This article concerns the morality of establishing regulated kidney markets in an effort to reduce the chronic shortage of kidneys for transplant. The article tries to rebut the view, recently defended by James Taylor, that if we hold autonomy to be intrinsically valuable, then we should be in favor of such markets. The article then argues that, under current conditions, the buying and selling of organs in regulated markets would sometimes violate two Kantian principles that are seen as moral (...) constraints. One principle forbids expressing disrespect for the dignity of humanity; the other forbids treating others merely as means. In light of the moral danger posed by regulated markets, the article advocates an alternative way of diminishing the current organ shortage, namely opt-out systems of cadaveric organ donation. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification (...) in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

Kant distinguishes between autonomous and heteronomous agents. Because Kant is concerned with the nature of moral action, not its consequences, he isn’t concerned with whether autonomous agents achieve better outcomes than heteronomous agents. And yet, the question about the expected outcomes of the different types of agency is an interesting one to pursue, for it is not obvious up front which type of agent would achieve better outcomes. This paper uses game theory to explore and begin to answer this question. (...) We present a game theoretic examination of five forms of heteronomy and their corresponding forms of autonomy. We show that across a significant range of interactive situations agents who have the autonomy to choose between selfishness and either empathy or altruism achieve expected material payoffs equal to the maximum expected material payoffs of the corresponding heteronomous agents. We also show that across the same range of interactions agents who have the autonomy to choose between a deontological moral law and selfishness, empathy, or altruism achieve higher expected material payoffs than the corresponding heteronomous agents. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a (...) foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

This paper aims to draw attention to an explanatory problem posed by the existence of multiply realized or universal behavior exhibited by certain physical systems. The problem is to explain how it is possible that systems radically distinct at lower-scales can nevertheless exhibit identical or nearly identical behavior at upper-scales. Theoretically this is reflected by the fact that continuum theories such as fluid mechanics are spectacularly successful at predicting, describing, and explaining fluid behaviors despite the fact that they do not (...) recognize the discrete nature of fluids. A standard attempt to reduce one theory to another, is shown to fail to answer the appropriate question about autonomy. (shrink)

This paper studies the relationship between promoting people's welfare and respecting their autonomy of choice under risk. I highlight a conflict between these two aims. Given compelling assumptions, welfarists end up disregarding people's unanimous preference, even when everyone involved is entirely rational and only concerned with maximizing their own welfare. Non-welfarist theories of social choice are then considered. They are shown to face difficulties, too: either they fail to respect the value of welfare in at least one important sense, (...) or they end up prioritizing different people's welfare differently in non-risky choices, on the basis of their attitudes to risk, which are intuitively irrelevant in this context. (shrink)

Challenging many of the currently accepted conceptions of autonomy and of how it is valued, Oshana develops a social-relational account of autonomy that is constituted by a person's relations with others and by the absence of certain social relations. She denies that command over one's motives and the freedom to realize one's will are sufficient to secure the kind of command over one's life that autonomy requires, and argues against psychological, procedural, and content neutral accounts of (...) class='Hi'>autonomy. (shrink)

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to (...) date. I critically review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates. (shrink)

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value (...) of personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of (...) class='Hi'>autonomy, and argue that a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Part of what makes the environment valuable is its autonomy. There are some who think that any human influence on an environment is necessarily autonomy-compromising because it is a form of human control. In this article, I will assume human influence on the environment necessarily undermines autonomy. However, I will argue, even given this assumption, it is still possible for the intervention to enable autonomy in the long run. My focus is on genetic intervention into organisms, (...) because some might think human influence in these cases cannot dissipate. I argue this is mistaken and, borrowing a concept from botany, I argue genes, even genes inserted into a genome by humans, can “naturalize.” Furthermore, they can function in ways that are autonomy-enabling to the individual and to the system to which the organism belongs. (shrink)

