This chapter contains sections titled: Introduction Liberty of Thought and Expression Autonomy and Individuality Autonomy, Individuality, and Community: The Case of Mormon Polygamy Further Reading.

The impact and use of Information and Communication Technologies (ICTs) in healthcare settings has been increasing since 2019. This is greatly due to the COVID‐19 pandemic. But beyond accommodating an extraordinary and complex situation in terms of healthcare services, or beyond replacing personalised care delivered by healthcare professionals (HCPs), has there been a process of information and consultation for communities and HCPs? Do we have the basic requirements needed to make such use commonplace in health care? What will the impact (...) be on communities and their governance? Have we arrived here by consensus or by imposition? Our purpose has been to conduct a transnational analysis by approaching communities, social actors, and healthcare professionals in three territories in a pilot study following a qualitative methodology. The aim being to discover the potential impact of such measures beyond the right to health and if such measures are compatible with the purpose of population settling in rural areas. Furthermore, to identify if this entails a conflict of value and priorities or if we need new ethical reviews both for communities and healthcare professionals. (shrink)

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient’s autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that our answer (...) to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing. (shrink)

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue (...) that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms. (shrink)

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue (...) that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms. (shrink)

This volume brings together leading philosophers of Judaism on the issue of autonomy in the Jewish tradition. Addressing themselves to the relationship of the individual Jew to the Jewish community and to the world at large, some selections are systematic in scope, while others are more historically focused. The authors address issues ranging from the earliest expressions of individual human fulfillment in the Bible and medieval Jewish discussions of the human good to modern discussions of the necessity for the (...) Jew to maintain both a Jewish sensibility as well as an active engagement in the modern pluralistic state. Contributors include Eugene Borowitz, Elliot N. Dorff, Daniel H. Frank, Robert Gibbs, Lenn E. Goodman, Ze'ev Levy, Kenneth Seeskin, and Martin D. Yaffe. (shrink)

Today, the earth is an interconnected globe humming with electronic transmissions-a chattering planet nestled in the provident silence of space. The ethical question is whether this is contributing to authentic human development and helping individuals and peoples to be true to their transcendent destiny. The new media are powerful tools for education, cultural enrichment, commercial activity, political participation, intercultural dialogue and understanding. They also can serve the cause of religion. Yet the new information technology needs to be informed and guided (...) by solidarity in the service of the common good bridging the digital divide within and among nations. The value-laden message of Western secular culture to people and traditional societies in many cases ill-prepared to evaluate it leads to widespread crisis, for example, in regard to marriage and family life. This technology can be a means for solving human problems, promoting the integral development of persons, creating a world governed by justice, peace, and love. It also can help men and women in their age-old search for self-understanding. Like today's world itself, the world of media, including the Internet, has been brought by Christ, inchoately yet truly, within the boundaries of the kingdom of God and placed in service to the word of salvation. (shrink)

If a state with liberal political and justificatory commitments extends benefits of various kinds to persons forming families, what qualifications may such a state place on the right to access to those benefits? I will make two assumptions for the purposes of this paper. The first is the political and justificatory terrain of some form of political or otherwise non-perfectionist liberalism. The assumption is that we are considering the resources and limitations of a community of persons who accept moral (...) pluralism (if not a specific doctrine like the "burdens of judgment"), some priority for individual freedom, and the obligation to justify public coercion and exclusion in terms accessible and fair to all members of morally and culturally diverse society. The second is that it is justified for a liberal state to recognize some forms of domestic partnerships or families in the first place and extend further benefits to them such as tax credits or laws extending (or facilitating the extension of) medical or social insurance. It is, of course, possible to imagine the argument that the liberal state gets out of the marriage business by getting out of it entirely - by extending no recognition or positive rights to families whatsoever beyond negative non-interference rights. I am interested in the dilemma of a society broadly like existing liberal ones which is committed both to subsidizing families and also to justificatory neutrality (expressed in American constitutional legal terms as the requirement of providing a "rational basis" for unequal treatment). Given these assumptions, I believe that the most justifiable policy on liberal grounds is not the institution of "marriage" increasingly open to new constituent relationships but rather a status of "registered domestic partnership" which fulfills the social and moral aims behind subsidizing the family but is entirely neutral not only to the gender or even to the numbers of the partners, but also to the affective and emotional content of domestic life and the purposes behind contracting domestic partnerships. So is there a right to polygamy and incestuous marriage? There is not a specific right to either and thus there is no a priori reason why some restrictions or even prohibitions on them might not be justified, but the same is true for every specific act where a general right to the freedom exists. I argue in this paper, however, that the arguments compatible with public reason for prohibiting them outright, or even for excluding them from the permissible types of legally registered partnerships, are quite weak. I argue that objections to polygamy from (1) female autonomy, (2) damage to children, (3) fairness in the marital market, and (4) the unfair burdening of society are serious and worth refuting, but do not establish a victorious case against multi-member relationships. As to incest, there are two separate questions. The first is whether the new institution of "registered domestic partnerships" should be open to them. The answer to that, given the state's lack of interest in citizens' reasons for forming partnerships and in what they do whilst being registered in one, is clearly "yes." The second is whether, entirely separate from the issue of legal recognition of domestic partnership, the state has a legitimate rational interest in deterring, preventing or punishing consanguineous sexual relations between close blood relations (first-degree incest). Here, the objections to allowing such relations are those from (1) child abuse; (2) unfair burdening of society; and (3) the creation of bad lives. I argue that while rape and other forms of child abuse would be no more legal or tolerated than they are now, the concern about any form of weakening a society's legal and political resources to combat such abuses does indeed register on the justificatory scale, but does not prove that such first-degree incestuous sexual relations are inherently bad enough to warrant intervention. I then argue that the concern about unfairly burdening society with unhealthy persons is not as dangerously totalitarian as we might initially fear, but nor is it strong enough to justify an outright prohibition. Finally, I argue that a concern to dissuade persons from creating certain kinds of lives (children with extreme birth defects) is also not as dangerously totalitarian as we might initially fear, and in fact goes further towards explaining why we might have a legitimate interest in intervening. Nonetheless, I argue that the criminalization of such acts only make sense when they are indicators of other offenses, namely negligence or abuse, and it thus seems that the act of consanguineous reproduction is itself insufficient. (shrink)

