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)

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)

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers (...) to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (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.

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 essay* takes two notions of autonomy and two notions of explanation and argues that colours occur in explanations that fall under all of them. The claim that colours can be used to explain anything at all may seem to some people an outrage. But their pessimism is unjustified and the orthodox dispositional view which may seem to support it, I shall argue, itself has difficulties. In broad terms, Section 2 shows that there exist good straight scientific laws of (...) colour, constituting what one might call a phenomenal science. Section 3 offers a larger view of what we are doing when we attribute colours to things, a view which makes it a case of holistic explanation, similar in many ways to psychological explanation. Section 2 emphasizes the model of scientific explanation, and Section 3 the holistic model found in rational explanation; but it will emerge that colour explanation in different ways fits both models, as it also does the two principal notions of autonomy that the first section identifies. (shrink)

To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems (...) that when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question. (shrink)

Like being able to drive a car, being autonomous is a socially attributed, claimed, and contested status. Normative debates about criteria for autonomy (and what autonomy entitles one to) are best understood, not as debates about what autonomy, at core, really is, but rather as debates about the relative merits of various possible packages of thresholds, entitlements, regulations, values, and institutions. Within different “regimes” of autonomy, different criteria for (degrees of) autonomy become authoritative. Neoliberal, solidaristic, (...) and perfectionist regimes entail conflicting understandings of what gets you autonomy and what autonomy gets you—for example, in relation to policies regarding physician-assisted suicide or financial support for senior citizens. In light of this, justifying a particular understanding of autonomy is inseparable from the task of arguing for the context-specific merits of a regime of autonomy as a whole and in relation to other ethical and political commitments. (shrink)

It has been argued - most prominently in Harry Frankfurt's recent work - that the normative authority of personal commitments derives not from their intrinsic worth but from the way in which one's will is invested in what one cares about. In this essay, I argue that even if this approach is construed broadly and supplemented in various ways, its intrasubjective character leaves it ill-prepared to explain the normative grip of commitments in cases of purported self-betrayal. As an alternative, I (...) sketch a view that focuses on intersubjective constraints of intelligibility built into social practices and on the pragmatics of how those norms are contested in an ongoing fashion. (shrink)

The principled approach to theory building that has been a conspicuous mark of bioethical theory for the past generation has in recent years fallen under considerable critical scrutiny. Although some critics have confined themselves to reordering the dominant principles, others have rejected a principled approach entirely and turned to alternative paradigms. Prominent among critics are antiprin-ciplists, who want to jettison the principle-based approach altogether and adopt a casuistic model, and communitarians, who favor an eclectic model combining features of both the (...) casuistic model and a modified principled approach. Particularly conspicuous in virtually all such critiques is their challenge to the preeminence of the principle of autonomy. Critical barbs have been aimed not only at theories favoring a hierarchical ordering of moral principles that give first place to autonomy, but also at those that include autonomy among a set of ostensibly coequal principles. Though these critics have performed a valued function by displacing bioethical principles from their Olympian perch beyond actual decision-making contexts, some version of the principle of autonomy may, nonetheless, be well worth defending but for very different reasons than those put forward by its supporters. (shrink)

This essay* takes two notions of autonomy and two notions of explanation and argues that colours occur in explanations that fall under all of them. The claim that colours can be used to explain anything at all may seem to some people an outrage. But their pessimism is unjustified and the orthodox dispositional view which may seem to support it, I shall argue, itself has difficulties. In broad terms, Section 2 shows that there exist good straight scientific laws of (...) colour, constituting what one might call a phenomenal science. Section 3 offers a larger view of what we are doing when we attribute colours to things, a view which makes it a case of holistic explanation, similar in many ways to psychological explanation. Section 2 emphasizes the model of scientific explanation, and Section 3 the holistic model found in rational explanation; but it will emerge that colour explanation in different ways fits both models, as it also does the two principal notions of autonomy that the first section identifies. (shrink)