The new mechanists and the autonomy approach both aim to account for how biological phenomena are explained. One identifies appeals to how components of a mechanism are organized so that their activities produce a phenomenon. The other directs attention towards the whole organism and focuses on how it achieves self-maintenance. This paper discusses challenges each confronts and how each could benefit from collaboration with the other: the new mechanistic framework can gain by taking into account what happens outside individual (...) mechanisms, while the autonomy approach can ground itself in biological research into how the actual components constituting an autonomous system interact and contribute in different ways to realize and maintain the system. To press the case that these two traditions should be constructively integrated we describe how three recent developments in the autonomy tradition together provide a bridge between the two traditions: (1) a framework of work and constraints, (2) a conception of function grounded in the organization of an autonomous system, and (3) a focus on control. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Well-Being, Disease, and DisabilityJulian Savulescu (bio)Keywordsautonomy, well-being, mental disorder, psychiatric disease, disability, welfare, body integrity identity disorderVarelius seeks to redefine what constitutes mental disorder or mental illness. (I use these terms interchangeably.) "According to this account, 'a person is mentally disordered when her psychological capacity for autonomy is diminished as compared with that of a typical member of our species of her age-group" (Varelius 2009). This (...) is a stimulating and important paper. Varelius describes fruitfully the relationship between mental illness and autonomy, specifically the ways in which mental disorder can undermine autonomy. This is valuable in understanding the impact of mental illness on the lives of people who suffer from it, which is a serious issue in practical ethics. But is it what constitutes mental disorder or illness? There are logical, conceptual reasons why we should not redefine mental illness in this way.Incomplete Account of Mental DisorderThere are a family of related concepts: disease, injury, disorder, illness, disability. There are old and entrenched disputes about how we should define these concepts. Varelius' paper is a contribution to the definition of mental disorder and illness.The primary classificatory category that defines medical practice is that of health and disease. Disease, broadly construed, involves the presence of pathology. Pathology can result from processes primarily or predominantly internal to the organism, such as genetic disease (although external factors affect their expression), or from processes primarily or predominantly external to the organism, such as injuries.The concepts of disorder and illness relate to the concept of disease. Disorder could be defined in terms of the functional effect of pathology. Illness could be defined in terms of the experiential impact of disease.1 How these terms are precisely defined and related need not concern us at the present. What matters is that the primary category is disease.Psychiatry has evolved in its use of terminology. What used to be called psychiatric diseases are now often called mental disorders. I now claim, for the purposes of illustration of the argument (though it does not require this claim), that the dominant category is disease. Indeed, what are called mental disorders appear in the International Classification of Diseases.Disease can be divided into the mental and physical. I believe that the mental will one day be [End Page 59] shown to be shown to be entirely a subset of the physical. That is, that brain pathology will be a cause, if not the only cause, of mental disease. But others may believe the sets of mental and physical disease are intersecting but not coextensive.What matters is that mental disease is a subcategory of the more general category of disease. It must have the same definitional features as "disease" plus some extra ones specific to the "mental," or mind. (The same points apply if you use "disorder" as the dominant category rather than "disease.")One problem for Varelius is this: how does this autonomy account of "mental disease" relate to an account of "physical disease," and "disease" in general? If mental disease is defined in terms of its impact on the psychological capacities necessary for autonomy, how is "disease" in general, or physical disease, to be defined? One obvious response is to define these related concepts in a similar way:Disease: "a person is diseased when her capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group." Physical disease: "a person is physically disordered when her physical capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group."This interpretation is suggested by the following passage from Varelius:As contrasted with the actual condition of being autonomous, as a capacity of an individual autonomy means that a person has the psychological and bodily abilities that being autonomous... requires.(2009)It would be radical to define disease in general in terms of capacity for autonomy. There is no doubt that disease affects our autonomy, and that is morally significant, but these seem clearly separable concepts. Varelius could respond that he is not defining mental disease but rather the mental component... (shrink)