Can researchers, interested in novel ways to assess HIV seroprevalence among populations which are otherwise hidden, collect condoms that have been discarded on the ground in a public sex environment and test them for HIV? Researchers, who use other types of abandoned samples, such as discarded syringes, hair or saliva samples, or excess biological samples, confront similar issues. This review evaluates whether such abandoned tissues can be studied based on U.S. Code of Federal Regulations and literature on related issues including: (...) research involving banked tissues, blinded seroprevalence studies, and property claims that individuals might make on the samples.It also addresses broader questions of potential for stigma and risk to individuals and communities. The article concludes that the research should be permitted legally because either it does not involve human subjects, or it satisfies the requirements for waiver of consent; and that the research should also be permitted because the ethical principal of avoiding harm to individuals is fully satisfied based on a careful reading of the lessons of the tissue bank, biological property rights, and blinded seroprevalence study debates, as well as a consideration of other potential harms that might be involved. (shrink)

In this article, an argument is made for extending bioethical principles to place-based community and cultural group protections when there are conflicting perspectives on reporting individual results of biomonitoring studies. Bioethical principles of beneficence, nonmaleficence, respect for autonomy, and justice can incorporate participatory decision-making and understandings of the group conditions of individual research participants, particularly for research studies with vulnerable groups. Arguments for and against biomonitoring communication to individual participants are reviewed here. Assessments of risks and benefits of biomonitoring (...) communication can be improved by considering the contextual conditions of cultural groups and place-based communities. Providing participatory decision-making with all stakeholders about biomonitoring communication can provide more fair benefits than adopting a general, prescriptive clinical standard that favors only group report-backs when clinical utility is low and the scientific understandings of low dose exposures of chemical contaminants to humans are still uncertain. (shrink)

