Online research in philosophy

Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will (...) take responsibility forpatient care. (shrink)

In this article the various descriptions and interpretations ofprofessional autonomy, as have been given in the articles from Belgium,Italy and the UK are subjected to a further analysis. The implicit claimthat professional autonomy of physicians is beneficial for the health ofpatients is scrutinized and is proven to be untrue and invalid. Theconclusion is that professional autonomy is more directed at theinterests of physicians than of those of patients and deserves nospecial place in health care.

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on (...) health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

Professional autonomy interferes at a structural level with the variousaspects of the health care system. The health care systems that can bedistinguished all feature a specific design of professional autonomy,but experience their own governance problems. Empirical health caresystems in the West are a nationally coloured blend of ideal type healthcare systems. From a normative perspective, the optimal health caresystem should consist of elements of all the ideal types. A workableoptimum taking national values into account could be (...) attained bygovernance structures that also introduce elements from other ideal typesystems. Thus a normative approach to medical practice guaranteeing anessential degree of professional autonomy for a relationship of trustbetween the patient and the physician, could be combined with anefficient and equitable allocation of health care resources. (shrink)

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has (...) tomake reference to the following fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice. (shrink)

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized (...) in the Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship. (shrink)

Employed professionals (e.g., accountants or engineers)-and those who study them-sometimes claim that their status as employeesdenies them the “autonomy” necessary to be “true professionals.” Is this a conceptual claim or an empirical claim? How might it be proved or disproved? This paper draws on recent work on autonomy to try to answer these questions. In the course of doing that, it identifies three literatures concerned with autonomy and suggests an approach bringing them together in a way likely (...) to be useful both to philosophers interested in the concept and to social scientists interested in studying autonomy in the workplace. (shrink)

Health care is not merely a matter of individual encounters between patients and physicians or other health care personnel. For patients and those who provide health care come to these encounters already possessed of learned habits of perception and judgment, valuation and action, which define their roles in relation to one another and affect every aspect of their encounter. So the presuppositions of these encounters must be examined if our understanding of patients' autonomy is to be complete. In this (...) paper I sketch three models of what is presupposed in the relationship between the health care professional and the lay patient; and I discuss the ways in which patients' autonomy is preserved and/or compromised under each of the three models. The models discussed are the Guild Model, the Commercial Model, and the Interactive Model. (shrink)

A growing literature addresses the ethicalimplications of electronic surveillance atwork, frequently assigning ethical priority tovalues such as the right to privacy. Thispaper suggests that, in practice, the issuesare sociologically more complex than someaccounts suggest. This is because manyworkplace electronic technologies not designedor deployed for surveillance purposesnevertheless embody surveillance capacity. Thiscapacity may not be immediately obvious toparticipants or lend itself to simpledeployment. Moreover, because of their primaryfunctions, such systems embody a range of otherfeatures which are potentially beneficial forthose utilising them. As (...) a result, more complexethical dilemmas emerge as different desired goods compete for priority in thedecision-making of individuals and groups. From a sociological point of view this raisesinteresting questions about the way ethicaldilemmas arise in the context of the ongoingsocial relationships of work. The paperexplores these issues using data from a studyof the development and implementation of acomputerised instructional package in amaternity setting. This medical settingillustrates clearly how seeking to assignethical priority to a particular concern, suchas the right to privacy, cannot butoversimplify the real day to day dilemmasencountered by participants. At the same time,the example of the instructional packagedemonstrates that it is difficult to predict inadvance what ethical issues will be raised bytechnologies that almost always turn out tohave a range of capabilities beyond thoseenvisaged in their original designspecification. (shrink)

Autonomy is considered to be an important feature of professionals and to provide a necessary basis for their informed judgments. In this article these notions will be challenged. In this article I use Michel Foucault's deconstruction of the idea of the autonomous citizen, and his later attempts to reconstruct that idea, in order to bring some new perspectives to the discussion about the foundation of professionalism. The turning point in Foucault's discussion about autonomy is to be found in (...) his proposal for an ethics of the self. This ethics invites a break with the normalising discourses of modernity. As I see it, this makes it particularly relevant to a discussion about the principles of professionalism. The conception of parrhesia is central. I use the role of the teacher to illustrate my arguments. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis (...) of the ethical concepts associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making , Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society -- namely, an individual's right to make independent decisions (...) -- has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 1-2, July 2012.