Hysterectomy (or hysterectomy with oophorectomy) is the most frequently performed major surgery in the United States, affecting approximately 700,000 women each year (Easterday, 1983). There has long been interest in the psychological effects of these surgeries. However, apart from the concern that some hysterectomies may be unnecessary (Pearse, 1976), there has been little attention to bioethical issues relating to hysterectomy. Physicians and nurses are ethically obligated to respect the woman who may have a hysterectomy by treating her as an autonomous (...) agent. Informed consent within the context of a decision for hysterectomy should include balanced information and supportive exploration of the woman's values, goals, and life plan. Care of the patient should assist her adjustment, thereby also promoting her autonomy. Physician attitudes toward hysterectomy and the hysterectomy patient can have a major influence on patient self-determination. (shrink)

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based (...) approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action. (shrink)

ABSTRACT There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements. We present six neuroenhancement scenarios and analyse how autonomy accounts (...) evaluate them. Some cases are considered differently by criminal courts; we demonstrate where academic autonomy theories and legal reasoning diverge and ascertain whether courts should reconsider their concept of autonomy. We argue that authenticity is not an appropriate condition for autonomy and that new enhancement technologies pose no unique threats to personal autonomy. (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)

The concept of personal autonomy is central to discussions about democratic rights, personal freedom and individualism in the marketplace. This book, first published in 1986, discusses the concept of personal autonomy in all its facets. It charts historically the discussion of the concept by political thinkers and relates the concept of the autonomy of the individual to the related discussion in political thought about the autonomy of states. It argues that defining personal autonomy as freedom (...) to act without external constraints is too narrow and emphasises instead that personal autonomy implies individual self-determination in accordance with a chosen plan of life. It discusses the nature of personal autonomy and explores the circumstances in which it ought to be restricted. In particular, it argues the need to restrict the economic autonomy of the individual in order to promote the value of community. (shrink)

This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese wordJiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress’s individual autonomy, relational autonomy, and O’Neill’s principled autonomy as the three major (...) ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term ‘a form of autonomy’ first used by Edmund Pellegrino in 1992 and examine the nature of ‘a form of autonomy.’ We finally conclude that the crux of what Pellegrino calls ‘something close to autonomy,’ or ‘a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term ‘Bioethics across the Globe’ instead of ‘Global Bioethics’, calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader’s understanding of Japan and will contribute to the progress of bioethics worldwide. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, (...) is currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

Conceptions of individual autonomy and of rational autonomy have played large parts in twentieth century moral philosophy, yet it is hard to see how either could be basic to morality. Kant's conception of autonomy is radically different. He predicated autonomy neither of individual selves nor of processes of choosing, but of principles of action. Principles of action are Kantianly autonomous only if they are law-like in form and could be universal in scope; they are heteronomous if, (...) although law-like in form, they cannot have universal scope. Puzzles about claims linking morality, reason and autonomy are greatly reduced by recognising the distinctiveness of Kantian autonomy. (shrink)

In my contribution I want to describe a notion of autonomy in social terms namely in discursive practices. I already presented autonomy as grounded on the Sellarsian “metaphor” of the game of giving and asking for reasons reinterpreted by Robert Brandom. The model was centered mostly on practices of justification starting from an inferentialist view of the propositional content. However, I think that together with speech acts in ordinary language we must provide a description of the role of (...) prelinguistic practices for autonomy. This further step is implied by the fact that it is important to clarify the dimension of “readiness” to give or ask for reasons on which Swindler rightly insists in his Introduction to my book Autonomy. A Matter of Content. Autonomy develops in a language game that is connected with cooperation. The language game I want to point out is similar to the functional approach of Wittgenstein but starts from a Fregean perspective and takes into consideration neurobiological processes which bridge the gap between brain and world and represent the “motor” of our activity in the world. (shrink)

This book focuses on informed consent in African Traditional Medicine (ATM). ATM forms a large portion of the healthcare systems in Africa. WHO statistics show that as much as 80% of the population in Africa uses traditional medicine for primary health care. With such a large constituency, it follows that ATM and its practices should receive more attention in bioethics. By comparing the ethics of care approach with the ATM approach to Relational Autonomy In Consent (RAIC), the authors argue (...) that the ATM focus on consent based on consensus constitutes a legitimate informed consent. This book is distinctive insofar as it employs the ethics of care as a hermeneutic to interpret ATM. The analysis examines the ethics of care movement in Western bioethics to explore its relational approach to informed consent. Additionally, this is the first known study that discusses healthcare ethics committees in ATM. (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)