This study was aimed at examining the impacts of the Sharing economy on the individual and community Quality of Life and wellbeing by looking at their associated influencing factors using Village Savings and Loans Associations as a model of sharing economy in Malawi. An online community-based cross-sectional study design was conducted from November 2020 through January 2021. In the survey, 402 Village Savings and Loans Associations members from the Mzuzu City area participated, recruited using snowball and respondent-driven sampling (...) techniques. The sample size was computed using a single population proportion using the Yamane formula. Descriptive statistics and ordinal logistic regression model techniques were also employed. Additionally, we used the Chi-Square test, two-way ANOVA, and Ordinal regression model to determine statistical associations between socioeconomic data and QOL and wellbeing variables with a 5% level of significance. On the aspect of community wellbeing, the findings of our study indicated that income provided members with options to live a better QOL and wellbeing within the community by either facilitating payment for better education, eating healthier foods, acquiring assets, etc. Further, the absence of discrimination provided a platform for voice, inclusion, and social trust, enhancing freedom of expression. We also found that education facilitated better earnings and knowledge of public health-related issues. As for the contribution to the sharing economy, our study has emphasized the role played by trust in enhancing sharing economy. We recommend and encourage people to join these VSLAs so as to improve their QOL and wellbeing. However, there is a need to replicate the study on a larger scale to validate our study findings for effective policy formulation and implementation geared to improving the overall quality of people’s lives. Based on these findings, we further recommend that authorities reinstate programs like National Strategy for Financial Inclusion 2016–2020 and Savings and Loan Groups Best Practice Guidelines 2016–2017 that could further enhance the future of VSLAs, which are vital for QOL and community wellbeing of the people in developing countries like Malawi. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Concepts, Communication, and the Relevance of Philosophy to Human Rights:A Response to Randall PeerenboomStephen C. AngleRandy Peerenboom has paid me the enormous compliment of thinking it worthwhile to engage in sustained, critical dialogue with my book. In this response to his review essay, I attempt to return the compliment. I focus on issues surrounding concepts and communication, since that is where Peerenboom puts his emphasis. Near the end, I (...) look at what is at stake in our discussions of Raz, touch on the question of judgments and objectivity, and close with some thoughts about the relevance of history to my goals in the book. [End Page 320]At the heart of Peerenboom's critique of my account of concepts and communication are two concerns. First, he worries that I do not "provide a satisfactory answer to the questions of how to determine whether we are dealing with a single concept or discourse or multiple concepts or discourses." Second, he suggests that my entire discussion of concepts, "while interesting academically, at least for those with a taste for philosophy, diverts attention from the real issues." I will begin with the first. A valuable result of Peerenboom's essay is that it helps me to see where I have not made myself as clear as I would have liked to. At various points in the book, I raise the issue of the normative nature of questions like those Peerenboom has posed (see, e.g., pp. 27 and 32), but this is clearly something that needs more emphasis. Asking what a word means, or whether two people share a concept, or, for that matter, where the boundaries of a discourse lie are never simple, descriptive questions. These are normative questions, which always receive normative answers. By "normative," I mean that the questions and their answers are prescriptive for those in my shared community. When someone says "we mean such-and-such by that word," the "we" is crucial: it is saying that people like us, in some respect, ought to talk this way. Thinking about language in normative terms permeates Brandom's approach. He writes, for example: "When the prosecutor at Oscar Wilde's trial asked him to say under oath whether a particular passage in one of his works did or did not constitute blasphemy, Wilde replied 'Blasphemy is not one of my words.'"1 Wilde recognized, that is, that using the word "blasphemy" brought with it certain commitments that he—and other like-minded individuals—ought to reject, even if he were to deny that a particular passage was blasphemous.So far so good. But Peerenboom sees a tension between what looks like a community-based definition of concepts—perhaps all Chinese ought therefore to share the same commitments?—and my endorsement of a holistic approach to meaning, according to which our individual webs of commitments always vary from one to another. This latter idea leads him to be puzzled about when two people can ever be said to share the same concept. He searches for a criterion for a sufficiently similar concept, wonders whether my talk of "keeping score" can provide such a criterion, and in the end decides that the choice of where to draw these lines is, in many cases, arbitrary. There is indeed a tension, and some arbitrariness, too, although not exactly where Peerenboom sees it. But none of this is problematic, I think, and in any case it emerges from the very complexity of our linguistic practice. Communities do not impose norms on us: we authorize the norms through the ways we speak, act, and react to others. "Authorize" is apt because it combines the ideas of creation and legitimation. Our perpetual roles as authorizers of a community's linguistic (and other) norms give us a certain amount of autonomy with respect to the norms, as well as explaining some variance, as we (consciously or unconsciously) push boundaries in one direction or another. At the same time, no one is a member of only one community. We interact with different groups at different times and in different ways, which puts the notion that we could be bound by the norms of a single... (shrink)

Individuals use their capacity for autonomy to express preferences regarding food choices. Food choices are fundamental, universal, and reflect a diversity of interests and cultural preferences. Traditionally, autonomy is cast in only epistemic terms, and the social and political dimension of it, where autonomy obstruction tends to arise, is omitted. This reflects problematic limits in the Cartesian notion of the individual. Because this notion ignores context and embodiment, the external and internal constraints on autonomy that extend from social location are (...) not considered. Therefore, reconceptions of the individual and autonomy which emphasize social location and relational interdependency are needed. To combat autonomy obstruction, individuals can appeal to community and community autonomy as a social mechanism. Communities are social groups characterized by people living in places with shared goals. Recognizing their interdependency, individuals can organize as communities in order to accomplish objectives that they cannot on their own. While community autonomy is valuable unto itself, it can also enhance individual autonomy. (shrink)

This essay investigates how a liberal state should treat violations of human rights within minority cultures. It is argued that the best approach gives due weight to the following three features: the free exercise of culture, protection of human rights and the balance of power between the majority and minority communities in a given polity. This balanced approach is contrasted with the theories of Kukathas, Okin and Spinner-Halev, who are criticised for concentrating on only the first, second and third of (...) these features respectively. The Arab Israeli Plonit case and the Indian Muslim Shah Bano case are used to illustrate this argument. The Israeli treatment of Plonit shows the virtues of the author's preferred approach, while the Indian treatment of Shah Bano indicates the dangers of concentrating on the second feature alone, as many liberals advocate, and neglecting the other two. (shrink)

Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries have potentially lifelong (...) consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult. (shrink)

Abstract:The moral and political implications of new forms of organisation and resource allocation in education are explored. Markets, even when heavily regulated and administered, induce effects contrary to the values of individual and social freedom upon which public education is understood to be founded. Their ‘efficiency’ as allocative and distributive mechanisms is questioned and examined specifically in relation to the formative and constitutive role of community life in conferring identity and autonomy upon individuals. Competition, it is claimed, leads to (...) stratification of opportunities and outcomes. Putative efficiency gains may be outweighed by equity losses. (shrink)