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)

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of (...) the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (shrink)

This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional (...) class='Hi'>autonomy occurred inthe United Kingdom. The level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk. (shrink)

A tension between the professions' pursuit of autonomy and the public's demand for accountability has led to the development of codes of ethics as both a foundation and guide for professional conduct in the face of morally ambiguous situations. The profession as an institution serves as a normative reference group for individual practitioners and through a code of ethics clarifies, for both its members and outsiders, the norms that ought to govern professional behavior. Three types of codes (...) can be identified — aspirational, educational and regulatory. All codes serve multiple interests and, as a consequence, perform many functions, eight of which are discussed. The process of developing a code of ethics is assessed because of the role it plays in gaining consensus on professional values and ethical norms. After discussing some of the weaknesses in current approaches to professional self-regulation, several new private and public initiatives are proposed. (shrink)

Based on the case of Caster Semenya, I argue in this paper that the practice of Gender Verification Testing (GVT) in professional sports is unethical and pointless. The presumed benefit of GVT—ensuring fair competition for female athletes—is virtually nonexistent compared to its potential harms, in particular the exposure of individual athletes to a largely interphobic public. GVTs constitute a serious incursion on the athlete’s dignity, autonomy, and privacy; an incursion that cannot be justified by the appeal to fairness. (...) My argument will proceed in four steps. In sections 1-5, I provide background information on the definition of intersexuality, the history and methods of Gender Verification Testing, and the performance gap between men and women in professional athletics. In sections 6 and 7, I develop my main argument against GVT. In section 8, I offer a supplementary argument against GVT from the history of “gender engineering” in professional sports in the 1970s and 1980s. In section 9, I briefly consider the suggestion that the presence of intersex athletes in professional sports would force us to abandon gender segregation. (shrink)

Kantian autonomy is often thought to be independent of time and place, but J. B. Schneewind in his landmark study, The Invention of Autonomy, has shown that there is much to be learned by setting Kant's moral philosophy in the context of the history of modern moral philosophy. The distinguished authors in the collection continue Schneewind's project by relating Kant's work to the historical context of his predecessors and to the empirical context of human agency. This will be (...) a valuable resource for professionals and advanced students in philosophy, the history of ideas, and the history of political thought. (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range (...) of delusions, which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of (...) autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (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)

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the (...) class='Hi'>autonomy paradox, to which the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (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.

Although bioethics is a lively and expanding interdisciplinary field, there is not enough research about the patient-doctor relationship, a central issue in philosophy of medicine. This article surveys the state of the field, paying attention to recent work by Alfred Tauber, and supplementing it with insights from Hans Jonas's philosophy of technology in order to propose a principle of responsible autonomy for health care. Based on a comparative look across different sub-fields in bioethics, the resulting model claims that physician (...) responsibility is essential to professional integrity, providing an alternative to other active trends emphasizing patient autonomy, such as Robert Veatch's contractual model. (shrink)

One of the underlying ethical values of the Patient Self-Determination Act (PSDA) is the legal right of patients to decide on their own medical care, i.e., to accept or refuse medical treatment. Yet, there is a growing concern that a patient's legal right to determine medical treatment might result in health care professionals violating their own personal and/or professional ethical values. I shall therefore briefly review the requirements of the PSDA and outline the consequences of this act for a (...) particular case. The application of the Act becomes problematic in this case because the health care professionals involved believe that the treatments involved are medically futile. I consider the potential conflict between autonomy and futility. The thesis defended is that patient autonomy is not an absolute moral right and that health care professionals are not only permitted, but are sometimes morally required, to withhold and/or withdraw futile treatments even if the patient or the patient's surrogate request (demand!) that the treatments be continued. (shrink)

In the United States, disease screening is offered to the public as a consumer service. It has been proposed that the act of “consumption” is a manifestation of agency and that the decision to consume is an exercise of autonomy. The enthusiasm of the American public for disease screening and the expansion in the demand for all sorts of disease screening in recent years can be viewed as an expression of such autonomy. Here, we argue that the enthusiasm (...) for disease screening witnessed in the American public today may be more a reflection of the constraint on autonomy than its facilitation. It is our opinion that the articulation of socio-historical processes has contributed to a moral imperative which is reflected in the decision making of individuals around disease screening. We suggest medical and health professionals have a responsibility to facilitate the exercise of individual autonomy in health care decision making as an integral component of professional obligation. These professionals need to problematise healthcare activities that constrain individual autonomy. (shrink)

In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of (...) care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)

