Autonomy and authority are often regarded as opposites. In this paper, I argue that autonomy should be conceived of as a specific form of (practical) authority and that this perspective is useful for identifying the conditions of personal autonomy. I will first highlight some structural analogies in the functioning of the concepts "autonomy" and "authority" and explain the resulting constraints on accounts of personal autonomy. I will then show that the problems of certain internalist and (...) externalist accounts of autonomy are rooted in a false understanding of the foundation on which the authority that is characteristic of autonomy rests. To conclude, I present an account in which this foundation is given by a person’s maturity (Mündigkeit), defensiveness (Wehrhaftigkeit) and participation (Mitsprache): Thus, a person is autonomous to the extent that she can cope with her own affairs, can defend herself against external encroachments and can participate in common affairs. (shrink)

What is it for a person to be autonomous? Starting with a philosophical puzzle about personal autonomy and by way of critically discussing contemporary accounts, this monograph argues that AUTONOMY is a thick normative concept – the concept of a certain kind of practical authority. It then develops a conception of autonomy which solves the puzzle and offers an adequate understanding of what it means to determine oneself.

A new landscape of prenatal testing is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development (...) supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling. (shrink)

John peteet, charlotte witvliet, and c. stephen evans are to be commended for drawing our attention to the relatively neglected virtue of accountability, and for making the case that it is an important virtue to cultivate in general and specifically within the context of psychiatry. I find little to object to in their discussion, and so my comments here will be more of an invitation for them to address in greater detail two important issues: the relationship between accountability and (...) class='Hi'>autonomy, and the role of motivation in the virtue of accountability.According to Peteet et al., a person with the virtue of accountable is someone who “embraces being accountable”. The virtue is said to... (shrink)

This paper elaborates on the deliberative democracy argument for freedom of expression in terms of its relationship to different dimensions of autonomy. It engages the objection that Enlightenment theories pose a threat to cultures that reject autonomy and argues that autonomy-based democracy is not only compatible with but necessary for respect for cultural diversity. On the basis of an intersubjective epistemology, it argues that people cannot know how to live on mutually respectful terms without engaging in public (...) deliberation and developing some degree of personal autonomy. While freedom of expression is indispensable for deliberation and autonomy, this does not mean that people have no obligations regarding how they speak to each other. The moral insights provided by deliberation depend on the participants in the process treating one another with respect. The argument is related to the Danish cartoon controversy. (shrink)

Autonomy is increasingly rejected as a fundamental principle by liberal political theorists because it is regarded as incompatible with respect for diversity. This article seeks, via an analysis of the Danish cartoon controversy, to show that the relationship between autonomy and diversity is more complex than often posited. Particularly, it asks whether the autonomy defense of freedom of expression encourages disrespect for religious feelings. Autonomy leads to disrespect for diversity only when it is understood as a (...) character ideal that must be promoted as an end in itself. If it by contrast is understood as something we should presume everyone possesses, it provides a strong basis for equal respect among people from diverse cultures. A Kantian conception of autonomy can justify the right to freedom of expression while it at the same time requires that we in the exercise of freedom of expression show respect for others as equals. (shrink)

The systems studied in the special sciences are often said to be causally autonomous, in the sense that their higher-level properties have causal powers that are independent of the causal powers of their more basic physical properties. This view was espoused by the British emergentists, who claimed that systems achieving a certain level of organizational complexity have distinctive causal powers that emerge from their constituent elements but do not derive from them. More recently, non-reductive physicalists have espoused a similar view (...) about the causal autonomy of special-science properties. They argue that since these properties can typically have multiple physical realizations, they are not identical to physical properties, and further they possess causal powers that differ from those of their physical realisers. Despite the orthodoxy of this view, it is hard to find a clear exposition of its meaning or a defence of it in terms of a well-motivated account of causation. In this paper, we aim to address this gap in the literature by clarifying what is implied by the doctrine of the causal autonomy of special-science properties and by defending the doctrine using a prominent theory of causation from the philosophy of science. (shrink)