The long-running discourse on respect for human dignity and autonomy in the physician-patient relationship pertaining to persons with dementia (PwDs) is explored deeply in this paper through the use of a real-life case, to highlight the complex interplay between autonomy and best interest when it comes to a PwD's experiential and critical interests. Many scenarios and perspectives are described and applies to the case. However, there are a few perspectives, which are touched upon that could do with further (...) scrutiny. Firstly, it has been argued that rigid adherence to the advance directives of PwDs means that PwDs will be the only people who are not allowed to ever change their minds. This withdrawal of a fundamental freedom hardly accords with respect for human dignity, or for any residual autonomy that these individuals may still enjoy. Secondly, viewing this case through the lens of care ethics, and incorporating the recently proposed conceptual framework of anthropological vulnerability, may reveal valuable insights regarding care provision and caring physician-patient relationships. These perspectives would analyse the role of relational ontology, particularly in relation to significant others, significant communities, and caregivers. (shrink)

This paper considers the applicability of expressive theories of punishment to the punishment of corporate entities. The author argues that although arguments which suggest that the denunciatory account is superior to a communicative account in paradigmatic cases of punishment cannot be transferred straightforwardly to cover this kind of case, there are other reasons, connected with the different attitudes we have to regret and remorse in individual and collective cases, for preferring a communicative to a denunciatory account here.

This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) (...) provide prospective subjects the choice to participate in standard doubleblind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials. (shrink)

Autonomy is traditionally considered to be an epistemic capacity of individuals to think for themselves, and the community is held to be its central obstruction. Autonomy is the internal capacity to freely use reason to form beliefs and preferences that are one’s own. It is premised on the atomistic individual conceived as a decontextualized rational mind. Accordingly, natural, physical, and social externalities have not been included in discourse on autonomy. But if individuals are seen as embodied dwellers within social (...) and natural environments and are reconceived as ecological, that is, partly constituted by their environments, then autonomy must likewise be reconceived. Ecological autonomy is an internal epistemic capacity to think and an external actional capacity to act for oneself in relation to other individuals and environments. Whereas traditional and even relational autonomy require that competency and authenticity conditions must be met for internal thinking, ecological autonomy requires two sets of competency and authenticity conditions, one for internal thought and one for external action. An ecological treatment holds that while community can obstruct autonomy, it also generates and sustains it to reveal how community and place are co-defined as mutually constitutive companion concepts with alternate emphases. Place emphasizes physical and social, and natural and artificial environments, but includes people and social practices. Community emphasizes people, social practices, knowledge, and values, but includes the environing world. (shrink)

It is now widely accepted that microorganisms play many important roles in the lives of plants and animals. Every macroorganism has been shaped in some way by microorganisms. The recognition of the ubiquity and importance of microorganisms has led some to argue for a revolution in how we understand biological individuality and the primary units of natural selection. The term “holobiont” was introduced as a name for the biological unit made up by a host and all of its associated microorganisms, (...) and much of this new debate about biological individuality has focused on whether holobionts are integrated individuals or communities. In this paper, I show how parts of the holobiont can span both characterizations. I argue that most holobionts share more affinities with communities than they do with organisms, and that, except for maybe in rare cases, holobionts do not meet the criteria for being organisms, evolutionary individuals, or units of selection. (shrink)

This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) (...) provide prospective subjects the choice to participate in standard doubleblind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials. Keywords: autonomy, double-blind trials, prerandomized and randomized trials, informed consent CiteULike Connotea Del.icio.us What's this? (shrink)

The dissertation explores the implications of the liberal value of individual autonomy for the rights of cultural minorities in liberal societies. Liberals traditionally have assumed that respect for autonomy precludes the political recognition of citizens' cultural identities. But in recent years a number of self-styled "liberal nationalists" have argued that honoring the value of autonomy actually entitles cultural minorities and their members to a plethora of cultural rights, including political autonomy, minority jurisdiction over land and language, the public subsidization of (...) ethnic festivals, the symbolic recognition of ethnic and religious groups, and even a right to national self-determination. I argue that both the "liberal neutralist" and the "liberal nationalist" accounts of what individual autonomy stands for are mistaken. I present an alternative way of viewing the connection between the value of individual autonomy and claims for cultural recognition, one that preserves the primacy and inherent complexity of this central liberal value. Rightly understood, liberal autonomy supports the political recognition of cultural identity in principle and in a wide range of cases, but the principle and the cases fall well short of the extravagant claims recently made in its name. My analysis suggests that the principle of liberal autonomy sustains a civil right to cultural expression in the manner of classical civil rights, an approach that many liberal democracies implicitly have been moving toward in recent years. (shrink)

Many AIDS-related issues are polarised. At the social level, civil rights or liberties are seen as being in conflict with general utility, and an analogous distinction is often assumed to exist at the one-to-one, individual level at which doctors work. In this paper the latter form of the distinction is argued to be false. By seeing autonomy as part of welfare, doctors can think more directly about such issues as paternalism, confidentiality, and consent. A number of these issues are discussed (...) in the light of the revised conception of welfare, in the form of simplified case studies. (shrink)