Abstract:ABSTRACTThis article examines the relationship between African customary practices and queerness in post-apartheid South Africa. I argue that black South African queers reconstitute African “tradition” and customary practices through various forms of cultural and discursive labor that function to contest the un-Africanness of same-sex sexuality and insist on visibility and communal belonging. Examining customary practices ranging from circumcision to lobola and traditional African religions, I argue for African “tradition” as a set of living practices constantly in formation. The contestation between (...) queerness and African custom reveals a set of practices that are reconstituted. These set of reconstituted practices form “usable traditions” for black South African queers and their allies. Usable traditions forge an important space for understanding how black sexual autonomy is formed within communal understandings of self. (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 chapter presents a variety of considerations suggesting that autonomy is a valuable ideal, focusing on its value for women. The focus is on women for several reasons. First, autonomy has not always been idealized for women. Even though autonomy is more widely encouraged and supported in women than ever before, it is still not regarded as a particularly feminine value or virtue. If a case for autonomy can be made out for women in particular against (...) this history, then the case for autonomy in general should prove easier to secure. Second, feminist philosophers have figured prominently among those who have expressed doubts and reservations about the value of autonomy. Focusing on the case of women's autonomy in particular helps to answer those criticisms. (shrink)

Ethno‐cultural minority rights have been regarded as a part of human rights since the last decade of the twentieth century. These rights are often formulated in predominantly culturalist terms. Citing the importance of culture in the lives of members, they are conceptualized as tools for protecting the distinct identity of minority cultures. This paper claims that this way of formulating minority rights is to portray minority communities as if they were not concerned with the pathologies of modern democracies, such as (...) the increasing marginalization of citizens from democratic life, far‐right populism, and the subordination of democracy into the functional requirements of economy. Accordingly, it argues for a theory of minority rights that formulates these rights as tools for protecting democracy against such pathologies. In doing so, it takes its point of departure from Jürgen Habermas’s communicative action theory and his understanding of democracy and public autonomy. (shrink)

The Ford Pinto’s fuel tank was prone to rupture in collisions above 20 mph, sometimes resulting in burn deaths. An infamous Ford memo estimated the cost of a shield correcting the problem at $11. Should Ford have installed the shield, holding public safety paramount, or, respecting consumer autonomy, have made the shield an option? Answering this question requires distinguishing between three kinds of autonomy: merechoice autonomy (deciding something for oneself, regardless of the content of the choice), proclamative (...) autonomy (making a choice that holds up a value or standard, commitment to which is partly definitive of who one is), and high-impact autonomy (making a choice that profoundly affects one’s ability to make proclamative choices). (This is not a formal distinction, that is, a distinction meant be to be clear, rigorous, and neutral). Autonomy is thus asymmetric: choosing to do x may be highly proclamative while choosing not to do x is not. In the Pinto case, not giving consumers the option of declining the shield undercuts only mere-choice autonomy. Several arguments are provided (including an argument based on the nature of moral agency) that proclamative autonomy (and, derivatively, high-impact autonomy), rather than mere-choice autonomy, has significant positive value. More precisely, it is argued that, as a rule, the more proclamative a choice is, other things being equal, the more weight autonomy claims about that choice possess. The paper concludes that common sense is correct about the Pinto case. In some instances, consumer choice may legitimately count more than the engineer’s commitment to public safety (particularly when proclamative choice is involved). However, losing the opportunity to save $11 is not too large a price to pay in order to counter market pressures against safety by inducing in engineers a professional commitment to put safety first. (shrink)