There have long been controversies about how it is that minds can fit into a physical universe. Emergence in Mind presents new essays by a distinguished group of philosophers investigating whether mental properties can be said to 'emerge' from the physical processes in the universe. Such emergence requires mental properties to be different from physical properties, and much of the discussion relates to what the consequences of such a difference might be in areas such as freedom of the will, and (...) the possibility of scientific explanations of non-physical phenomena. The volume also extends the debate about emergence by considering the independence of chemical properties from physical properties, and investigating what would need to be the case for there to be groups that could be said to exercise rationality. (shrink)

Public health is often distinguished from heaslth care in that it is said to serve more 'collective' goals, such as 'the common good' rather than the good of individual people. However, it is not clear what this good is supposed to be (although it is supposed to be 'common'). In regular health care we see in the West a gradual expansion of traditional goals exclusively in terms of length and quality of life to goals having to do more with (...) class='Hi'>autonomy - the ability of people to control and direct their own lives. This has lead to a number of questions regarding how such an ethical ideal of promotion of autonomy may be construed, whether or not it really is an ideal, what practical consequences it has etc. (shrink)

While health care goals are usually formulated in terms of the securing of good health for the population, the goal of public health is to an increasing extent, at least in Western countries, being formulated in terms of the provision of societal preconditions for securing of good health. This goal may be attained although no one enjoys good health as a result, namely if people choose not to make use of the preconditions provided. However, reaching this goal may still seem (...) desirable in that it promotes the autonomy of people with regard to health-related choices. In this presentation, I address the questions: 1) whether or not the promotion of autonomy may be supported as goal of public health on the basis of ethical theories dealing with autonomy, 2) whether this support is equally strong regardless of the economic, social and cultural conditions of different countries. I will argue that the first question may be answered affirmatively only if certain important revisions are made in the ethical theories in questions but that these revisions at the same time raise a number of very complicated issues in theory as well as in practice. Regarding the second question, I will claim that in so far as the goal of promoting autonomy may be morally justified, there are a number of reasons supporting the suggestion that this justification is much stronger in societal settings where reasonably high health and welfare levels are allready secured. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of (...) autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

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

Technical advances in genome editing methods raise the question how autonomy should figure in theological ethical debates about genetic enhancements. Thinking primarily of the parents’ reproductive autonomy, several secular and theological thinkers argue parents should be allowed to ‘enhance’ an embryo genetically. Jürgen Habermas’s critique of enhancements in the name of the child’s autonomy, meanwhile, has been met with a critique of autonomy in theology. This article argues that theological views about God’s relationship to the creature (...) provide strong theological grounds for a new appropriation of autonomy. A liberal maximisation of individual choice is to be viewed critically, but more recent discourses on relational autonomy see certain forms of vulnerability contribute to a communal understanding of autonomy. This view dovetails with Habermas’s argument, according to which enhancements create too strong a temptation towards overly directive parenting—less in modifying an embryo than in the ensuing relationship to the child. (shrink)

It is often argued that higher-level special-science properties cannot be causally efficacious since the lower-level physical properties on which they supervene are doing all the causal work. This claim is usually derived from an exclusion principle stating that if a higher-level property F supervenes on a physical property F* that is causally sufficient for a property G, then F cannot cause G. We employ an account of causation as difference-making to show that the truth or falsity of this principle is (...) a contingent matter and derive necessary and sufficient conditions under which a version of it holds. We argue that one important instance of the principle, far from undermining non-reductive physicalism, actually supports the causal autonomy of certain higher-level properties. (shrink)

ABSTRACTThe article discusses the reception of Schelling’s philosophy by the young Paul Tillich. During his study on the theological faculty of the University of Halle from 1905 until 1907 Tillich was influenced by the Fichte interpretation of Fritz Medicus. Tillich uses Fichte’s philosophy as a theoretical frame for a modern theology. The problems from this Fichte reception lay in the concept of freedom as autonomy. In Schelling’s philosophy, especially in his concept of freedom as the possibility to come into (...) contradiction with oneself, the young Tillich finds the solution for these problems. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...) of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