Nondirective genetic counseling developed as a means of promoting informed and independent decision-making. To the extent that it minimizes risks of coercion, this counseling approach effectively respects client autonomy. However, it also permits clients to make partially informed, poorly reasoned or ethically questionable choices, and denies counselors a means of demonstrating accountability for the use of their services. These practical and ethical tensions result from an excessive focus on noncoercion while neglecting the contribution of adequate information and deliberative competence (...) to autonomous decision-making. A counseling approach that emphasizes the role of deliberation may more reliably produce thoroughly reasoned decisions. In such an approach, characterized by dialogue, counselors are responsible for ensuring that decisions are fully informed and carefully deliberated. Counseling remains nonprescriptive, but in the course of discussion counselors may introduce unsolicited information and/or challenge what they believe are questionable choices. By this means clients can be better assured that the decisions they make are fully considered, while counselors demonstrate a limited degree of professional accountability. (shrink)

Background Non-therapeutic trials in which terminally ill cancer patients are asked to undergo procedures such as biopsies or venipunctures for research purposes, have become increasingly important to learn more about how cancer cells work and to realize the full potential of clinical research. Considering that implementing non-therapeutic studies is not likely to result in direct benefits for the patient, some authors are concerned that involving patients in such research may be exploitive of vulnerable patients and should not occur at all, (...) or should be greatly restricted, while some proponents doubt whether such restrictions are appropriate. Our objective was to explore clinician-researcher attitudes and concerns when recruiting patients who are in advanced stages of cancer into non-therapeutic research. Methods We conducted a qualitative exploratory study by carrying out open-ended interviews with health professionals, including physicians, research nurses, and study coordinators. Interviews were audio-recorded and transcribed. Analysis was carried out using grounded theory. Results The analysis of the interviews unveiled three prominent themes: 1) ethical considerations; 2) patient-centered issues; 3) health professional issues. Respondents identified ethical issues surrounding autonomy, respect for persons, beneficence, non-maleficence, discrimination, and confidentiality; bringing to light that patients contribute to science because of a sense of altruism and that they want reassurance before consenting. Several patient-centered and health professional issues are having an impact on the recruitment of patients for non-therapeutic research. Facilitators were most commonly associated with patient-centered issues enhancing communication, whereas barriers in non-therapeutic research were most often professionally based, including the doctor-patient relationship, time constraints, and a lack of education and training in research. Conclusions This paper aims to contribute to debates on the overall challenges of recruiting patients to non-therapeutic research. This exploratory study identified general awareness of key ethical issues, as well as key facilitators and barriers to the recruitment of patients to non-therapeutic studies. Due to the important role played by clinicians and clinician-researchers in the recruitment of patients, it is essential to facilitate a greater understanding of the challenges faced; to promote effective communication; and to encourage educational research training programs. (shrink)

Autonomy and responsibility are interrelated concepts crucial to the moral analysis of professional persons, organizations and institutions, and for the purpose of this paper, I focus on the persons, organizations, and institution of journalism. My paper’s thesis hinges on the notion that the confluence of the concepts of autonomy and responsibility creates a natural conceptual foundation for understanding moral praise and blame. Though in moral philosophy this notion has long been accepted, it has not yet been carefully (...) applied to the practice of journalism. Applying these concepts to journalism, I will argue, is crucial for accurately determining moral praise and blame, as it adds a structure to evaluating ethical behavior in a way that has not yet been put forward. (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)

Ethics and regulation have become catchwords of the late 1990s, yet relatively little has been written about the ethical discourse and regulation of the legal professions in England and Wales. This book represents the first attempt to subject the ethical discourse of the English legal professions to in-depth analysis and sustained critique. Drawing on insights from moral philosophy, social theory, the sociology of the legal profession, public law theories of regulation, and the extensive American literature on lawyers' ethics, it argues (...) that, in seeking to provide definitive answers to particular problems of professional conduct, professional legal ethics has failed to deliver an approach which requires lawyers actively to engage with the ethical issues raised by legal practice. Through an analysis of the core issues facing lawyers, the authors locate this failure in the profession's reliance on a liberal and adversarial role morality that conceptualises the ethical values of human dignity, autonomy and equality in a formalistic and narrowly legalistic manner. This encourages lawyers to overlook the real invasions of these values so often wrought by upholding clients legal rights, and to ignore the competing claims of affected third parties, the wider community and the environment In seeking to move beyond critique, the authors develop throughout the book a contextual approach to individual ethical decision-making and outline a range of institutional, regulatory and educational reforms which, they suggest, could form the basis for a more ethical brand of professionalism. -/- Professional Legal Ethics: Critical Interrogations is a wide-ranging and thought-provoking analysis written for lawyers, ethicists and policy-makers interested in this neglected area of professional ethics and regulation. (shrink)