This paper examines, on the basis of a longitudinal corpus of 50 early modern authors, how change at the aggregate level of the community interacts with variation and change at the micro-level of the individual language user. In doing so, this study aims to address the methodological gap between collective change and entrenchment, that is, the gap between language as a social phenomenon and the cognitive processes responsible for the continuous reorganization of linguistic knowledge in individual speakers. Taking up (...) the case of the prepositional passive, this study documents a strong community-wide increase in use that is accompanied by increasing schematicity. A comparison of the 50 authors reveals that regularities arising at the macro-level conceal highly complex and variable individual behavior, aspects of which may be explained by studying the larger (social) context in which these individuals operate (e. g., age cohorts, community of practice, biographical insights). Further analysis, focusing on how authors use the prepositional passive in unique and similar ways, elucidates the role of small individual biases in long-term change. Overall, it is demonstrated that language change is an emergent phenomenon that results from the complex interaction between individual speakers, who themselves may change their linguistic behavior to varying degrees. (shrink)

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by its legal apparatus (...) come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person‐ and people‐centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision‐making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision‐making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system. (shrink)

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as (...) well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)

To restructure and systematize the concept of personalization, in this study we introduce a two-dimensional and relational typology of personalization of political representation, comprising a horizontal as well as a vertical dimension, and put it to an empirical test. We concertedly utilize content analyses of political newspaper and television coverage as well as of party press releases during the 2008 Austrian election campaign. With regard to the Austrian case, the findings outline that personalization of political representation is not a (...) universal phenomenon; it rather appears as a context- and logic-sensitive communicational phenomenon. Political public relations shows significantly higher levels of horizontal as well as vertical diversification than the media by being more individualized and less monopolized by leaders and executive elites. Additionally, political representation in the tabloid press is more personalized than in quality papers, and the communication of catch-all parties is more individualized than of niche parties. (shrink)

(OPEN ACCESS) In this article, I explore the implications of three moral grounds for the justification of supported voting – respect as opacity, respect as equal status, and respect as political care. For each ground, I ask whether it justifies surrogate voting for voters unable to either communicate or give effect to their electoral judgments, due to some cognitive or communicative disability. (Henceforth: incommunicability cases.) I argue that respect as opacity does not permit surrogate voting, and equal status does not (...) justify such support – although the latter account can make sense of the value loss involved in the persistent non-participation of individuals with cognitive and communicative disabilities. Finally, I argue that an account of supported voting based on the ethics of political care can accommodate a pro tanto moral permission to provide surrogate voting as a form of support in incommunicability cases, and it can account for the inclusive approach of the UN Convention on the Rights of Persons with Disabilities to supported decision-making. However, I show that in incommunicability cases, what the political community and individual caretakers ultimately owe to adult fellow citizens as equal members of the political community is some adequate form of political care – but not necessarily surrogate voting. (shrink)

Disasters and public health emergencies raise a variety of ethical dilemmas, often including those that require balancing the best interests of individuals against those of groups or communities. The on-going COVID-19 pandemic provides examples of these ethical conflicts, as do other recent outbreaks. Decisions and actions in this context must address different ethical issues, ranging from those directly related to autonomy, consent, privacy and confidentiality to those related to interventions and technologies, such as efficacy, effectiveness, safety and fair access. This (...) paper aims to identify ethical conflicts with complex resolutions involving aspects related to values, rights and needs of individuals and the collective, and to suggest how such challenges could lead to more positive experiences and outcomes when confronted in future emergencies. (shrink)

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported (...) continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift be approached with caution. (shrink)

The challenge in maintaining patient autonomy regarding medical decision-making and confidentiality lies not only in control over information transferred to and regarding patients, but in the ambiguity of autonomy itself. post-modernity is characterized by the recognition of not just numerous accounts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, and an element of human flourishing. In each case, it can have a different content, (...) depending in part on whether it is given a nomological or a volitional construal. Different accounts of autonomy can lead to strikingly different understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of autonomy they themselves affirm. In the face of competing accounts of moral probity, autonomy in a secular morality and bioethics must by default be understood in terms of the permission of patients, which makes space for numerous moral accounts and different communal construals of free choice, which in turn will legitimate different practices of informing patients and maintaining confidentiality. (shrink)

The Chinese ethical tradition has often been thought to oppose Western views of the self as autonomous and possessed of individual rights with views that emphasize the centrality of relationship and community to the self. The essays in this collection discuss the validity of that contrast as it concerns Confucianism, the single most influential Chinese school of thought. Alasdair MacIntyre, the single most influential philosopher to articulate the need for dialogue across traditions, contributes a concluding essay of commentary. This (...) is the only consistently philosophical collection on Asia and human rights and could be used in courses on comparative ethics, political philosophy and Asian area studies. (shrink)