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

While promoting population health has been the classic goal of public health practice and policy, in recent decades, new objectives in terms of autonomy and equality have been introduced. These different goals are analysed, and it is demonstrated how they may conflict severly in several ways, leaving serious unclarities both regarding the normative issue of what goal should be pursued by public health, what that implies in practical terms, and the descriptive issue of what goal that actually is pursued (...) in different contexts. A basic conflict of perspective is handled by integrating the ideas of public health striving for health-related autonomy and equality, resulting in a prioritarian oriented population approach to health-related autonomy. This integrated goal is demonstrated to constrain itself in several ways attractive from the point of view of the classic goal, but several serious problems remain. For this reason, a model where all of the three goals are integrated into one coherent structure where they can be assigned varying degrees of importance relative to the level of population health is described. It is argued that this model avoids the problems set out earlier, and is actually normatively preferable to the classic goal alone. It is furthermore argued that the model may be employed as a useful tool for descriptive ethics, as well as a vehicle for international harmonisation of public health policies. A number of practical implications regarding, e.g., the importance of respecting autonomy and the allocation of public health resources are noted, as are a battery of questions for further research. (shrink)

Christian Leduc | : Dans le présent article, je montre que Maupertuis et Euler proposent une conception contrastée de la métaphysique de la nature. Il s’agit principalement pour eux de repositionner la cosmologie par rapport aux sciences de la nature. Au lieu de considérer la métaphysique comme étant au fondement des théories scientifiques, comme le supposent Descartes, Wolff et, d’une certaine manière, Kant, ou simplement d’interdire l’idée même d’une cosmologie, comme le stipulerait à la même époque d’Alembert, Maupertuis et Euler, (...) renversent l’ordre des disciplines pour donner aux sciences physiques une primauté sur la métaphysique. Ce repositionnement entraîne évidemment plusieurs questions : d’abord, de quelle manière les théories scientifiques peuvent-elles valider ou infirmer un principe métaphysique? Plus important encore, quel rôle incombe à la métaphysique de la nature, étant donné que les sciences possèdent non seulement une autonomie théorique, mais même une priorité sur les réflexions ontologiques. Il semblerait d’ailleurs que la métaphysique se réduise, pour ces deux philosophes, au seul domaine du cosmologique, en particulier aux questions qui concernent la force et le principe de moindre action, au statut ontologique de l’espace et du temps et aux déterminations de la matière que sont l’étendue, l’inertie, l’impénétrabilité et le mouvement. | : In this paper, I show that Maupertuis and Euler offer a contrasting conception of metaphysics of nature. It consists mainly for them in repositioning cosmology in relation to natural sciences. Instead of considering metaphysics to be at the foundation of scientific theories, as was assumed by Descartes, Wolff, and, in a certain way, Kant, or simply prohibiting the very idea of a cosmology, as d’Alembert would stipulate at the same period, Maupertuis and Euler invert the order of disciplines to give priority to physical sciences over metaphysics. This repositioning leads of course to several questions : first, how does scientific theories validate or deny metaphysical principles? Even more important, which role falls to metaphysics of nature given that sciences not only possess a theoretical autonomy, but also a priority over ontological reflections? Besides, it seems that metaphysics would be reduced, for these two philosophers, to the realm of cosmology alone, in particular to questions concerning force and the principle of least action, the ontological status of space and time, and the first constituents of matter, such as extension, inertia, impenetrability, and motion. (shrink)

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention and return-to-work. However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional (...) contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility, social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences. (shrink)

Is it allowable for your government, or anyone else, to influence or coerce you 'for your own sake'? This is a question about paternalism, or interference with a person's liberty or autonomy with the intention of promoting their good or averting harm, which has created considerable controversy at least since John Stuart Mill's On Liberty. Mill famously decried paternalism of any kind, whether carried out by private individuals or the state. In this volume of new essays, leading moral, political (...) and legal philosophers address how to define paternalism, its justification, and the implications for public policy, professional ethics and criminal law. So-called 'libertarian' or non-coercive paternalism receives considerable attention. The discussion addresses the nature of freedom and autonomy and the relation of individuals to law, policy and the state. The volume will interest a wide range of readers in political philosophy, public policy and the philosophy of law. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

In this article, I will argue in favor of both the ethical and epistemological utility of explanations in artificial intelligence -based medical technology. I will build on the notion of “explicability” due to Floridi, which considers both the intelligibility and accountability of AI systems to be important for truly delivering AI-powered services that strengthen autonomy, beneficence, and fairness. I maintain that explicable algorithms do, in fact, strengthen these ethical principles in medicine, e.g., in terms of direct patient–physician contact, as (...) well as on a longer-term epistemological level by facilitating scientific progress that is informed through practice. With this article, I will therefore attempt to counter arguments against demands for explicable AI in medicine that are based on a notion of “whatever heals is right.” I will elucidate my elaboration on the positive aspects of explicable AI in medicine as well as by pointing out risks of non-explicable AI. (shrink)

