This paper argues for a conception of autonomy that takes social oppression seriously without sapping autonomy of its valuable focus on individual self-direction. Building on recent work in relational accounts of autonomy, the paper argues that current conceptions of autonomy from liberal, feminist and critical theorists do not adequately account for the social features of belief formation. The paper then develops an alternative conception of relational autonomy that focuses on how autonomy contains both individualistic and social epistemic features. Rather than (...) consider autonomy to reside in an impenetrable inner citadel, a place immune from external influences, the paper argues that we must acknowledge the hermeneutic relationship between individual and social processes of belief adjudication. Taking such an argument seriously results in the need to alter our conception of autonomy and the schooling needed to foster its growth. (shrink)

This paper presents a formal framework that purports to capture some aspects of Kant's theory of freedom. In particular, we argue that the analysis sheds further light on Kant's distinction between a negative and a positive concept of freedom. The paper shows that the two concepts are not equivalent: we not only argue that in a Kantian perspective negative freedom need not entail positive freedom, but also that there are situations in which a person can be said to be positively (...) but not negatively free (in a Kantian sense). (shrink)

With the publication of A Theory of Justice in 1971, John Rawls not only rejuvenated contemporary political philosophy but also defended a Kantian form of Enlightenment liberalism called “justice as fairness.” Enlightenment liberalism stresses the development and exercise of our capacity for autonomy, while Reformation liberalism emphasizes diversity and the toleration that encourages it. These two strands of liberalism are often mutually supporting, but they conflict in a surprising number of cases, whether over the accommodation of group difference, the design (...) of civic education, or the promotion of liberal values internationally. During the 1980’s, however, Rawls began to jettison key Kantian characteristics of his theory, a process culminating in the 1993 release of Political Liberalism and completing the transformation of justice as fairness into a Reformation liberalism. -/- Reconstructing Rawls argues that this transformation was a tragic mistake because it jeopardized the most important features of his theory, viz. the lexical priorities of right, liberty, and fair equality of opportunity as well as the difference principle. Controversially, this book contends that Rawls’s so-called “political turn,” motivated by a newfound interest in diversity and the accommodation of difference, has been unhealthy for autonomy-based liberalism and has pushed liberalism more broadly towards cultural relativism, be it in the guise of liberal multiculturalism or critiques of cosmopolitan distributive-justice theories. The book then demonstrates that the central elements of justice as fairness can only be defended within the context of a Kantian Enlightenment liberalism and that Rawls’s hope for a more pluralistic grounding for his theory, endorsed by a wide variety of belief systems present in modern democratic societies, is illusory. -/- Reconstructing Rawls is the first book to systematically compare Rawls’s and Kant’s theories and the first to offer an internal critique and reconstruction of justice as fairness, reconceiving it as a comprehensive, universalistic Kantian liberalism. By doing so, it gives us both the vision of a liberal world order—“a republicanism of all states, together and separately,” as Kant put it—and a mode of justification addressed to all men and women, not as members of particular nations, races, and faiths, but as human beings, as citizens of the world. In short, it reclaims Rawls for the Enlightenment. (shrink)

The use of placebo controls in surgical research, or ‘sham surgery’ as it sometimes described, raises a number of ethical issues. Despite such issues, sham surgery is presently being employed, albeit very rarely, in surgical research. In this paper, the ethical implications of such control groups are discussed in the context of research into various conditions, including Parkinson's Disease and arthritis. Conflicting ethical considerations include: i) patients' best interests in relation to the harms and risks involved; ii) the need for (...) more rigorous methods in surgical research, and iii) the question of patient autonomy. Contextual features which may influence the ethical acceptability of a specific sham-controlled surgical trial are discussed. (shrink)