Many health care professionals (HCPs) are understandably reluctant to treat patients in environments infested with bedbugs, in part due to the risk of themselves becoming bedbug vectors to their own homes and workplaces. However, bedbugs are increasingly widespread in care settings, such as nursing homes, as well as in private homes visited by HCPs, leading to increased questions of how health care organizations and their staff ought to respond. This situation is associated with a range of ethical considerations including the (...) duty of care, stigmatization, vulnerability, confidentiality, risks for third parties, and professional autonomy. In this article, we analyze these issues using a case study approach. We consider how patients whose living environments are infested with bedbugs can receive care in the community setting in a manner that supports their well-being, is consistent with fairness in care provision, and takes into account risks for HCPs and third parties. We also discuss limits and obstacles to the provision of care in these situations. (shrink)

Weak emergence has been offered as an explication of the ubiquitous notion of emergence used in complexity science (Bedau 1997). After outlining the problem of emergence and comparing weak emergence with the two other main objectivist approaches to emergence, this paper explains a version of weak emergence and illustrates it with cellular automata. Then it explains the sort of downward causation and explanatory autonomy involved in weak emergence.

Kant’s ethics conceives of rational beings as autonomous–capable of legislating the moral law, and of motivating themselves to act out of respect for that law. Kant’s ethics also includes a notion of the highest good, the union of virtue with happiness proportional to, and consequent on, virtue. According to Kant, morality sets forth the highest good as an object of the totality of all things good as ends. Much about Kant’s conception of the highest good is controversial. This paper focuses (...) on the apparent conflict between Kant’s claim that we are autonomous, and passages in which he seems to suggest that we require belief in the possibility of the highest good to motivate moral action. I distinguish three distinct versions of these problematic claims that seem to be present in Kant’s texts: that the highest good serves as (1) a motivational supplement to respect for the moral law, (2) a fundamental spring of right action, and (3) a condition of the bindingness of moral requirements. I argue that the texts are better interpreted to yield alternatives to (2) and (3) that do not conflict with our autonomy. I also argue that, properly understood, (1) does not conflict with our autonomy. In arguing for the last claim, I explore Kant’s notion of radical evil and its implications for human agency and virtue. (shrink)

From the outset, critical social theory has sought to diagnose people’s participation in their own oppression, by revealing the roots of irrational and self-undermining choices in the complex interplay between human nature, social structures, and cultural beliefs. As part of this project, Ideologiekritik has aimed to expose faulty conceptions of this interplay, so that the objectively pathological character of what people are “freely” choosing could come more clearly into view. The challenge, however, has always been to find a way of (...) doing this without arrogantly assuming special access to what is good for people. And this danger of paternalism is one to which social theorists have all too often fallen prey. In this brief essay, I focus on contemporary instances of clearly self-defeating behavior in contexts of complex choices. I begin by discussing a recent attempt to diagnose and solve these failures of choices, namely the public policy recommendations of behavioral economist Richard Thaler and reform-minded legal theorist Cass Sunstein. Their influential “libertarian paternalist” approach is particularly interesting, both in what it includes (attention to the socially constructed nature of choice situations and the roots of the problems in human nature) and in what it leaves out (an understanding of the social construction of human nature and an adequate appreciation of the value of autonomy). After discussing it, I consider a broadly perfectionist alternative, to the effect that the problem lies in a failure to adequately appreciate the importance of developing autonomy. I then turn to sketching the outlines of a new approach, based on the concept of “autonomy gaps,” which approaches overly demanding policies in relational and action-theoretical terms. In the final section, I show how this provides the basis for an analysis both in terms of a critique of ideology and of social pathology. (shrink)

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including (...) self-conception, self-worth, memory, and the imagination. (shrink)

Socialization enforces gendered standards of politeness that encourage men to be dominating and women to be deferential in mixed-gender discourse. This gendered dynamic of politeness places women in a double bind. If women are to participate in polite discourse with men, and thus to avail of smooth and fortuitous social interaction, women demote themselves to a lower social ranking. If women wish to rise above such ranking, then they fail to be polite and hence, open themselves to a wellspring of (...) social discord, dissention, and antagonism. The possibility for women’s politeness in mixed-gender conversation threatens more than cooperation, it undermines the possibility for self-respect and autonomy. (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 used the concept to analyze various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

Jeremy Waldron has recently raised the question of whether there is anything approximating the creative self-authorship of personal autonomy in the writings of Immanuel Kant. After considering the possibility that Kantian prudential reasoning might serve as a conception of personal autonomy, 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)

Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception (...) of autonomy that is operative in the context of medicine. (shrink)

This book offers a thorough reflection on the relationship between autonomy and paternalism, and argues that, from both theoretical and practical angles, the ...

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued (...) that O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. -/- Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. -/- This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (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.