Individuality and collectivity are central concepts in sociological inquiry. Incorporating cultural history, social theory, urban and economic sociology, Borch proposes an innovative rethinking of these key terms and their interconnections via the concept of the social avalanche. Drawing on classical sociology, he argues that while individuality embodies a tension between the collective and individual autonomy, certain situations, such as crowds and other moments of group behaviour, can subsume the individual entirely within the collective. These events, or social avalanches, produce (...) an experience of being swept away suddenly and losing one's sense of self. Cities are often on the verge of social avalanches, their urban inhabitants torn between de-individualising external pressure and autonomous self-presentation. Similarly, Borch argues that present-day financial markets, dominated by computerised trading, abound with social avalanches and the tensional interplay of mimesis and autonomous decision-making. Borch argues that it is no longer humans but fully automated algorithms that avalanche in these markets. (shrink)

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern (...) physician behavior—beneficence, nonmaleficence, autonomy, and social justice—are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur. (shrink)

L'existence d'un tiers-secteur de la communication, s'appuyant sur la recherche d'une autonomie accrue de la gestion de médias, apparaît à des moments divers et selon des formes variées, en correspondant notamment à différents cadres juridiques. Ainsi dans la période récente, les exemples tiennent à des coopératives d'édition de presse, des télévisions associatives et à un forum regroupant des sociétés de rédacteurs.The existence of third-sector communication, drawing on research increased autonomy of media management, appears at various times and in various (...) forms, in particular corresponding to different legal frameworks. Thus in recent years, examples of cooperatives hold publishing press, television associative and a forum of companies editors. (shrink)

The debate in philosophy of science in the twentieth century over the theory-laden-ness of observation showed both that there are many ways in which scientific observation depends on theory, and also highlighted some ways in which it is blind to theoretical assumptions. Debates in the philosophy of medicine have shown how concepts and theories of illness are value-laden, especially in psychiatry. Kious in his helpful and stimulating target article argues that the mainstream approach to autonomy depends on assumptions about (...) value, and this conclusion is surely correct. However, his focus on the concept of non-voluntariness is problematic, as I argue, and we are better off not seeing it as laden with. (shrink)

The Heraclitean tradition in the Herculaneum papyri is a topic which involves some of the most important research fields of ancient philosophy: ethics, physics and cosmology, theology and aesthetics. This paper concentrates on Heraclitus’ fr. 18 Marcovich, where the pre-Socratic philosopher talks about an unspecified κοπίδων ἀρχηγόϲ. The fragment occurs in the seventh book of Philodemus’ Rhetoric and is the only direct quotation of Heraclitus in this multi-volume treatise. This article presents a new textual reconstruction of the two columns of (...) the papyrus in which the same passage is quoted and attempts: 1. to contextualize the quotation inside the Philodemean paraphrase of a treatise by the Stoic Diogenes of Babylon against the rhetoricians of his time; 2. to reconsider the grammatical and philosophical problem of the subject of the Heraclitean quotation. Almost all scholars have considered Pythagoras to be the target of Heraclitus. But certain elements allow us to go beyond this old opinion and to understand this fragment as something of more than a personal dispute. Rhetoric, according to its supporters, was an ‘art’ since Homer’s times and gained its professional autonomy with Corax and Tisias. There is no reason to believe that, in quoting Heraclitus, Diogenes has totally changed the subject of the fragment he cites. That subject could originally have been very similar to that attested in the Philodemean paraphrase, that is the education of the rhetoricians. (shrink)

Utilitarianism has dominated media ethics for a century. For Mill, individual autonomy and neutrality are the foundations of his On Liberty and System of Logic, as well as his Utilitarianism. These concepts fit naturally with media ethics theory and professional practice in a democratic society. However, the weaknesses in utilitarianism articulated by Ross and others direct us at this stage to a dialogic ethics of duty instead. Habermas's discourse ethics, feminist ethics, and communitarian ethics are examples of duty ethics (...) rooted in the dialogic relation that enable us to start over intellectually. (shrink)