Some have objected to human enhancement on the grounds that it violates the autonomy of the enhanced. These objections, however, overlook the interesting possibility that autonomy itself could be enhanced. How, exactly, to enhance autonomy is a difficult problem due to the numerous and diverse accounts of autonomy in the literature. Existing accounts of autonomy enhancement rely on narrow and controversial conceptions of autonomy. However, we identify one feature of autonomy common to many mainstream accounts: reasoning ability. Autonomy can then (...) be enhanced by improving people’s reasoning ability, in particular through cognitive enhancement; given how valuable autonomy is usually taken to be, this gives us extra reason to pursue such cognitive enhancements. Moreover, autonomy-based objections will be especially weak against such enhancements. As we will argue, those who are worried that enhancements will inhibit people’s autonomy should actually embrace those enhancements that will improve autonomy. (shrink)

Political liberals argue that the classical conception of autonomy must be discarded because it is sectarian and metaphysical. This article rejects that a commitment to autonomy necessarily leads to sectarianism and questions the notion that respect for persons is separable from the commitment to autonomy. It defends a Kantian approach to autonomy, as belonging to the standpoint of practical reason, and argues that in this approach autonomy is a norm regulating how we should treat each other as opposed to a (...) good to be promoted. This approach also avoids the metaphysical idea of autonomy as self-origination of binding principles. (shrink)

Debates over how to conceptualize the nursing role were prominent in the nursing literature during the latter part of the twentieth century. There were, broadly, two schools of thought. Writers like Henderson and Orem used the idea of a self‐care deficit to understand the nurse as doing for the patient what he or she could not do alone. Later writers found this paternalistic and emphasized the importance of the patient's free will. This essay uses the ideas of positive and negative (...) freedom to explore the differing conceptions of autonomy which are implicit in this debate. The notion of positive freedom has often been criticized as paternalistic, and the criticisms of self‐care in the nursing literature echo criticisms from political philosophy. Recent work on relational autonomy and on the relationship between autonomy and identity are used to address these objections. This essay argues for a more nuanced conception of the obligation to support autonomy that includes both positive (freedom to) and negative (freedom from) dimensions. This conception of autonomy provides a moral foundation for conceptualizing nursing in something like Henderson's terms: as involving the duty to expand the patient's capacities. The essay concludes by generalizing the lesson. Respect for autonomy on the part of any health care provider requires both respect for the patient's choices and a commitment to expand the patient's ability to actualize their choices. (shrink)

Background Denmark has implemented a comprehensive, nationwide pharmaceutical information system, and this system has been evaluated by the Danish Council of Ethics. The system can be seen as an exemplar of a comprehensive health information system for clinical use. Analysis The paper analyses 1) how informed consent can be implemented in the system and how different implementations create different impacts on autonomy and control of information, and 2) arguments directed towards justifying not seeking informed consent in this context. Results and (...) Conclusion Based on the analysis a heuristic is provided which enables a ranking and estimation of the impact on autonomy and control of information of different options for consent to entry of data into the system and use of data from the system. The danger of routinisation of consent is identified. The Danish pharmaceutical information system raises issues in relation to autonomy and control of information, issues that will also occur in relation to other similar comprehensive health information systems. Some of these issues are well understood and their impact can be judged using the heuristic which is provided. More research is, however needed in relation to routinisation of consent. (shrink)

(2013). Autonomy and the Normativity Question: Framing Considerations. International Journal of Philosophical Studies. ???aop.label???. doi: 10.1080/09672559.2012.727014.

In this paper I will argue that Mill employs a tacit concept of competence in On Liberty. I will focus on the role of truth and individuality in On Liberty. Competence is a precondition for individuality, and as such, it is a threshold concept: those above the threshold are sensitive to rational argument and should be free to pursue happiness in their own way (because they are guided by the truth), whereas those who fail to meet this threshold should be (...) educated and paternalistically be kept out of harm's way until they are able to find the truth for and by themselves. (edited). (shrink)

Aesthetic hedonism is the view that to be aesthetically good is to please. For most aesthetic hedonists, aesthetic normativity is hedonic normativity. This paper argues that Kant's third critique contains resources for a non-hedonic account of aesthetic normativity as sourced in autonomy as self-legislation. A case is made that the account is also Kant's because it ties his aesthetics into a key theme of his larger philosophy.