The article attempts to show how memory influenced the formation of the unique spiritual identity of Edith Stein, who was born and grew up in the religious tradition of Judaism, but as an adult became the member of the Catholic Church. What seems to be unusual in her religious self-perception is the fact that despite conversion, Edith permanently regarded herself as a Jew and firmly claimed that she constantly belonged to the Jewish community. Her mind-set was immensely influenced by (...) the image of Jesus as a devout Jew portrayed in the New Testament, zealously practicing the sacred rites of Judaism, as well as her later analysis of the Christian and Jewish ways of worship. Her study exposed a deep bond linking Christianity with Judaism and by revealing this bond Edith Stein evoked the forgotten truth about the Jewish roots of Christianity which is deeply rooted in the faith of the Old Testament and draws a lot from the richness of its tradition. Undoubtedly, this important link reminded by Edith Stein, raised and developed later by the official teaching of the Catholic Church, was possible because she remembered the religious tradition in which she grew up and which she experienced in her childhood. Memory, therefore, became the constituent that shaped her own spiritual identity, but also contributed to the reinterpretation of the identity of the Christian community. (shrink)

This research contributes to emergent theories on subject formation by showing how community garden participants in a small rural town in Northern Peru came to embrace a set of ideas and practices related to organic agriculture. Most CG scholarship describes the myriad benefits for participants and their communities, as well as individuals’ motivations for wanting to grow their own food. Relatively little research has explored how various kinds of gardens and their organizers produce subjects. Drawing from scholarship on (...) class='Hi'>community gardens and subject formation, I examine the emergence of what I call an “organic subjectivity” among garden participants. Based on interviews and fieldwork conducted in Peru, I argue that the making of organic subjects in the CG is the result of three primary influences: the changing agrarian context in the community marked by the adoption of conventional farming practices, the influence of the garden organizer as the agent of an organic ideology, and the material practices associated with CG participation. This case study reinforces the notion that CGs produce subjects and that such subjects could well be oriented towards an agenda of progressive agrarian change that promotes environmental awareness and ecological farming practices, key elements of emerging alternative food networks in the global North and South. (shrink)

BackgroundThe Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed (...) consent and potential limitations to the principle of respect for autonomy in African communities.MethodsWe conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.ResultsBased on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.ConclusionsWe conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities. (shrink)

Bioethicists, medical professionals and lawyers who support Posthumous Assisted Reproduction as an ethical procedure in the case of the deceased’s spouse often oppose it in the case of the deceased’s parents. In addition, supporters of PAR usually rely on an individualistic version of liberalism, thus focusing on a personal rather than relational approach to autonomy. This article proposes an alternative and comprehensive theoretical framework for the practice of PAR, based on the concepts of solidarity and relational autonomy. By (...) analyzing empirical data on people’s attitudes towards PAR, we reveal an important distinction between the deceased’s wish and the deceased’s consent. In addition, we show that in the majority of cases individuals report that the well-being of their relatives is paramount once they are dead. This finding, as will be demonstrated in the article, is not fully in line with Tremellen and Savulescu’s position who allow PAR in the case of the deceased’s spouse but not in the case of his parents. We also suggest that a relational autonomy perspective can be used to evaluate the choices and actions of the deceased, and to justify the requests for PAR by his spouse or parents. Furthermore, the discussion leads us to analyze both Sandel’s account of solidarity and the more recent account of Prainsack and Buyx. We conclude that PAR can be considered as a solidarity-based practice, both at the familial and societal level, an aspect that should be given more emphasis in the discourse surrounding PAR. (shrink)

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated (...) in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community. (shrink)

A disaster is an occurrence disrupting a community’s normal functioning and existence. The disruption may render it impossible to comply with principles and to respect, protect, and fulfill rights as it happens in ordinary times; it may induce an overwhelming shortage of resources and make tragic decisions unavoidable. From its very beginning, the COVID-19 pandemic evoked the scenario of disaster medicine, where triage is likely to imply not simply postponing a treatment but letting someone die. However, it is not (...) only the health care system that faces disruption risks. Lockdown measures and other restrictions were imposed to curb the pandemic, impinging upon individual freedom as well as economic activities. The proposal of mandatory vaccination implied a suspension of the principle of autonomy, which is a fundamental pillar of modern medicine. Out of the ordinary balancing efforts may be required, and two questions arise. Do such exceptional circumstances suggest reconsidering the criteria to apply, especially when essential, life-saving treatments are at stake? Who should decide? Science offers the premises to build on, but the last word does not belong to science. It remains the province of ethics and politics. (shrink)

The advent of HIV focussed broad social attention on the group of people most affected by it in Australia, the so-called ‘gay community’. However, what a gay community actually was, and what kind of rights and duties were being attached to it remained unclear. However, it is obvious that such a community — or communities — did not fit the model proposed by communitarian writers like Michael Sandel and Charles Taylor, whereby subjects cannot stand outside their own (...) constitutive attachments. I also consider the common criticism of communitarianism, and see what kinds of collectives can in fact be considered ethical.The first part of this paper looks at the ethical issues surrounding community attachment of this kind in Australia in relation to the ethics of HIV/aids clinical research. In particular I examine the way in which certain forms of gay community attachment can be used to strengthen personal autonomy and check exploitation within the prevention and research process.The second part of this paper draws upon the issues just discussed. In particular I focus on the use of ‘community’ in the research process in developing countries, and suggest ways in which cultural considerations might strengthen autonomy. However, I go on to suggest that in many cases the idea of community has served the opposite purpose, and has in fact been used to oppress certain individuals and groups within the developing world, in the so-called interests of the greater good. In order to avoid this, I suggest a model of social and ethical research whereby all subjects and researchers in the clinical process might stand in greater relationships of equality with each other. (shrink)