The much‐noted decline of “state autonomy” theories owes partly to external challenges to state power, such as globalization, supranational regimes, and the like. But advanced democratic states have also long been seen as threatened from within, especially by powerful private interest groups. The extent of private‐interest influence on policy making depends in important part on corporate lobbyists, a group whose activities are chronicled in this essay. Lobbyists exercise considerably more autonomy from the private clients who hire them than (...) has previously been acknowledged. This portrait ultimately suggests that the national state and civil society may be mutually supportive rather than strictly separate spheres. (shrink)

Sometimes neuroscientists discover distinct realizations for a single psychological property. In considering such cases, some philosophers have maintained that scientists will abandon the single multiply realized psychological property in favor of one or more uniquely realized psychological properties. In this paper, we build on the Dimensioned theory of realization and a companion theory of multiple realization to argue that this is not the case. Whether scientists postulate unique realizations or multiple realizations is not determined by the neuroscience alone, but by (...) the psychological theory under examination. Thus, one might say that, in the splitting or non-splitting of properties, psychology enjoys a kind of autonomy from neuroscience. (shrink)

The principle of autonomy is widely recognized to be of utmost importance in bioethics; however, we argue that this principle is often misapplied when one fails to distinguish two different contexts in medicine. When a particular patient is offered treatment options, she has the ultimate say in whether to proceed with any of those treatments. However, when deciding whether a particular intervention should be regarded as a form of medical treatment in the first place, it is the medical community (...) who has the ultimate say. Some argue that particular interventions should be allowed by virtue of the fact that they are autonomously requested. But making such an argument fails to distinguish between these two contexts and misapplies the principle of autonomy, ultimately having the potential to instigate problematic changes in the practice of medicine. (shrink)

Lawrence Haworth's book, Autonomy, discusses “Autonomy as a Psychological Idea”, and “Autonomy as a Normative Idea”. Part 1 discusses autonomy in relation to rationality, agency, and responsibility, defends it against Skinnerian sceptics, and outlines a theory of autonomous decision-making and the autonomous task environment. Haworth's conception of autonomy integrates and builds on the concepts of S. I. Benn, G. Dworkin, H. Frankfurt, and R. W. White. Part 2 centres on social/political theory, and not, despite the (...) book's subtitle, on ethics as such. Haworth argues that only autonomy, and not liberty or happiness, is an intrinsic value, and fundamental right. His “autonomist” theory of liberty rights, a form of revisionary liberalism derived from the later idealists, is opposed to the classical liberal/libertarian theory. The arguments prompt a re-examination of the role of autonomy in the arguments for liberty, but do not, in my view, make a persuasive case for “autonomism” against classical liberalism. The book is chiefly noteworthy for its success in covering many important topics connected with autonomy, in an impressively short space, and in an always clear and often very insightful way. (shrink)

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide a (...) firmer basis for ethical guidelinesand policies in this field. (shrink)

Over the last half decade or so, Jürgen Habermas has increasingly employed the interview format, both as a means of presenting his changing views on philosophical topics in an accessible way, and as a means of debating current social and political issues. This new, expanded edition of Autonomy and Solidarity includes an additional five interviews in which Habermas discusses such themes as the history and significance of the Frankfurt School, the social and political development of post-war Germany, the moral (...) status of civil disobedience, the implications of the "Historians' Dispute," and the function of national identity in the modern world. Never before published autobiographical material covering Habermas' early years at the Frankfurt Institute for Social Research is followed by an extended philosophical interrogation of his latest thinking on the relations between ethics, morality and law. With an extended introduction by Peter Dews, exploring the status and prospects of Critical Theory in the light of the recent revolutionary transformations in Europe, Autonomy and Solidarity should be of interest and value both to newcomers and those already familiar with Habermas' thought. (shrink)