For decades, the greater part of efforts to improve regulatory frameworks for research ethics has focused on informed consent procedures; their design, codification and regulation. Why is informed consent thought to be so important? Since the publication of the Belmont Report in 1979, the standard response has been that obtaining informed consent is a way of treating individuals as autonomous agents. Despite its political success, the philosophical validity of this Belmont view cannot be taken for granted. If the Belmont view (...) is to be based on a conception of autonomy that generates moral justification, it will either have to be reinterpreted along Kantian lines or coupled with a something like Mill’s conception of individuality. The Kantian interpretation would be a radical reinterpretation of the Belmont view, while the Millian justification is incompatible with the liberal requirement that justification for public policy should be neutral between controversial conceptions of the good. This consequence might be avoided by replacing Mill’s conception of individuality with a procedural conception of autonomy, but I argue that the resulting view would in fact fail to support a non-Kantian, autonomy-based justification of informed consent. These difficulties suggest that insofar as informed consent is justified by respect for persons and considerations of autonomy, as the Belmont report maintained, the justification should be along the lines of Kantian autonomy and not individual autonomy. (shrink)

The article analyses the three terms autonomy, dignity and vulnerability. The relevance and practical application of the terms is tested in two spheres. First, as guiding principles in the area of ethics of medicines and science. Second, as human rights principles, serving to guide the conduct of public policies for an effective realization of human rights. The article argues that all human beings have the same dignity, but that the autonomy—and therefore vulnerability—differs considerably. Simply said, with reduced autonomy comes increased (...) vulnerability, implying extra attention to the protective dimensions. The article finds that the three terms approach the protection of human beings in different ways and that all are relevant and applicable in both spheres, but that an isolated notion of autonomy and a ‘group-based’ notion of vulnerability are not adequate. (shrink)

All people have human rights and, intuitively, there is a close connection between human rights, needs, and autonomy. The two main theories about the natureand value of human rights often fail to account for this connection. Interest theories, on which rights protect individuals’ important interests, usually fail to capturethe close relationship between human rights and autonomy; autonomy is not constitutive of the interests human rights protect. Will theories, on which human rights protect individuals’ autonomy, cannot explain why the nonautonomous have (...) a human right to meet their needs. This paper argues that it is possible to account for the close connection between human rights, needs, and autonomy if human rights at least protect individuals’ ability to live minimally good lives. It argues that people need whatever will enable them to live such lives and autonomy is partly constitutive of such a life. This argument also has importantimplications for some other key debates in the human rights literature. (shrink)

The paper defends the theoretical strength and consistency of Rawls's constructivism, showing its ability to articulate and convincingly weave together several key ethical ideas; yet it questions the political relevance of this admirable normative architecture. After having illustrated Rawls's conception of moral agency and practical reason, the paper tackles two criticisms raised by Scheffler. First the allegation of naturalism based on Rawls's disdain of common sense ideas on desert is rebutted. It is then shown that, contrary to Scheffler's contention, Rawls (...) takes proper account of our moral sentiments in the process of constructing his normative theory. Finally, the second criticism is assessed, namely the inability of Rawls's theory to increase consent around liberal policies. Despite disagreement with details of Scheffler's argument, it is suggested that the failure of recent normative liberal theories to have a political impact belies their inability to take into proper consideration the reality of politics. A more realistic appraisal of political life and of historical events and developments are called for if political philosophy wants to be something more than an academic exercise. (shrink)

Strategies for improving individual decision making have attracted attention from a range of disciplines. Surprisingly, neuroscience has been largely absent from this conversation, despite the fact that it has recently begun illuminating the neural bases of how and why we make decisions, and is poised for further such advances. Here we address empirical and normative questions about “nudging” through the lens of neuroscience. We suggest that the neuroscience of decision making can provide a framework for understanding how nudges work, and (...) how they can be improved. Towards this end, we first examine how nudges can be incorporated into a leading model of decision making supported by neurobiological data, and use the model to make predictions about the relative effectiveness of different classes of nudges. We then use the model to demonstrate how nudges can both infringe upon and promote autonomy. Finally, we explore the normative implications of the converging consensus from neuroscience and related fields that many everyday decisions are susceptible to covert external influences. (shrink)