In recent years the concepts of individual autonomy and political liberalism have been the subjects of intense debate, but these discussions have occurred largely within separate academic disciplines. Autonomy and the Challenges to Liberalism contains for the first time new essays devoted to foundational questions regarding both the notion of the autonomous self and the nature and justification of liberalism. Written by leading figures in moral, legal and political theory, the volume covers inter alia the following topics: the (...) nature of the self and its relation to autonomy, the social dimensions of autonomy and the political dynamics of respect and recognition, and the concept of autonomy underlying the principles of liberalism. (shrink)

Why has autonomy been a leading idea in philosophical writing on bioethics, and why has trust been marginal? In this important book, Onora O'Neill suggests that the conceptions of individual autonomy so widely relied on in bioethics are philosophically and ethically inadequate, and that they undermine rather than support relations of trust. She shows how Kant's non-individualistic view of autonomy provides a stronger basis for an approach to medicine, science and biotechnology, and does not marginalize untrustworthiness, while (...) also explaining why trustworthy individuals and institutions are often undeservingly mistrusted. Her arguments are illustrated with issues raised by practices such as the use of genetic information by the police or insurers, research using human tissues, uses of new reproductive technologies, and media practices for reporting on medicine, science and technology. Autonomy and Trust in Bioethics will appeal to a wide range of readers in ethics, bioethics and related disciplines. (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)

As commonly understood, professional ethics consists of shared duties and episodic dilemmas--the responsibilities incumbent on all members of specific professions joined together with the dilemmas that arise when these responsibilities conflict. Martin challenges this "consensus paradigm" as he rethinks professional ethics to include personal commitments and ideals, of which many are not mandatory. Using specific examples from a wide range of professions, including medicine, law, high school teaching, journalism, engineering, and ministry, he explores how personal commitments motivate, guide, (...) and give meaning to work. (shrink)

In this paper, I examine two versions of the so-called “hierarchical” approach to personal autonomy, 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)

In Professional Ethics and Civic Morals , Emile Durkheim outlined the core of his theory of morality and social rights which was to dominate his work throughout the course of his life. In Durkheim's view, sociology is a science of morals which are objective social facts, and these moral regulations form the basis of individual rights and obligations. This book is crucial to an understanding of Durkheim's sociology because it contains his much-neglected theory of the state as a moral (...) institution, and it provides an understanding of his critique of anomie and egoistic individualism. The growing interest in cultural revolution and moral regulation make this edition of Durkheim's classic work especially timely. The new preface by Bryan Turner sets the book in its intellectual and historical context, and illustrates the relevance of this work to present day debates on the state, society, and moral regulation. (shrink)

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)

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.

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 personal autonomy. 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 (...) class='Hi'>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)

Concepts We thank all three commentators for extremely constructive, insightful, and gracious commentaries. We cannot address all their valuable points. In this response, we elucidate and relate the concepts of addiction, disease, disability, autonomy, and well-being. We examine some of the implications of these relationships in the context of the helpful responses made by our commentators. We begin with the definitions of the relevant concepts which we employ: ¥? ? ? Addiction (Liberal Concept): An addiction is a strong appetite. (...) ¥? ? ? Appetites: An appetite is a disposition that generates desires that are urgent, oriented toward some rewarding behavior, periodically recurring, often in predictable circumstances, sated temporarily by their fulfillment, and generally provide pleasure. ¥? ? ? Disease (Naturalistic Concept): A disease is some biological or psychological state that results in subfunctioning of the organism in a given set of environmental and social circumstances, C. The reference class is a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species. A normal function is a part or process within members of the reference class and is a statistically typical contribution by it to their individual survival and reproduction (Boorse 1977, 1997). ¥? ? ? Disability (Welfarist Concept): A disability is a relatively stable biological or psychological state that tends to reduce the amount of well-being that this person will enjoy in a given set of environmental and social circumstances (Savulescu and Kahane 2009; Kahane and Savulescu, 2009). ¥? ? ? Autonomy (Rationalist Concept): A person rationally desires or values some state of affairs if and only if he or she desires that state of affairs while (1) being in possession of all relevant. (shrink)

Communitarians like Alasdair MacIntyre, Charles Taylor, and Michael Sandel, defend what we may call the ‘social constitution thesis.’ This is the view that participation in society makes us what we are. This claim, however, is ambiguous. In an attempt to shed some light on it and to better understand the impact its truth would have on our beliefs regarding autonomy, I offer four possible ways it could be understood and four corresponding senses of individual independence and autonomy. I (...) also indicate what senses liberals can accept that we are socially constituted and in what sense I take communitarians to argue we are socially constituted. (shrink)