Scholars disagree about the proper justification of human rights and which rights qualify as human rights. While some argue for a very limited set of human rights, others defend more comprehensive accounts. In this paper I suggest that a defence of a comprehensive set of human rights can be strengthened by combining constructivist deontological and well-being based teleological justifications. To this end, I discuss two prominent proponents of constructivism and the well-being approach: Rainer Forst and Simon Caney. Forst criticises teleological (...) justifications for grounding human rights in non-universalizable conceptions of the good, such as autonomy, that can reasonably be rejected by others. Constructivism, in contrast, does not rest on any particular idea of the good life and thus allows for greater ethical plurality. I reject this specific criticism, arguing that Caney’s approach ultimately allows for the same plurality. I also highlight that constructivism on its own cannot justify rights of people who are not (yet) able to reason. The well-being approach provides substantive arguments for the rights of these individuals. However, these arguments are made with the framework provided by constructivism. I hold, contra Caney, that Forst’s right to justification is primary in that it is the unavoidable basis from which justice issues can be dealt with in a reasonable way and that the main function of human rights is to protect the equal moral status of persons. I conclude that Forst’s constructivist and Caney’s well-being approach are complementary rather than rivalrous: when combined they provide a more robust justification for a comprehensive set of human rights than considered separately. (shrink)

Societal decisions regarding the possible granting of permission for industrial and power plants, waste disposals, traffic routes and other facilities implementing modern science and technology (here simply called technology-decisions) often provoke debates regarding the risks involved. A main theme in these debates concerns the magnitudes of these risks and whether or not they are worth taking to reach some aim. This is also a main theme in traditional risk-analysis and critical discussions of risk-management. However, sometimes the fact that some people (...) do not want to be exposed to the risks in question has been suggested as an independent argument, i.e. regardless of the magnitudes of these risks. A well known phenomenon in this respect on the local and national level is what has been labelled "not in my backyard" (NIMBY), but the argument also has been used on an international level. In accordance, the view that unwanted risks are less acceptable than wanted or indifferent ones (regardless of their magnitudes) has been proposed as being highly relevant for technology-decisions. The paper explores to what extent there are good reasons for accepting such a proposal. The main part of the paper is devoted to an examination of the extent to which the view that unwanted risks are less acceptable than wanted ones can be supported by, on the one hand, welfare-based ethical theories underlying standard models for risk-analysis, such as utilitarianism, and, on the other, a moral requirement to respect the autonomy of individual persons. Also, the very concept of an unwanted risk is explored and some peculiarities are noted. It is argued that no categorical impermissibility of exposing people to unwanted risks can be supported. However, there are still good reasons for policy-makers to consider the degree to which risks are unwanted as a factor in technology-decisions that is relevant independently of the welfare-gains at stake. In particular, policy-makers should avoid paternalism in risk-management, i.e.. (shrink)

Standard versions of the requirement of informed consent state that patients who are offered to enter a clinical trial of a medical procedure should be informed about risks and possible benefits of this procedure (compared to available alternatives) in order to facilitate a rational decision whether or not to participate. However, in many real cases where new medical procedures are to be clinically tested for the first time the information available for such communication to prospective patients is very scarce, vague (...) and/or uncertain. This phenomenon is illustrated by the clinical introduction of new procedures in reproductive medicine, such as preimplantation genetic diagnosis (PGD). Regarding such procedures, it has ben argued that, in such cases, the quality of the available information may be too low for the obtaining of informed consent to be possible, even if it is successfully communicated. Others, instead, holds that informed consent may always be obtained regardless of the quality of the available information. Unfortunately, the standard litterature on informed consent give no clue as to which of these interpretations is correct. This issue is explored by connecting the concept of informed consent to ethical ideas of respect for autonomy and ideas of rational decision making. It is argued, first, that low quality of available information regarding the risks and possible benefits of a medical procedure may indeed make the obtaining of informed consent from patients to undergo this procedure impossible even in theory. However, it is also argued that whether or not this is the case must be relativized to the actual needs and deires of individual patients. Thus, regarding one and the same procedure, informed consent may be impossible to obtain from some patients due to the low quality of the available information regarding this procedure, but still be possible to obtain from other patients. (shrink)