Nudging is considered a promising approach for behavioural change. At the same time, nudging has raised ethical concerns, specifically in relation to the impact of nudges on autonomous choice. A complexity is that in this debate authors may appeal to different understandings or dimensions of autonomy. Clarifying the different conceptualisations of autonomy in ethical debates around nudging would help to advance our understanding of the ethics of nudging. A literature review of these considerations was conducted in order to (...) identify and differentiate between the conceptualisations of autonomy. In 33 articles on the ethics of nudging, we identified 280 autonomy considerations, which we labelled with 790 unique autonomy codes and grouped under 61 unique super-codes. Finally, we formulated three general conceptualisations of autonomy. Freedom of choice refers to the availability of options and the environment in which individuals have to make choices. Agency involves an individual's capacity to deliberate and determine what to choose. Self-constitution relates to someone's identity and self-chosen goals. In the debate about the ethics of nudging, authors refer to different senses of autonomy. Clarifying these conceptualisations contributes to a better understanding of how nudges can undermine or, on the other hand, strengthen autonomy. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to (...) exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die. (shrink)

This book draws connections and explores important questions at the intersection of the debates about relational autonomy and relational equality. Although these two research areas share several common assumptions and concerns, their connections have not been systematically explored. The essays in this volume address theoretical questions at the intersection of relational theories of autonomy and equality and also consider how these theoretical considerations play out in real-world contexts. Several chapters explore possible conceptual links between relational autonomy and (...) equality by considering the role of values--such as agency, non-domination, and self-respect--to which both relational autonomy theorists and relational egalitarians are committed. Others reflect on how debates about autonomy and equality can clarify our thinking about oppression based on race and gender, and how such oppression affects interpersonal relationships. Autonomy and Equality: Relational Approaches is the first book to specifically address the relationship between these two research areas. It will be of interest to scholars and graduate students working in social and political philosophy, moral philosophy, and feminist philosophy. (shrink)

The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks (...) associated with chronic care. The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy. (shrink)

Agency is the human capacity to freely choose one’s thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it (...) is argued that to respect the autonomy of individuals, it is essential to establish their agency. (shrink)

Throughout the 20th century, market capitalism was defended on parallel grounds. First, it promotes freedom by enabling individuals to exploit their own property and labor-power; second, it facilitates an efficient allocation and use of resources. Recently, however, both defenses have begun to unravel—as capitalism has moved into its “platform” phase. Today, the pursuit of allocative efficiency, bolstered by pervasive data surveillance, often undermines individual freedom rather than promoting it. And more fundamentally, the very idea that markets are necessary to achieve (...) allocative efficiency has come under strain. Even supposing, for argument’s sake, that the claim was true in the early 20th century when von Mises and Hayek pioneered it, advances in computing have rekindled the old “socialist calculation” debate. And this time around, markets—as information technology—are unlikely to have the upper hand. -/- All of this, we argue, raises an important set of governance questions regarding the political economy of the future. We focus on two: How much should our economic system prioritize freedom, and to what extent should it rely on markets? The arc of platform capitalism bends, increasingly, toward a system that neither prioritizes freedom nor relies on markets. And the dominant critical response, exemplified by Shoshana Zuboff’s work, has been to call for a restoration of market capitalism. Longer term, however, we believe it would be more productive to think about how “postmarket” economic arrangements might promote freedom—or better yet, autonomy—even more effectively than markets, and to determine the practical steps necessary to realize that possibility. (shrink)

This paper extends Mori’s (IEEE Robot Autom Mag 19:98–100, 2012) uncanny valley-hypothesis to include technologies that fail its basic criterion that uncanniness arises when the subject experiences a discrepancy in a machine’s human likeness. In so doing, the paper considers Mori’s hypothesis about the uncanny valley as an instance of what Heidegger calls the ‘challenging revealing’ nature of modern technology. It introduces seeming autonomy and heteronomy as phenomenological categories that ground human being-in-the-world including our experience of things and people. (...) It is suggested that this categorical distinction is more foundational than Heidegger’s existential structures and phenomenological categories. Having introduced this novel phenomenological distinction, the paper considers the limits of Mori’s hypothesis by drawing on an example from science fiction that showcases that uncanniness need not only be caused by machines that resemble human beings. In so doing, it explores how the seeming autonomy-heteronomy distinction clarifies (at least some of) the uncanniness that can arise when humans encounter advanced technology which is irreducible to the anthropocentrism that shapes Mori’s original hypothesis. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action (...) and decision-making. Descriptively, it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