The majority of current attention on the question of autonomy has focused on the internal reflection of the agent. The quality of an agent’s reflection on her potential action (or motivating desire or value) is taken to determine whether or not that action is autonomous. In this paper, I argue that there is something missing in most of these contemporary accounts of autonomy. By focusing overwhelmingly on the way in which the agent reflects, such accounts overlook the importance (...) of what the agent is reflecting upon. Whichever of these current formulations of autonomy we accept, reflection could be undertaken in full accordance with the conditions set, and yet the action fail to be autonomous. This will occur, I argue, if the agent is mistaken about the object of her reflection. More precisely, if she has a particular kind of false belief about the action she is contemplating undertaking, then no amount of reflection can render that action autonomous. This suggests the need for externalist conditions to be incorporated into an account of autonomy. (shrink)

The principal aim of this volume is to elucidate what freedom, sovereignty, and autonomy mean for Nietzsche and what philosophical resources he gives us to re ...

Women have historically been prevented from living autonomously by systematic injustice, subordination, and oppression. The lingering effects of these practices have prompted many feminists to view autonomy with suspicion. Here, Marilyn Friedman defends the ideal of feminist autonomy. In her eyes, behavior is autonomous if it accords with the wants, cares, values, or commitments that the actor has reaffirmed and is able to sustain in the face of opposition. By her account, autonomy is socially grounded yet also (...) individualizing and sometimes socially disruptive, qualities that can be ultimately advantageous for women. Friedman applies the concept of autonomy to domains of special interest to women. She defends the importance of autonomy in romantic love, considers how social institutions should respond to women who choose to remain in abusive relationships, and argues that liberal societies should tolerate minority cultural practices that violate women's rights so long as the women in question have chosen autonomously to live according to those practices. (shrink)

The concepts of autonomy and of critical thinking play a central role in many contemporary accounts of the aims of education. This book analyses their relationship to each other and to education, exploring their roles in mortality and politics before examining the role of critical thinking in fulfilling the educational aim of preparing young people for autonomy. The author analyses different senses of the terms 'autonomy' and 'critical thinking' and the implications for education. Implications of the discussion (...) for contemporary practice are also considered. (shrink)

Despite receiving considerable philosophical attention, the concept of autonomy remains contested. In this paper, we diagnose one source of the continuing problem—an excessive emphasis on reflective self-appraisal in the dominant procedural models of autonomy—and suggest a solution. We argue that minimalist conceptions of rational self-appraisal are subject to fatal counterexamples. Yet, attempts to provide a more robust account of rational self-appraisal are too demanding to capture our intuitions about who counts as an autonomous agent. We argue that no (...) procedure of rational reflection will confer autonomy; rather autonomy is a matter of an agent’s actions flowing from her substantive commitments. Instead of rational self-reflection, autonomous actions are the product of the motive of care, which anchors an agent’s occurent desires to her system of value. (shrink)

Andrews Reath presents a selection of his best essays on various features of Kant's moral psychology and moral theory, with particular emphasis on his conception of rational agency and his conception of autonomy. Together the essays articulate Reath's original approach to Kant's views about human autonomy, which explains Kant's belief that objective moral requirements are based on principles we choose for ourselves. With two new papers, and revised versions of several others, the volume will be of great interest (...) to all students and scholars of Kant and of moral philosophy. (shrink)

Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a (...) rigorous articulation and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)

Part I: Seeking ethical values for the professions -- Sources of guidance and the basis of ethics -- Seeking a foundation for ethics in the professions -- Values integral to the role of professions -- Part II: Exploring values as principles -- Seeking the best results -- Treating people justly and fairly -- Treating people justly and fairly -- Respecting autonomy -- Acting with integrity -- Part III: Applying principles to practice -- Ethical thinking in professional situations -- (...) Dealing with dilemmas -- Blame -- A guide to thinking about rights. (shrink)

In this paper, I try to show that externalist compatibilism in the debate on personal autonomy 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)

This paper examines the notion that psychology is autonomous. It is argued that we need to distinguish between (a) the question of whether psychological explanations are autonomous, and (b) the question of whether the process of psychological discovery is autonomous. The issue is approached by providing a reinterpretation of Robert Cummins's notion of functional analysis (FA). A distinction is drawn between FA as an explanatory strategy and FA as an investigative strategy. It is argued that the identification of functional components (...) of the cognitive system may draw on knowledge about brain structure, without thereby jeopardizing the explanatory autonomy of psychology. (shrink)