This article provides a donor-focused analysis of how transnational reproductive donation intersects with issues central to bodily autonomy of surrogates and egg donors from the global South. Little is known about the autonomy of surrogates and egg donors, especially among those from the global South. This article addresses this gap by examining two key issues on surrogacy and egg donation—conflict of interest and recruitment market. With these issues, this paper presents contexts of the reproductive body as a space (...) of contestation for autonomy. Analysis reveals that bodily autonomy is not an absolute entitlement available for surrogates and egg donors from the global South. Having bodily autonomy is a privileged disposition rather than a universal liberty for reproductive donors. The discussions in this work encourage further examination to understand the multi-layered experiences of reproductive donors from the global South, towards deeper interrogation of the processes of reproductive industry. (shrink)

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, (...) in which actions are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training. (shrink)

This study explored 12 cancer patients’ experiences from participating in an online and on-site Shared Reading group for 16 weeks in Norway. Shared Reading is a practice in which prose and poetry are read aloud in small parts and discussed along the way. The study is a qualitative evaluation study with a particular focus on how the participants experienced the reading group supported their life living with cancer. The study was mainly based on the data collected from focus group discussions (...) with the participants, which was analysed qualitatively through open coding. In total, four themes were identified: open space, disconnecting through connecting, community, and resonances and echoes. The participants expressed that the RG helped them to “balance life and cancer”, and “disconnect” from their illness. The cognitive effort needed was beneficial for the participants as a form for “cognitive training.” Since many of the participants had, due to their illness, completely stopped reading books, the reading group also brought literature back into the participants’ lives. Furthermore, it was essential for the participants to feel they contributed to a community, to feel useful and valuable for others. The texts were also important, as some of them resonated strongly with the participants in the way of activating memories and connecting a text to own experiences. After a session, a text could still have an impact as an echo. The results are synthesised, discussed, and supported through the framework of self-determination theory and, more specifically, the basic psychological need theory. The reading group was experienced as a support for autonomy, competence, and relatedness and promoted a feeling of intrinsic motivation that brought about new dimensions in the participants’ lives. The study wishes to increase our knowledge of the benefits of integrating Shared Reading groups as a low-cost, literature-based psychosocial support in cancer organisations. (shrink)

Continuing on the value of givenness, Dennis Vanden Auweele argues that a modern project for absolutized autonomy cannot do but dread silence, which signals a hiccup or momentary lapse in the project of logos. And yet, Vanden Auweele shows that silence can be a convalescence that renders human beings receptive to something in excess of finite determination, which can in turn inspire self-determination to new heights.

Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals’ autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected (...) key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically. (shrink)

Peter Gardner; Personal Autonomy and Religious Upbringing: the ‘problem’, Journal of Philosophy of Education, Volume 25, Issue 1, 30 May 2006, Pages 69–81, http.

Some argue that to be effective in healthcare settings autonomy needs to be strengthened. The author thinks autonomy is fundamentally inadequate in healthcare settings and requires supplementation by experience-based paternalism on the part of doctors and healthcare providers.

I shall draw on my experience of being an ICU patient to make some practical, ethical, and philosophical points about the care of the critically ill. The recurring theme in this paper is ICU psychosis. I suggest that discharged patients ought to be educated about it; I discuss the obstacles in the way of accurately measuring it; I argue that we must rethink autonomy in light of it; and I suggest that the self disintegrates in the face of it.

The aim of this paper is to suggest that a necessary condition of autonomy has not been sufficiently recognized in the literature: the capacity to critically reflect on one’s practical attitudes (desires, preferences, values, etc.) in the light of new experiences . It will be argued that most prominent accounts of autonomy—ahistorical as well as history-sensitive—have either altogether failed to recognize this condition or at least failed to give an explicit account of it.

This paper aims to distinguish a conception of ‘free will’ that Nietzsche opposes (that of the pure agent unaffected by contingencies of character and circumstance) and one that he supports. In Human, All Too Human Nietzsche propounds the ‘total unfreedom’ of the will. But by the time of Beyond Good and Evil and the Genealogy he is more concerned (a) to trace the affective psychological states underlying beliefs in both free will and ‘unfree will’, (b) to suggest that the will (...) might become free in certain individuals, a matter of having a consistent strong character, self-knowledge, and ability to create values. The paper explores the kind of autonomy required in agents who would ‘revalue’ existing values. (shrink)

