just fine without the word, and that a good number of confusions would be dispelled along the way. This collection of new papers goes a long way toward responding to this challenge in ways that both undercut and vindicate aspects of this complaint.
Part IV. Section 1. The Personal and the Political Value of Autonomy: Disparities in autonomy competency number among the many ways in which women and men in western societies are unequal. Meyers holds that although personalautonomy is not the sole or paramount value, medial autonomy is not only a personal good, but is also a political good.
To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems (...) that when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question. (shrink)
: Debates on precedent autonomy and some forms of paternalistic interventions, which are related to questions of personal identity, are analyzed. The discussion is based on the distinction between personal identity as persistence and as biographical identity. It first is shown that categorical objections to advance directives and "Ulysses contracts" are based on false assumptions about personal identity that conflate persistence and biographical identity. Therefore, advance directives and "Ulysses contracts" are ethically acceptable tools for prolonging one's (...)autonomy. The notions of personality and biographical identity are used to analyze the ethically relevant features. Thereby, it is shown that these concepts are operative in and useful for thinking in biomedical ethics. The overall conclusion is that categorical arguments against precedent autonomy or "Ulysses contracts" are based on misleading theories of personal identity and that advance directives are an ethically respectable tool for prolonging individuals' autonomy in cases of dementia and mental illness. (shrink)
The Hypothesis of Extended Cognition (HEC)—that many cognitive processes are carried out by a hybrid coalition of neural, bodily and environmental factors—entails that the intentional states that are reasons for action might best be ascribed to wider entities of which individual persons are only parts. I look at different kinds of extended cognition and agency, exploring their consequences for concerns about the moral agency and personal responsibility of such extended entities. Can extended entities be moral agents and bear responsibility (...) for actions, in addition to or in place of the individuals typically held responsible? What does it mean to be autonomous when one’s cognition is influenced and supported by a milieu of environmental factors? To answer these questions, I explore strong parallels between HEC’s critique of individualism in cognition, and feminist critiques of individualist accounts of self, agency, and autonomy. This relational and social conception of autonomous agency, as scaffolded and supported (or undermined and impaired) by a milieu of social, relational, and normative factors, has important lessons for HEC. Drawing together these two visions of distributed and decentralized aspects of personhood highlights how cognition, action, and responsibility are inextricably linked. It also encourages a reconceptualization of all cognition and all concerns about responsibility for actions, not simply as sometimes extended around individuals, but as fundamentally communal, social, and normative, with individual cognition and individual moral responsibility being derivative special cases, not the paradigm examples. Individuals are merely one of many possible loci of cognition, action, and responsibility. (shrink)
This is the most detailed, sophisticated and comprehensive treatment of autonomy currently available. Moreover it argues for a quite different conception of autonomy from that found in the philosophical literature. Professor Berofsky claims that the idea of autonomy originating in the self is a seductive but ultimately illusory one. The only serious way of approaching the subject is to pay due attention to psychology, and to view autonomy as the liberation from the disabling effects of physiological (...) and psychological afflictions. A sustained critique of concepts such as moral autonomy, self-realisation, ideal autonomy, and identification is offered. The author replaces these with an alternative model that reveals how spontaneity, vitality and competence enable human beings to act in the real world. (shrink)
The aim of this paper is to suggest that a necessary condition of autonomy has not been sufficiently recognized in the literature: the capacity to critically reflect on one’s practical attitudes (desires, preferences, values, etc.) in the light of new experiences . It will be argued that most prominent accounts of autonomy—ahistorical as well as history-sensitive—have either altogether failed to recognize this condition or at least failed to give an explicit account of it.
I argue that the moral right to privacy is the moral right to consent to access by others to one’s personal information. Although this thesis is relatively simple and already implicit in considerations about privacy, it has, nevertheless, been overlooked by philosophers. In the paper, I present and defend my account of the moral right to privacy, respond to possible objections to it, and attempt to show its advantages over two recent accounts: one by Steve Matthews and the other (...) by Adam Moore. I also offer reasons to think that my account can be assimilated into a broad range of fundamental ethical approaches (i.e., a variety of consequentialist,deontological, and natural law approaches). Given the number and variety of such approaches, however, I can only attempt to make a prima facie case for the adaptability of the proposed account. (shrink)
A response to Susan Hekman's article "Reconstituting the Subject: Feminism, Modernism, and Postmodernism" and to her review of Diana T. Meyers' book Self, Society, and Personal Choice both of which appeared in Hypatia 6(2).