The notion of epistemic responsibility applied to memory has been in general examined in the framework of the responsibilities that a collective holds for past injustices, but it has never been the object of an analysis of its own. In this article, I propose to isolate and explore it in detail. For this purpose, I start by conceptualizing the epistemic responsibility applied to individual memories. I conclude that an epistemic responsible individual rememberer is a vigilant agent who knows when to (...) engage in different kinds of mental and non-mental actions in order to monitor and update her memories, and who develops and nurture different kinds of virtuous attitudes that guide those actions. These (epistemic) virtuous attitudes are oriented not only towards herself but also towards others. Whereas this conception of epistemic responsibility does not pose a problem to understand shared memories of family members and friends, it may seem suspicious when applied to large-scale collective memories. These memories, which I name historical memories, are memories of events that have a traumatic impact for the community, are permeated by unequal relations of power, keep a complex relationship with historical science, and present other characteristics that distinguish them from individual memories. But despite these differences, the analysis undertaken in this work shows that the general principles that govern the epistemic responsibility of individual and (large-scale) collective rememberers are similar, and are based on similar grounds: pragmatic considerations about the consequences of misremembering or forgetting and a feeling of care. The similarities at the individual and collective scale of the epistemic vigilant attitude that is and should be taken toward our significant past may partially justify the use of the same epithet—“memory”—to refer to these different kinds of representations. (shrink)

In an era of global interdependence, the concept of autonomy may no longer name our core moral need. Shifting friendships and enmities across political boundaries bear significant consequences for the individual. Perhaps social alliances and hostilities have always had an impact on the flourishing of individuals and communities. But globalization (especially as viewed through the technology of the information age) magnifies the impact of external forces on sovereign bodies. These forces remind individuals of the need to establish the right kind (...) of connections, and diminish (but do not exclude) the relative importance of autonomy for moral and political discourse. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Autonomy and Community: Readings in Contemporary Kantian Social Philosophy ed. by Jane Kneller and Sidney AxinnJeanine GrenbergJane Kneller and Sidney Axinn, editors, Autonomy and Community: Readings in Contemporary Kantian Social Philosophy. Albany: State University of New York Press, 1998. Pp. xi + 334. Paper, $21.95.The intent of this volume is not narrow textual exegesis but the application of Kantian themes to “problems of contemporary society,” (xi). (...) The editors thus advise their readers that “[t]he present collection is … ‘Kantian’ in a broad sense,” and that the opinions put forward by the contributors may “diverge rather widely” (viii) from Kant’s own. In an introductory essay, Jane Kneller notes further that the book distinguishes between “political” philosophy in a narrow sense, and “social” philosophy, which is concerned with “the behaviour of human beings” more broadly construed. Kant, Kneller argues, does have such a “social philosophy,” and this volume will reveal it.The book is largely successful in its stated goal. The essays run the gamut of careful, if controversial, textual analyses (e.g., Allen Wood’s and Robert Paul Wolff’s essays) to those which take Kant simply as a launching pad for an analysis of a variety of social issues. At times, this relation to Kant is a positive one (e.g., Harry van der Linden’s claim that Kant provides the basis for enterprise democracy), and at times negative (e.g., Charles Mills’ claim that Kantian respect for persons masks a “dark ontology” which supports structural racism).A careful reader can find among these varied essays interestingly opposed approaches to similar topics. Wolff and Sharon Anderson-Gold [End Page 538] end up at loggerheads over the relation of Kant’s ethical and social philosophies. Wolff makes Kant’s justification of morality derivative of the establishment of the social contract. But Anderson-Gold argues for a reversed relationship; for her, Kant’s “principle of humanity” grounds a basic human right of persons in any society to be free from certain types of state interference.Another interesting juxtaposition is found between Nelson Potter and Thomas Auxter, both of whom tackle Kant’s views on retributivism. Potter seeks to humanize retributivism by showing its basis in equality and respect for persons. Auxter takes a diametrically opposed approach, arguing that Kant’s moral theory can stand unscathed if we eliminate his now outdated retributivist commitments.A meta-issue looms in all these discussions: what does and doesn’t count as “Kantian”? This book, wisely, provides no hard and fast definition; rather, by presenting a broad variety of at times seriously divergent points of view, it constitutes a refreshingly pluralistic response to what counts as Kantian: Kantian is as Kantian does. It is rare to find such diversity of interpretation in a single volume, and this book is to be commended for achieving it.There are, however, prices to pay for the achievement of diversity, the largest being a certain disconnectedness of thought. The sectioning of the book into two parts—“Kantian Social Theory” and “Kant and Contemporary Social Issues” —instead of helping to guide the reader, ends up encouraging an ultimately strained distinction. Why does Robin Schott’s essay on feminism belong with “social theory” instead of “contemporary social issues”? Why don’t Anderson-Gold’s reflections on the relationship between moral and social issues qualify as “social theory”? It might have been better, organizationally, to highlight more specific themes by distinguishing sections on “Retributivism,” “International Law,” and the like.The individual essays vary in their success in defending their stated theses. Allen Wood is insightful and even-handed in convincing this initially skeptical reader of what seems, at first blush, a rather implausible view of Kant as an historical materialist. Though some may not find his own position to be very “liberal,” Gerald Gaus’ assessment of the current state of Kantian liberalist approaches to environmental values and his proposed alternative are cogent, enlightening and challenging. Sidney Axinn’s acceptance, without argument, of a simple analogy between individual persons and individual nation states to argue for the need for a world government makes his account ultimately dissatisfying. Charles Mills rightly takes note of an editor’s concern that... (shrink)