Popular Frankfurt-style theories of autonomy hold that (i) autonomy is motivation in action by psychological attitudes that have ‘authority’ to constitute the agent's perspective, and (ii) attitudes have this authority in virtue of their formal role in the individual's psychological system, rather than their substantive content. I pose a challenge to such ‘psychologistic’ views, taking Frankfurt's and Bratman's theories as my targets. I argue that motivation by attitudes that play the roles picked out by psychologistic theories is compatible (...) with radically unintelligible behavior. Because of this, psychologistic views are committed to classifying certain agents as ‘autonomous’ whom we intuitively find to be dysfunctional. I then argue that a necessary condition for autonomy is that an agent's behavior is intelligible in a particular way: autonomy necessarily involves acting from a subjective practical perspective that is, in principle, minimally comprehensible to others – not simply in a causal sense, but in a substantive, socio-cultural sense. (shrink)

Contrary to what we might initially think, domestic violence is not simply a violation of respect. This characterization of domestic violence misses two key points. First, the issue of respect in connection with domestic violence is not as straightforward as it appears. Second, domestic violence is also a violation of care. These key points explain how domestic violence negatively affects a victim’s autonomy and agency—the ability to choose and pursue her own goals and life plan.We have a moral responsibility (...) to respond to the problem of domestic violence as individuals. But the state also has a responsibility to respond. According to Kant in the Doctrine of Right, one of the purposes of the state is to secure just treatment for everyone. I argue that this includes an obligation to put in place policies and services that will promote the autonomy and agency of victims of domestic violence. (shrink)

In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not (...) believe that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny. (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)

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of (...) autonomous action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1). (shrink)

Carazan's dream : Kant's early theory of freedom -- Kant's archimedean moment : remarks in observation concerning the feeling of the beautiful and the sublime -- Rousseau, Count Verri, and the true economy of human nature : lectures on anthropology, 1772-1781 -- The paradox of autonomy -- Moral hesitation in religion within the boundaries of bare reason -- Kant's true politics : Völkerrecht in toward perpetual peace and the metaphysics of morals -- Kant as educator : conflict of the (...) faculties, part one -- Archimedes revisited : honor and history in the conflict of the faculties, part two -- Kant's Jewish problem. (shrink)

The paper offers an analysis of the problem of integrating ethical principles into the practice of software design. The approach is grounded on a review of the relevant literature from Computer Ethics and Professional Ethics. The paper is divided into four sections. The first section reviews some key questions that arise when the ethical impact of computational artefacts is analysed. The inner informational nature of such questions is used to argue in favour of the need for a specific branch (...) of ethics called Information Ethics. Such ethics deal with a specific class of ethical problems and Informational Privacy is introduced as a paradigmatic example. The second section analyses the ethical nature of computational artefacts. This section highlights the fact that this nature is impossible to comprehend without first considering designers, users, and patients alongside the artefacts they create, use and are affected by. Some of key ethical concepts are discussed, such as freedom, agency, control, autonomy and accountability. The third section illustrates how autonomous computational artefacts are rapidly changing the way in which computation is used and perceived. The description of the ethical challenges posed to software engineers by this shift in perspective closes the section. The fourth and last section of the paper is dedicated to a discussion of Professional Ethics for software engineers. After establishing the limits of the professional codes of practice, it is argued that ethical considerations are best embedded directly into software design practise. In this context, the Value Sensitive Design approach is considered and insight into how this is being integrated into current research in ethical design methodologies is given. (shrink)

A central idea in moral and political philosophy, 'autonomy' is generally understood as some form of self-governance or self-direction. Certain Stoics, modern philosophers such as Spinoza, and most importantly, Immanuel Kant, are among the great philosophers who have offered important insights on the concept. Some theorists analyze autonomy in terms of the self being moved by its higher-order desires. Others argue that autonomy must be understood in terms of acting from reason or from a sense of moral (...) duty independent of the passions. Autonomy seems closely related to the notion of freedom, but in what sense: freedom from coercion, freedom from psychological constraints, or freedom from material necessity? Various approaches to these and similar questions yield different implications for public policy. Is capitalism, social democracy or socialism more favorable to autonomy? The essays in this volume address these important questions. (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)

This is the first volume to bring together original essays that address the theoretical foundations of the concept of autonomy, as well as essays that ...