Autonomy, the ability to make decisions for ourselves about ourselves, is among the most prized of human liberties. In this review we reconsider the key conditions necessary for autonomous decision making, long debated by moral philosophers and ethicists, in light of current neuroscientific evidence. The most widely accepted criteria for autonomy are that decisions are made by a rationally deliberative and reflective agent and that these decisions are free of undue external influences. The corpus of neuroscientific data suggest that human (...) brains are capable of the hierarchical control required for reflective thought, but that decisions conventionally perceived as autonomous may not be rational with respect to the deliberative process itself, and are rarely free from covert external influences. These findings cast doubt upon the capacity for autonomy as traditionally defined, and suggest that we reconsider valorizing the right to autonomy in order to align our moral values with neuroscientific naturalism. (shrink)

Background: Obtaining patients’ informed consent is an ethical and legal obligation in healthcare practice. Whilst the law provides prescriptive rules and guidelines, ethical theories of autonomy provide moral foundations. Models of practice of consent, have been developed in the bioethical literature to assist in understanding and integrating the ethical theory of autonomy and legal obligations into the clinical process of obtaining a patient’s informed consent to treatment.Aims: To review four models of consent and analyse the way each model incorporates the (...) ethical meaning of autonomy and how, as a consequence, they might change the actual communicative process of obtaining informed consent within clinical contexts.Methods: An iceberg framework of consent is used to conceptualise how ethical theories of autonomy are positioned and underpin the above surface, and visible clinical communication, including associated legal guidelines and ethical rules. Each model of consent is critically reviewed from the perspective of how it might shape the process of informed consent.Results and discussion: All four models would alter the process of obtaining consent. Two models provide structure and guidelines for the content and timing of obtaining patients’ consent. The two other models rely on an attitudinal shift in clinicians. They provide ideas for consent by focusing on underlying values, attitudes and meaning associated with the ethical meaning of autonomy.Conclusions: The paper concludes that models of practice that explicitly incorporate the underlying ethical meaning of autonomy as their basis, provide less prescriptive, but more theoretically rich guidance for healthcare communicative practices. (shrink)

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

Recent philosophy has developed an overblown concept of autonomy. In fact we do not have moral autonomy, and personal autonomy we only have in the sense of being able to decide some things that affect the course of our lives, not in the sense of shaping these lives and being master over them; nor ought we to have autonomy in the latter sense, or come closer to having it. As for our political institutions, they do not presuppose, as prevailing doctrines (...) claim they do, citizens’ autonomy in a more demanding sense. Freedom and democracy as understood for instance in the German constitution only assume subordinates capable of deciding some matters on their own. Current talk of autonomy is just gilding people’s real dependence. (shrink)

The idea of autonomy, presented as Kant’s main achievement in the Groundwork and the second Critique, is hardly present in the ethics of the “Doctrine of Virtue”. Against Pauline Kleingeld’s recent interpretation, I argue that this does not amount to a disappearance of the Principle of Autonomy, but to an important development of the notion of autonomy. I first show that Kant still advocated the Principle of Autonomy in the 1790s along with the thought of lawgiving through one’s maxims. I (...) then argue that the role of autonomy in Kant’s later ethics has a different focus than in the previous works, which requires to connect autonomy with autocracy. Conversely, in the “Doctrine of Virtue”, autocracy, which Kant had employed before as an independent notion, is construed as a new layer of autonomy. What Kant there calls subjective autonomy is thereby considered as reason’s self-government in the maxims of each rational agent. -/- . (shrink)

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)

El propósito central de este artículo es hacer un análisis desde una perspectiva constructivista del concepto de derecho de dos de los principios más importantes de la filosofía política de Kant: el principio del derecho y la idea del contrato original. El texto comienza con una breve exposición de lo que significa el constructivismo kantiano. A continuación se hace un análisis del concepto de derecho y de los atributos que definen a la ciudadanía, a saber: la libertad, la igualdad y (...) la independencia civil. En la última parte, se examina la concepción kantiana del contrato original y se trata de mostrar que hay, para Kant, deberes políticos tanto de derecho como de virtud. (shrink)