Gadow's understanding of nursing as a relational narrative anchored in a dialectic between the fundamental subjectivity of the individual client and the objectification of his illness poses some interesting questions for nursing ethics and care. For Gadow, nursing is an encounter with the immediate vulnerability of the client and also lends it responsibilities to the medical objectification of illness aiming at disease treatment and control. Hence, nursing agency is divided between its responsibilities induced by the personal vulnerability of the patient (...) and the more impersonal, but benevolent intention shaped by medical knowledge. Medical knowledge is impersonal in the sense that it is knowledge detached from the subjectivity of the patient. But how is nursing able to reconcile the interests derived from personal and experienced vulnerability with the more impersonal and often conflicting demands of medical knowledge? This question is even more intriguing because there seems to be an objective dimension within a patient's subjectivity itself: an autonomous person can critically evaluate his own subjectivity as a basis for informed self‐interest. The sick person is thus confronted with objectivity on two important levels: the objective facts of his disease and his detachment from his own experiential vulnerability when engaged in the critical evaluation of his self‐interest. This paper will discuss the normative dimensions of these complex and, frequently, conflicting perspectives from the theoretical perspectives of Thomas Nagel's normative responsibility and Sally Gadow's clinical epistemology and relational narratives. The empirical basis for the discussion will be an ongoing study of the ethical dimensions of pain relief and sedation in an intensive care unit. (shrink)

Advocates of cognitive enhancement maintain that technological advances would augment autonomy indirectly by expanding the range of options available to individuals, while, in a recent article in this journal, Schaefer, Kahane, and Savulescu propose that cognitive enhancement would improve it more directly. Here, autonomy, construed in broad procedural terms, is at the fore. In contrast, when lauding the goodness of enhancement expressly, supporters’ line of argument is utilitarian, of an ideal variety. An inherent conflict results, for, within their utilitarian frame, (...) the content of rational, hence autonomous, choices is quite restricted. Further, advocates do not clearly indicate their relative emphasis between the often conflicting goals of maximizing benefit and avoiding harm. In practice, their construction of harms is highly expansive, for disabilities include any constraints that “rational” people would decline if it were technically possible to do so. For advocates, this means that where enhancement measures are available, those constraints become avoidable limitations, and not to remove them is to harm. The centrality of harm-avoidance and their ideal utilitarian frame entail sociopolitical requirements that enhancement defenders disallow when trumpeting autonomy in the vein of individual choice. Advocates have thus not done enough to support the claim that their views are wholly separate from earlier eugenics. (shrink)

Over-simple internalist accounts of practical reasons imply that we cannot have reasons to become more rational, because they claim that we have a reason to φ only if we would have some desire to φ if we were fully rational. But if we were fully rational, we would have no desire to become more rational. Robert Johnson has recently argued that in their attempts to avoid this problem, existing versions of internalism yield reasons which do not have an appropriate connection (...) with potential explanations of action. I suggest that the problem is partly a result of failure to see that action-tokens are usually tokens of a wide variety of action-types, and that the internalist conditional need only be true of one of these types in order to justify a reason claim about the token. (shrink)

Economic Theory normally assumes the so-called homo economicus, a consequential model of rationality. We highlight the main features of this model in opposition to deontology: axiological homogeneity, maximization and agent neutrality. Amartya Sen’s criticism of standard consequentialism copes to those features, and includes commitment and duty in the economic rationality. We analyze his concept of preference to ascertain how far economic rationality can thus go in the direction of deontology. We conclude that, though diminished, the difference between them still remains.

El artículo defiende que los compromisos son tanto un tipo de acuerdo como un tipo de decisión. Los principales objetivos son: 1) identificar la estructura formal de las situaciones de compromiso en las que alguna decisión de compromiso es inevitable, incluyendo CDs que ponen en riesgo la integridad del decisor; 2) mediante las nociones de juicio básico y compulsivo propuestas por Amartya Sen, establecer cuándo una CD en una situación de compromiso podría estar moralmente justificada. Se concluye que las CDs (...) justificadas implican una contrición moral que ayuda a salvar la distancia entre deontología y consecuencialismo. (shrink)