Is there tension in a view of the conditions of being in a proper position to make aesthetic evaluations that is committed to aesthetic autonomy and norms of exposure? I define ‘aesthetic autonomy’ in terms of the Kantian idea that in order to make a proper aesthetic evaluation, one must rely on oneself rather than on any outside source. I define ‘norms of exposure’ in terms of the Humean idea that practice and aesthetic education are conditions of proper (...) aesthetic evaluation. Prima facie, these two commitments point toward competing accounts of whether exposure is a condition of being in a position to make proper aesthetic evaluations. However, I argue that a closer look at the Kantian position reveals that aesthetic exposure is a condition of being able to make aesthetic evaluations in an autonomous way in the Kantian framework. (shrink)

The prelims comprise: Introduction Controversial Choices Kinds of Normative Reasons for Action Limits on Respect for Autonomy Children and Controversial Choice Controversial Choices and the Duty to Strive Toward Perfection and Full Autonomy Acknowledgments Notes References.

In this paper, an attempt is made to give patient autonomy added conceptual clarity. A concept of patient autonomy grounded in both negative and positive freedoms is defended. Amartya Sen's capabilities approach is used as a conceptual framework in which patient autonomy and fairness are defined compatibly. It is argued that in a socially fair healthcare system, everyone should have at least the degree of patient autonomy that affords access to those healthcare services necessary for survival (...) and a minimally adequate level of quality of life, consistent with each person's naturally endowed health characteristics. (shrink)

Müller's goal of bringing neuroscience to bear on controversies in linguistics is laudable. However, some of his specific proposals about innateness and autonomy are misguided. Recent studies on the neurobiology of regular and irregular inflectional morphology indicate that these two linguistic processes are subserved by anatomically and physiologically distinct neural subsystems, whose functional organization is likely to be under direct genetic control rather than assembled by strictly epigenetic factors.

Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social environment (...) inhibits their ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (shrink)

The realities of long‐term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

The concept of second nature plays a central role in McDowell's project of reconciling thought's external constraint with its spontaneity or autonomy: our conceptual capacities are natural in the sense that they are fully integrated into the natural world, but they are a second nature to us since they are not reducible to elements that are intelligible apart from those conceptual capacities. Rather than offering a theory of second nature and an account of how we acquire one, McDowell suggests (...) that Aristotle's account of ethical character formation as the acquisition of a second nature serves as a model that can reassure us that thought's autonomy does not threaten its naturalness. However, far from providing such reassurance, the Aristotelian model of second nature actually generates an anxiety about how the acquisition of such autonomous conceptual abilities could be possible. (shrink)

This chapter argues for three related points. First, answerability is the key to intellectual autonomy. However, in order to enjoy that status that befits an intellectually autonomous subject, other epistemic subjects must also recognize that one is answerable for one’s believing. Second, systemic conditions of social oppression impede recognition since they promote situations in which members of oppressed groups are disabled in their attempts to make themselves answerable for their believing. Third, these oppressive conditions foster the development of the (...) epistemic vices of hyper-autonomy in privileged individuals and of heteronomy in those who are subordinated. (shrink)

Until recently, genetics counselors and medical geneticists considered themselves lucky if they could provide parents with predictive information about a small number of severe genetic disorders. Testing and counseling were indicated primarily for conditions of thithis s sort. Out of respect for the autonomy of parental reproductive decision making, the prevailing ethic of genetic counseling stressed nondirectiveness and value neutrality As summarized by Arthur Caplan, the hallmarks of this stance includea willingness to provide testing and counseling to all who (...) voluntarily seek it, the presentation of information concerning findings in a manner that is balanced and comprehensible to patients or clients, the fair and balanced presentation of all options for action if a problem is discovered, a willingness to answer all questions asked by those seeking services, and an obligation to protect privacy and confidentiality at all times regardless of societal needs or benefits. (shrink)

The Israeli Patient Rights Act attempts to accommodate personal autonomy within an avowedly paternalist communitarian state. Although Israel is still groping toward a solution, the legislation begins to show the different form a communitarian version of autonomy must take.