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were (...) manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sensemaking processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed. (shrink)

The Hypothesis of Extended Cognition (HEC)—that many cognitive processes are carried out by a hybrid coalition of neural, bodily and environmental factors—entails that the intentional states that are reasons for action might best be ascribed to wider entities of which individual persons are only parts. I look at different kinds of extended cognition and agency, exploring their consequences for concerns about the moral agency and personal responsibility of such extended entities. Can extended entities be moral agents and bear responsibility for (...) actions, in addition to or in place of the individuals typically held responsible? What does it mean to be autonomous when one’s cognition is influenced and supported by a milieu of environmental factors? To answer these questions, I explore strong parallels between HEC’s critique of individualism in cognition, and feminist critiques of individualist accounts of self, agency, and autonomy. This relational and social conception of autonomous agency, as scaffolded and supported (or undermined and impaired) by a milieu of social, relational, and normative factors, has important lessons for HEC. Drawing together these two visions of distributed and decentralized aspects of personhood highlights how cognition, action, and responsibility are inextricably linked. It also encourages a reconceptualization of all cognition and all concerns about responsibility for actions, not simply as sometimes extended around individuals, but as fundamentally communal, social, and normative, with individual cognition and individual moral responsibility being derivative special cases, not the paradigm examples. Individuals are merely one of many possible loci of cognition, action, and responsibility. (shrink)

That Jehovah’s Witnesses may refuse lifesaving blood transfusions is a morally accepted feature of contemporary medical practice. The principle of respect for autonomy supports this, and there is seldom reason to interfere with this choice because it rarely harms another individual. Advances in surgical technique have made it possible for transplant surgeons to perform bloodless organ transplant, enabling Jehovah’s Witnesses to benefit from this treatment. When the transplant organ is a directed donation from a family member or friend, no ethical (...) dilemma arises. However, when a Jehovah’s Witness cannot identify a living donor and wishes to be listed for organ transplant, the transplant team may face an ethical dilemma. On the one hand, it wishes to provide care to the patient that is compatible with her or his preferences. On the other hand, the team may wonder if it is fair to other patients who need an organ and will accept blood transfusion to include the Jehovah’s Witness patient on a waiting list for a donated organ. If the Jehovah’s Witness patient is listed and receives an organ, then a patient who also needs an organ, and who is willing to accept all care to optimize the success of the transplant, may be denied an organ.To frame the ethical dilemma outlined above we present an anonymized case of a Jehovah’s Witness woman in urgent need of a kidney, who was referred to one of the authors’ institution’s transplant center. We review the evolution of the Jehovah’s Witness position on blood transfusion and the medical community’s efforts to provide care that accommodates this religious commitment. If Witnesses are to be denied transplant in the name of justice, there must be an ethically sound reason. We identify two rationales in the literature: (1) this allocation is unacceptable because it will cost lives; (2) resources should be allocated to patients who comply with the standard of care. We argue that neither apply to this dilemma. We also emphasize the importance of examining the data on outcomes of transplant with and without transfusion. Our interpretation of the published data on transplant without transfusion is that the outcomes are similar. We conclude that, in the absence of data that resources are risked, it is not ethical to refuse to include a Jehovah’s Witness patient on a waiting list for an organ. Finally, we reflect on the heterogeneity in transplant institutes’ polices for accepting Jehovah’s Witness patients. (shrink)

During the Nazi era, most German physicians abrogated their responsibilities to individual patients, and instead chose to advocate the interests of an evil regime. In so doing, several fundamental bioethical principles were violated. Despite gross violations of individual rights, many physicians went on to have successful careers, and in many cases were honored. This paper will review the case of Hans Sewering, a participant in the Nazi euthanasia program who became the President-elect of the World Medical Association. The appropriate (...) stance for the medical and scientific community toward those who violate human rights and ignore fundamental ethical principles of the healing professions will be considered. (shrink)