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)
From Hippocrates to paternalism to autonomy : the new hegemony -- From autonomy to consent -- Consent, autonomy, and the law -- Autonomy at the end of life -- Autonomy and pregnancy -- Autonomy and genetic information -- Autonomy and organ transplantation -- Autonomy, consent, and the law.
It is a commonplace in liberal circles that individual persons have a right to individual autonomy or self-determination. Each mentally competent adult has a right to be at liberty to live and shape their own life in accordance with their own view about what makes for a good life, free from undue coercion or interference by others, so long as they do not harm others. In the words of John Stuart Mill, mentally-competent persons should have the liberty of “framing (...) the plan of our life to suit our own character, of doing as we like, subject to such consequences as may follow, without impediment from our fellow creatures, so long as what we do does not harm them, even though they may think our conduct foolish, perverse or wrong”. (shrink)
The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. (...) Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)
Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we (...) argue that current practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)
There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements. We present six neuroenhancement scenarios and analyse how autonomy accounts evaluate (...) them. Some cases are considered differently by criminal courts; we demonstrate where academic autonomy theories and legal reasoning diverge and ascertain whether courts should reconsider their concept of autonomy. We argue that authenticity is not an appropriate condition for autonomy and that new enhancement technologies pose no unique threats to personalautonomy. (shrink)
This paper explores the claim that someone can reasonably consider themselves to be under a duty to respect the autonomy of a person who does not have the capacities normally associated with substantial self-governance.
The basic relationship between people should be care, and the caring life is the highest which humans can live. Unfortunately, care that is not thoughtful slides into illegitimate intrusion on autonomy. Autonomy is a basic good, and we should not abridge it without good reason. On the other hand, it is not the only good. We must sometimes intervene in the lives of others to protect them from grave harms or provide them with important benefits. The reflective person, (...) therefore, needs guidelines for caring. Some contemporary moralists condemn paternalism categorically. This work examines weaknesses in their arguments and proposes new guidelines for paternalism, which it calls "parentalism" to avoid the patriarchal connotations of the old term. Its antiparentalism is more moderate than standard antipaternalism based on an exaggerated respect for autonomy. The work explores implications for both the personal sphere of interactions between individuals, such as friends and family members, and the public sphere of institutions, legislation, and the professional practices. (shrink)
If the incompatibilist is right, determinism annuls free will, but not necessarily autonomy. The possibly deterministic origin of values and beliefs that are objectively grounded does not undermine the autonomy of agents who maintain these for the right reasons. Nonobjective perspectives—preferences about lifestyle, profession, choice of mate— cannot anyway be entirely removed even for an unlimited being. Moreover, if one were lucky to have inherited contingencies that mesh perfectly with the world one happened to inhabit even if it (...) is deterministic, one would have the capacity for perfect autonomy. The extreme incompatibilist position that autonomy requires creation of self ex nihilo is incoherent. (shrink)
In this paper, I examine two versions of the so-called “hierarchical” approach to personalautonomy, based on the notion of “second-order desires”. My primary concern will be with the question of whether these approaches provide an adequate basis for understanding the dynamics of autonomy-ascription. I begin by distinguishing two versions of the hierarchical approach, each representing a different response to the oft-discussed “regress” objection. I then argue that both “structural hierarchicalism” (e.g., Frankfurt, Bratman) and “procedural hierarchicalism” (e.g., (...) Dworkin, Christman, Mele) have difficulties accommodating the dynamics of how the attribution of autonomy to persons is claimed, disputed, and resolved. Although they differ in details, both shortcomings can be traced to viewing autonomy as a metaphysical rather than a normative, practical matter. I conclude by suggesting that these difficulties underscore the advantages of a more constructivist and pragmatist. (shrink)