The First World War was supposed to end all wars, though soon followed WWII. Since 1945 wars continued to abound; now we confront a real prospect of a third world war. Many armed struggles and wars arise in attempts to end repressive government; still more are fomented by repressive governments, few of which acknowledge their repressive character. It is historically and culturally naive to suppose that peace is normal, and war an aberration; war, preparations for war and threats of war (...) belong to ‘normal’ human life. Our tolerance, acceptance or fostering of such repeated injustices and atrocities indicate pervasive failures to understand fundamentals of justice, and what we owe morally to ourselves and to all others, together with our responsibilities to preserve the biosphere, not merely our own store(s) of reserves. As matters both of justice and prudence we must re-orient ourselves, individually and collectively, to promote justice, peace and ecological responsibilities by identifying and instituting just forms of social cooperation, domestically and internationally. All of these are our problems, whether we recognize them or continue our pervasive negligence. We urgently require cogent understanding of the social dimensions of human judgment, rational assessment, right action, and public reason. This requires understanding (inter alia) how Kant’s explication of rational judgment and justification is fundamentally social, how these features of rational judgment and justification are constitutive of Kant’s account of individual autonomy, and how they are central to Kant’s account of proper public use of reason. Reasoning publically remains precarious, not because – as often alleged – the ‘Enlightenment project’ has failed. It has not failed, it has been thwarted, and in our public responsibilities we have too often failed it. (shrink)

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples for health care and the circumstances under which such a practice should be respected (...) as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples’ joint decision-making, and the ethics of couples’ joint decision-making. We believe that the extent to which couples’ joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples’ joint decision-making about a woman’s own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman’s autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples’ joint decision-making should be viewed as consistent with the principle of respect for the woman’s autonomy. At the other end of the spectrum are decisions made by the man without the woman’s input, representing domination of one partner by the other. We recommend viewing the dynamics of couples’ joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples’ joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question. (shrink)

Central to the ethical concerns raised by the prospect of increasingly autonomous military robots are issues of responsibility. In this paper we examine different conceptions of autonomy within the discourse on these robots to bring into focus what is at stake when it comes to the autonomous nature of military robots. We argue that due to the metaphorical use of the concept of autonomy, the autonomy of robots is often treated as a black box in discussions about (...) autonomous military robots. When the black box is opened up and we see how autonomy is understood and ‘made’ by those involved in the design and development of robots, the responsibility questions change significantly. (shrink)

In recent work, Robert Hopkins has argued that aesthetic judgements are autonomous. When a subject finds herself diverging in judgement from a group of others who, while independently applying the same method, have come to some opposing conclusion, then for ordinary empirical matters this is often reason enough for her to suspend judgement, or even to adopt their view, but this happens much more rarely in the case of beauty. Moreover, the opposing view does not act as a defeater to (...) her belief to the same extent as it does in the empirical case. Hopkins argues that this phenomenon, properly understood, poses a distinctive problem for aesthetic cognitivism. Such a result might seem to support a non-cognitivism about aesthetic judgement, but Hopkins argues that one of the most promising such accounts, a particular form of aesthetic quasi-realism, cannot account in a satisfactory way for aesthetic autonomy either. In this paper, I argue that Hopkins's argument is crucially enthymematic. Supplying the relevant premise makes space for an independently motivated explanation of autonomy, which is open to cognitivists and non-cognitivists alike. (shrink)