It is often thought that the computational paradigm provides a supporting case for the theoretical autonomy of the science of mind. However, I argue that computation is in fact incompatible with this alleged aspect of intentional explanation, and hence the foundational assumptions of orthodox cognitive science are mutually unstable. The most plausible way to relieve these foundational tensions is to relinquish the idea that the psychological level enjoys some special form of theoretical sovereignty. So, in contrast to well known (...) antireductionist views based on multiple realizability, I argue that the primary goal of a computational approach to the mind should be to facilitate a translation of the psychological to the neurophysiological. (shrink)

There is widespread agreement that it would be both morally and legally wrong to treat a competent patient, or to carry out research with a competent participant, without the voluntary consent of that patient or research participant. Furthermore, in medical ethics it is generally taken that that consent must be informed. The most widely given reason for this has been that informed consent is needed to respect the patient's or research participant's autonomy. In this article I set out to (...) challenge this claim by considering in detail each of the three most prominent ways in which ‘autonomy’ has been conceptualized in the medical ethics literature. I will argue that whilst these accounts support the claim that consent is needed if the treatment of competent patients, or research on competent individuals, is to respect their autonomy, they do not support the claim that informed consent is needed for this purpose. (shrink)

Self-creation and autonomy -- Creation, society and the imaginary -- Self and world -- The living body -- The human psyche -- The whole world and more : the meaning of the monadic psyche and its fate -- Magmas -- Determination and the logic of indeterminate being -- Indeterminacy and interpretation -- Autonomy and meaning.

The problem of standard-of-care in clinical research concerns the level of care that investigators ought to provide to research subjects in the control arm of their clinical trials. Commentators differ sharply on whether subjects in trials conducted in lower income countries should be provided with the same level of care as subjects in trials conducted in higher income countries. I consider an argument that commentators have employed on both sides of this debate: professional role arguments. These arguments claim to (...) justify a conclusion to the standard-of-care problem solely by appeal to the professional obligations that investigators possess. I argue that prominent versions of professional role arguments cannot justify a solution to the problem of standard-of-care that is both determinate and reasonable simply by appeal to the professional obligations of investigators. Instead, to do so, one must also (1) determine the level of care or types of treatment that individuals are entitled to as a matter of distributive justice, and (2) identify which agents possess the duties that correspond to these entitlements. The level of care that investigators owe to subjects in the control arm of their clinical trials is thus in part dependent on the level of care that these subjects are entitled to as a matter of distributive justice, and whether it is the investigators who possess the corresponding distributive obligation to provide them with the care that they are entitled to. (shrink)

Autonomy is a fundamental though contested concept both in philosophy and the broader intellectual culture of today’s liberal societies. For instance, most of us place great value on the opportunity to make our own decisions and to lead a life of our own choosing. Yet, there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared to other commitments. For example, the success of every group project requires that (...) group members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy; however, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or the social stigma that often attaches to it. This book is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates in philosophy and psychiatry. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics. (shrink)

Philosophy is a vast subject and it is growing day by day in many branches although it has many traditional branches like epistemology, metaphysics, ethics and logic etc. Professional ethics is a discipline of philosophy and a part of subject called as ETHICS. In professional ethics we study the morals and code of conduct to be used while one practices in his/her profession. Media is also a profession and there is also a code of conduct to this profession (...) better. If media professional be ready to work according to its professional ethics, he/she can have a good approach and it will direct him/her to play an important role in shaping good governance. In this paper it is an attempt made to draw a relation between all these conceptions and presents a theoretical interpretation of the above. (shrink)

This paper discusses the proposal made by Lombardi and Labarca (Found Chem 7:125–148, 2005) that internal realism can secure the ontological autonomy of chemistry. I argue that internal realism is not, by itself, sufficient to accomplish this task. The fact that conceptual schemes may differ with respect to their theoretical virtues, and the possibility that the relations between them may be reductive undermine the premise that each conceptual scheme has an equal right to define its own ontology, which is (...) a key premise in Lombardi and Labarca’s proposal. (shrink)

Despite the apparently universal recognition of a pervasive "success at any cost" amorality in the professional and business world, and the need to do something about it, attempts to establish a campus-wide professional ethics curriculum continue to encounter resistance at many colleges and universities. The main stumbling block seems to be a purely practical one: How do you fit a course on professional ethics into academic worksheets that are already over-crowded with essential technical courses in every (...) class='Hi'>professional discipline? I maintain, to the contrary, that the real problem is one of attitude and will, and these in turn rest upon a set of mistaken notions about the nature of professional ethics. In this essay I highlight what I take to be a number of fallacies about professional ethics and then suggest a better way to think about its place in the formal education of professionals. (shrink)

Katerina Deligiorgi offers a contemporary defence of autonomy which is Kantian but engages closely with recent arguments about agency, morality, and practical reasoning.

By looking closely at the ideas of Rosseau, Kant, and Mill, Autonomy and Patients' Decisions traces the modern concept of autonomy from its historical roots, ...

Personal autonomy 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)