It is both an ideal and an assumption of traditional conceptions of justice for liberal democracies that citizens are autonomous, self-governing persons. Yet standard accounts of the self and of self-government at work in such theories are hotly disputed and often roundly criticized in most of their guises. John Christman offers a sustained critical analysis of both the idea of the 'self' and of autonomy as these ideas function in political theory, offering interpretations of these ideas which avoid such (...) disputes and withstand such criticisms. Christman's model of individual autonomy takes into account the socially constructed nature of persons and their complex cultural and social identities, and he shows how this model can provide a foundation for principles of justice for complex democracies marked by radical difference among citizens. His book will interest a wide range of readers in philosophy, politics, and the social sciences. (shrink)
This book addresses two related topics: self-control and individual autonomy. In approaching these issues, Mele develops a conception of an ideally self-controlled person, and argues that even such a person can fall short of personalautonomy. He then examines what needs to be added to such a person to yield an autonomous agent and develops two overlapping answers: one for compatibilist believers in human autonomy and one for incompatibilists. While remaining neutral between those who hold that (...)autonomy is compatible with determinism and those who deny this, Mele shows that belief that there are autonomous agents is better grounded than belief that there are not. (shrink)
In this paper, I try to show that externalist compatibilism in the debate on personalautonomy and manipulated freedom is as yet untenable. I will argue that Alfred R. Mele’s paradigmatic, history-sensitive externalism about psychological autonomy in general and autonomous deliberation in particular faces an insurmountable problem: it cannot satisfy the crucial condition of adequacy “H” for externalist theories that I formulate in the text. Specifically, I will argue that, contrary to first appearances, externalist compatibilism does not (...) resolve the CNC manipulation problem. After briefly reflecting on the present status of responses to the manipulation problem in the debate between compatibilists and incompatibilists of various stripes, I will draw the over-all pessimistic conclusion that no party deals with this problem satisfactorily. (shrink)
The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of autonomy as derived from the right persons have to respect, as agents who can argue, persuade and be persuaded in matters of utmost personal significance such as decisions (...) about medical care. Hence, autonomy should and could be respected only after such an attempt has been made. Understanding suffering to a significant degree is a prerequisite to sincere efforts of persuasion. It is claimed that a modified and pragmatic form of discourse is the necessary framework for understanding suffering and for compassionately interacting with the frail. (shrink)
Personalautonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to (...) the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows. (shrink)
The puzzling case of the broken arm -- Hernias, diets, and drugs -- Why physicians cannot know what will benefit patients -- Sacrificing patient benefit to protect patient rights -- Societal interests and duties to others -- The new, limited, twenty-first-century role for physicians as patient assistants -- Abandoning modern medical concepts: doctor's "orders" and hospital "discharge" -- Medicine can't "indicate": so why do we talk that way? --"Treatments of choice" and "medical necessity": who is fooling whom? -- Abandoning informed (...) consent -- Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing -- The end of prescribing: why prescription writing is irrational -- The alternatives to prescribing -- Are fat people overweight? -- Beyond prettiness: death, disease, and being fat -- Universal but varied health insurance: only separate is equal -- Health insurance: the case for multiple lists -- Why hospice care should not be a part of ideal health care I: the history of the hospice -- Why hospice care should not be a part of ideal health care II: hospice in a postmodern era -- Randomized human experimentation: the modern dilemma -- Randomized human experimentation: a proposal for the new medicine -- Clinical practice guidelines and why they are wrong -- Outcomes research and how values sneak into finding of fact -- The consensus of medical experts and why it is wrong so often. (shrink)
This paper argues that, while there is a difference between personal and sub-personal explanation, claims of autonomy should be treated with scepticism. It distinguishes between horizontal and vertical explanatory relations that might hold between facts at the personal and farts at the sub-personal level. Noting that many philosophers are prepared to accept vertical explanatory relations between the two levels, I argue for the stronger claim that, in the case of at least three central personal (...) level phenomena, the demands of explanatory adequacy require postulating horizontal explanatory relations. (shrink)
My central thesis is that philosophers considering questions of epistemic value ought to devote greater attention to the enduring nature of beliefs. I begin by arguing that a commonly drawn analogy between beliefs and actions is flawed in important respects, and that a better, more fruitful analogue for belief would be desire, or a similarly enduring state of an agent. With this in hand, I argue that treating beliefs as enduring, constitutive states of agents allows us to capture the importance (...) of accessible, justified, and true beliefs to sustaining personal identity, autonomy, self-control, and authenticity. We thus arrive at a significant value to such beliefs through their crucial role in our personal, practical identities. (shrink)