Respecting the autonomy of agents grounds various obligations to others such as non-interference, deference to her authority over self-regarding decisions, limitations on paternalism, and so on. According to a broadly liberal moral sensibility, respecting others in this way implies accepting the valuesValue they autonomously hold even if they are judged problematic, immoral, self-destructive, or otherwise non-ideal. In discussions of such respect, it is generally assumed that persons expressing that respect have no direct bearing on whether the subject of that (...) respect is herself autonomous. However, in many situations, persons interact in a way that helps establish or re-establish the autonomy of one or both of these agents themselves.For example, the would-be paternalist may be a therapist whose professional obligationObligations is to facilitate the process of re-establishing autonomy for vulnerable victims of traumaTrauma. In such scenarios, the usual lines between hardPaternalismhard and softPaternalismsoft paternalism, as well as the standard liberal rejection of the former, do not apply. Still, it would be wrong for the aid workerAid workers to simply impose her views of a decent life on the struggling person. How, then, do we reformulate restrictions on paternalism and other such normative strictures grounded in respect forAutonomyrespect for autonomy in scenarios where the relationshipRelationships between client and aid workerAid workers is itself a crucial part of the process that results in the self-governingSelf-governing agency of the client?This paper explores these issues and argues that such scenarios indicate that conceptions of autonomy must view the self as diachronic as well as socially constituted but also must be sensitive to the ways that autonomy can sometimes be established only with others’ help. In particular, the obligationObligations to remain relatively neutralNeutral toward the content of others’ values in showing respect forPersonsrespect for their autonomy must be reformulated to take into account the way interpersonal dynamics themselves help establish the autonomy with which persons hold the values that they hold. These observations are applied to certain cases of aid and care where such questions are central. (shrink)

Lyotard defines being postmodern as an ‘incredulity toward metanarratives’. Such incredulity includes, in particular, skepticism vis-à-vis Enlightenment ideals like autonomy. Motivated by such skepticism, several educational scholars put into question education for autonomy as it is practiced in the formal settings of national school systems. More specifically, they criticize that practices of autonomy education can have certain normalizing and ideological e￿ects that undermine the aim of creating autonomous subjects. This article examines these critiques of education for (...) class='Hi'>autonomy and argues that they are best understood as calls for reforming educational practices, and not as outright rejections of education for autonomy. Thus, since the allegedly ‘postmodern’ critiques of autonomy education cannot be plausibly understood as radical ruptures with Enlightenment ideals, the article concludes that these critiques represent (merely) constructive self-critical reflections on what Habermas dubbed the ‘unfinished project of modernity’. (shrink)

Accounts of autonomy which acknowledge the importance of non-domination – that is, of being structurally protected against arbitrary interference with one's life – face an apparent problem with regards to intimate relationships. By their very nature, such relations open us up to psychological and material suffering that would not be possible absent the particular relationship; even worse, from the non-domination point of view, is that this vulnerability seems to be structural in a way exactly analogous to workplace or social (...) domination. If being powerless to prevent an employer causing me harm constitutes domination at work, then what relevant differences can support the intuition that being powerless to prevent my partner causing me comparable pain is not autonomy-hostile? I argue for the reassuring view that the obligations and possibility of pain arising from such relations aren't necessarily dominating; they would be so only if we believed that any obligation we have not explicitly agreed to is a restriction on our autonomy, and that is false. I conclude with a note of caution: even though intimate relations aren't necessarily dominating, they will often be contingently so if they take place in a wider social context of domination – such as that which we currently inhabit. (shrink)

abstract: Moral autonomy might seem to harbor inconsistency. Whereas nomos suggests that moral laws are grounded in our essence or nature (and thus are not up to us), autos suggests that they are grounded in some free act of self-legislation or prescription (and thus are up to us). Latter-day Kantians often respond by compromising on autonomy, deflating either nomos or autos. This investigation reconstructs how Christian Wolff, Kant’s great rationalist predecessor, already forged a path for embracing autonomy (...) without compromise. His reconciliation, I argue, rests on distinguishing different respects in which moral laws stand in need of grounding. I further unravel why no parallel reconciliation is found in Kant. This, I conclude, still leaves open that Kant may similarly seek to embrace autonomy without compromise. (shrink)