My aim is to show that the development of self-defense skills functions as a means of overcoming bodily encoded limits to autonomy. Through this discussion, I hope to broaden our understanding of the embodied nature of autonomy by illuminating the connection between bodily training and responses such as self-confidence, self-trust, and self-esteem. My paper aims toward these goals in two steps. First, it shows that self-defense training is valuable for women because it provides a security that one can (...) avoid or counter personal violence directed toward oneself. Second, I develop an account of self-defense training as a source of self-confidence. For women living within a social network working to undermine their self-trust and self- esteem, it is important to cultivate self-confidence, particularly since elements of that network involve threatening displays of aggression or superiority. Self- defense training in my account is not simply a route to recovery in the wake of personal violence. Instead, and primarily, it is the development of skills aimed at preventing personal violence. (shrink)
If we want to be autonomous, what do we want? The author shows that contemporary value-neutral and metaphysically economical conceptions of autonomy, such as that of Harry Frankfurt, face a serious problem. Drawing on Plato, Augustine, and Kant, this book provides a sketch of how "ancient" and "modern" can be reconciled to solve it. But at what expense? It turns out that the dominant modern ideal of autonomy cannot do without a costly metaphysics if it is to be (...) coherent. (shrink)
A recent argument in favor of a free market in human organs claims that such a market enhances personalautonomy. I argue here that such a market would, on the contrary, actually compromise the autonomy of those most likely to sell their organs, namely, the least well off members of society. A Marxian-inspired notion of exploitation is deployed to show how, and in what sense, this is the case.
In this paper, I address some of the shortcomings of established clinical ethics centring on personalautonomy and consent and what I label the Doctrine of Respecting PersonalAutonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. (...) Because of 'structural arbitrariness' in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personalautonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)
Stephen Darwall's The Second-Person Standpoint converges with Emmanuel Levinas's concern about the role of the second-person relationship in ethics. This paper contrasts their methodologies (regressive analysis of presuppositions versus phenomenology) to explain Darwall's narrower view of ethical experience in terms of expressed reactive attitudes. It delineates Darwall's overall justificatory strategy and the centrality of autonomy and reciprocity within it, in contrast to Levinas's emphasis on the experience of responsibility. Asymmetrical responsibility plays a more foundational role as a critical counterpoint (...) to 'mean-spirited' reciprocity than Darwall's laudable distinction between accountability and revenge, and responsibility even founds this distinction. The experience of being summoned to asymmetrical responsibility amplifies the meaning of 'authority', which is a presupposition for Darwall. Finally, asymmetrical responsibility helps develop decentred reasoning, invites risk beyond the boundaries of reciprocity at moments when autonomy appears endangered, reconciles respect and care at the experiential level, and presses to extend the scope of moral obligation. (shrink)
The autonomous person is one who has, in some sense, mastery over their desires. The prevailing way to understand such personalautonomy is in terms of a hierarchy of desires. For Harry Frankfurt, persons not only have first-order desires, but possess the additional capacity to form second-order desires. Second-order desires are formed through reflection on first-order desires and are thus expressive of the rational capacity which is characteristic of persons. Frankfurt's account of freedom of the will is founded (...) on his analysis of persons. It is only because persons possess second-order desires, resulting from their capacity for rational evaluation of first-order desires, that persons (and not those Frankfurt calls 'wantons') are well placed to possess freedom of will. Various objections have been raised in the literature against such second-order desire accounts of freedom of the will or autonomy. In my article, I raise the problem of instrumental second-order desires. I discuss the forms instrumental second-order desires can take and attempt to show that these cannot be the second-order desires that Frankfurt has in mind in his account. I then extend my critique by looking at non-instrumental second-order desires. I consider various forms which non-instrumental second-order desires can take and advance the argument that Frankfurt cannot have second-order desires such as these in mind either. Finally, I note that none of the suggestions considered will deliver a second-order desire account of autonomy, and that it is baffling just what Frankfurt does have in mind. (shrink)
Abstract Modern reflection on the ideal of personalautonomy has its Western origin in the philosophy of Jean-Jacques Rousseau, where autonomy, or self-legislation, involves citizens joining together to make laws for themselves that reflect their collective understanding of the common good. Four features of this conception of autonomy continue to be relevant today. First, autonomy, a type of freedom, is introduced into modern philosophy in order to make up for a perceived deficiency, or incompleteness, in (...) merely ?negative? freedom (the right to do as one pleases, unimpeded by others). Second, autonomy is taken to be not merely a complement of negative freedom but a higher, more valuable species of freedom. Third, at its origin personalautonomy is not conceived individualistically; rather, on Rousseau's account, autonomy is achievable only if citizens surrender part of their status as individuals and think of their social membership as essential, not merely accidental, to who they are. Finally, Rousseau's conception of autonomy is distinct from the contemporary ideal of autonomy defined as judging or deciding for oneself (according to one's own reason). Nevertheless, there is an important sense in which autonomy as Rousseau conceives it also requires the developed capacity for independent, self-determined judgment. (shrink)
Critics have charged that John Stuart Mill''s discussion as of paternalism in On Liberty is internally inconsistent, noting, for example, the numerous instances in which Mill explicitly endorses examples of paternalistic coercion. Similarly, commentators have noted an apparent contradiction between Mill''s political liberalism – according to which the state should be neutral among competing conceptions of the good – and Mill''s condemnation of non-autonomous ways of life, such as that of a servile wife. More generally, critics have argued that while (...) Mill professes an allegiance to utilitarianism, he actually abandons it in favor of a view that values personalautonomy as the greatest intrinsic good. This paper presents an interpretation of Mill that provides a viable and consistent treatment of paternalism, thereby refuting each of the aforementioned critiques. Mill''s views, it argues, are consistently utilitarian. Moreover, the interpretation accounts for all of Mill''s departures from his otherwise blanket prohibition of paternalistic legislation. In particular, it explains his most notorious example, the condemnation of voluntary contracts for slavery. The interpretation emphasizes Mill''s conceptual linkage between autonomy and utility, noting his implicit use of at least three different senses of the notion of autonomy. (shrink)
This article provides an intellectual archeology of how the term "respect" has functioned in the field of bioethics. I argue that over time the function of the term has shifted, with a significant turning point occurring in 1979. Prior to 1979, the term "respect" connoted primarily the notion of "respect for persons" which functioned as an umbrella which conferred protection to autonomous persons and those with compromised autonomy. But in 1979, with the First Edition of Principles of Biomedical Ethics (...) by Beauchamp and Childress, and the report of the Ethical Advisory Board (EAB) of the (then) Department of Health, Education, and Welfare entitled Research on In Vitro Fertilization, usage shifts from "respect for persons" to "respect for autonomy." Two results: 1) those with compromised autonomy are no longer protected by the canons of "respect" but rather the less overriding canons of beneficence; and 2) the term "respect" functions increasingly as a rhetorical device in public bioethics discourse. (shrink)
The value of a negatively defined private space is defended as important for the development of personalautonomy. It is argued that negative liberty is problematic when split off from its connection with this ideal. An ethical interpretation of personalautonomy is proposed according to which a private space is one of autonomy's preconditions. This leads to a conceptualization of privacy that is fruitful in two respects: it permits an account of privacy laws that avoids (...) certain pitfalls, and it serves as a basis for criticizing privacy-related failures of autonomy together with the social forces that produce them. Negative liberty is, furthermore, rejected as an adequate basis for modern law and democracy. Here, too, an ethically defined personalautonomy, of which negative liberty is a precondition, is held to be the most convincing normative foundation. A critical reading of Habermas' cooriginality thesis is offered in support of this argument. Key Words: cooriginality thesis Jürgen Habermas Herbert Marcuse negative liberty personalautonomy positive liberty privacy Martin Walser. (shrink)
Part II. Section 1. Recent Accounts of Autonomy: Emphasizing the problematic relationship between autonomy and socialization, Meyers explores prominent views of autonomy, including Robert Young's, Stanley Benn's, Harry Frankfurt's, Gerald Dworkin's, and Gary Watson's. Having identified three main models for "rescuing autonomy from socialization," she identifies a single defect underlying all of them - namely, their assumption that personalautonomy requires transcending socialization through free will.
Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personalautonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of (...) patient agency. Deficiencies in the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)
Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal (...)autonomy become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right. (shrink)
In this article, I distinguish personalautonomy from heteronomy, and consider whether autonomy provides a suitable basis for liberalism. I argue that liberal government should not promote autonomy in all its citizens, on the grounds that not all members of liberal democracies require autonomy for a good life. I then outline an alternative option that I call a liberalism of conscience, describing how it better respects heteronomous citizens. I subsequently clarify how a liberalism of conscience (...) is different than, and superior to, autonomy-based versions of liberalism. (shrink)
Using the example of an unconsented mouth swab I criticise the view that an action of this kind taken in itself is wrongful in respect of its being a violation of autonomy. This is so much inasmuch as autonomy merits respect only with regard to ‘critical life choices’. I consider the view that such an action is nevertheless harmful or risks serious harm. I also respond to two possible suggestions: that the action is of a kind that violates (...)autonomy; and, that the class of such actions violates autonomy. I suggest that the action is wrongful in as much as it is a bodily trespass. I consider, and criticise, two ways of understanding how morally I stand to my own body: as owner and as sovereign. In respect of the latter I consider Arthur Ripstein's recent defence of a sovereignty principle. Finally I criticise an attempt by Joel Feinberg to explain bodily trespass in terms of personalautonomy. (shrink)
Self-trust is a necessary condition of personalautonomy and self-respect. Self-trust involves a positive sense of the motivations and competence of the trusted person; a willingness to depend on him or her; and an acceptance of vulnerability. It does not preclude trust in others. A person may be rightly said to have too much self-trust; however core self-trust is essential for functioning as an autonomous human being.
To be recognized as an autonomous agent is to accorded fundamental respect-based, constitutionally protected rights of the sort that cannot be abridged except where a compelling state interest has been found, and whose abridgment survives strict scrutiny. The right to control your body is an expression of personalautonomy. The decision of the U.S. Supreme Court to uphold the federal Partial-Birth Abortion Ban Act violates this right and is thus flawed on legal grounds.
In English medical law, it is something of an axiom that adult competent patients have an absolute right to refuse all and any medical treatment, including potentially life-saving and life-sustaining treatment. This legal proposition, which is embedded in the doctrine of consent, has for the last few decades been regarded as the expression of the philosophical principle of personalautonomy and ethical right of self-determination. The Western ethical and legal traditions places heavy emphasis on notions of personal (...) sovereignty reflected in the strong rhetorical entrenchment of patient autonomy in judicial determinations of treatment refusal cases. In a spate of legal cases in the 1980s and 1990s judicial rhetoric .. (shrink)
It is plausible to think that part of what it is to be an autonomous agent is to adequately respond to important changes in one’s circumstances. The agent who has set her own course in life, but is unable to recognize and respond appropriately when evidence arises indicating the need to reconsider and perhaps adjust her plan, lacks an important form of personalautonomy. However, this “evidence-responsiveness” aspect of autonomy has not yet been adequately analyzed. Most (...) class='Hi'>autonomy theorists ignore it altogether and the few who have addressed it have failed to give a satisfactory account. In this paper, I first examine an evidence-responsiveness condition proposed by Arneson. I argue there that while Arneson’s condition provides a valuable framework in which to examine evidence-responsiveness, there are several crucial issues that it either fails to address at all or else fails to adequately resolve. That condition is therefore in need of further elaboration and refinement. I then examine a recent article in this journal by Blöser, Schöpf, and Willaschek which develops an account of autonomy that I argue can usefully be understood as employing and elaborating upon the general framework offered by Arneson. I argue that while the elaboration Blöser and her co-authors provide Arneson’s condition is instructive, it is inadequate in several important ways which indicate the form a more satisfactory evidence-responsiveness condition will take. I go on to develop such a condition and conclude by highlighting the advantages to be gained by including that condition in a complete theory of autonomy. (shrink)