(2013). Autonomy and the Normativity Question: Framing Considerations. International Journal of Philosophical Studies. ???aop.label???. doi: 10.1080/09672559.2012.727014.

Journal of Political Philosophy, Volume 30, Issue 2, Page 143-165, June 2022.

Autonomy is a vital principle in medical law and ethics. It occupies a prominent place in all medico-legal and ethical debate. But there is a dangerous presumption that it should have the only vote, or at least the casting vote. This book is an assault on that presumption, and an audit of autonomy's extraordinary status. This book surveys the main issues in medical law, noting in relation to each issue the power wielded by autonomy, asking whether that (...) power can be justified, and suggesting how other principles can and should contribute to the law. It concludes that autonomy's status cannot be intellectually or ethically justified, and that positive discrimination in favour of the other balancing principles is urgently needed in order to avoid some sinister results. 'This book is a sustained attack on the hegemony of the idea of autonomy in medical ethics and law. Charles Foster is no respecter of authority, whether of university professors or of law Lords. He grabs his readers by their lapels and shakes sense into them through a combination of no-nonsense rhetoric and subtle argument that is difficult to resist.' Tony Hope, Professor of Medical Ethics, Oxford University 'This book is unlikely to be in pristine state by the time you have finished reading it. Whether that is because you have thrown it in the air in celebration or thrown it across the room in frustration will depend on your perspective. But this book cannot leave you cold. It is a powerful polemic on the dominance of autonomy in medical law, which demands a reaction. Charles Foster sets out a powerful case that academic medical lawyers have elevated autonomy to a status it does not deserve in either ethical or legal terms. In a highly engaging, accessible account, he challenges many of the views which have become orthodox within the academic community. This will be a book which demands and will attract considerable debate.' Jonathan Herring, Exeter College, Oxford University 'This is a learned, lively and thought-provoking discussion of problems central to the courts' approach to ethical issues in medical law. What principles are involved? More significantly, which really underlie and inform the process of seeking justice in difficult cases? Charles Foster persuasively argues, and demonstrates, that respect for autonomy is but one of a number of ethical principles which interact and may conflict. He also addresses the sensitive issue of the extent to which thoughts and factors which go to influence legal decisions may not appear in the judgments.' Adrian Whitfield QC. 'Introducing the Jake La Motta of medical ethics. Foster is an academic street-fighter who has bloodied his hands in the court room. He provides a stinging, relentless, ground attack on the Goliath of medical ethics: the central place of autonomy in liberal medical ethics. This is now the first port of call for those who feel that medical ethics has become autonomized.' Julian Savulescu, Uehiro Chair in Practical Ethics, University of Oxford. "This important book offers a robust challenge to anyone, whether lawyer or 'ethicist', who sees respect for autonomy as the only game in town. It argues eloquently and effectively that, on the one hand, despite the reverence paid to it by judges, in practice the law, even in the context of consent, weaves together a number of moral threads of which autonomy is merely one, in the pursuit of a good decision. It argues on the other hand, that were the day-to-day practice of law to be guided primarily by respect for autonomy, this would be wrong. Foster concludes that whilst, 'any society that does not have laws robustly protecting autonomy is an unsafe and unhappy one', so too would be a society in which too much emphasis was placed on respect for autonomy at the expense of other important moral principles. This is essential reading for anyone interested in the role of autonomy and indeed of medical ethics, in the law." Michael Parker, Professor of Bioethics, University of Oxford. (shrink)

In “Autonomy and the Feminist Intuition,” Natalie Stoljar asks whether a procedural or a substantive approach to autonomy is best for addressing feminist concerns. In this paper, I build on Stoljar’s argument that feminists should adopt a strong substantive approach to autonomy. After briefly reviewing the problems with a purely procedural approach, I begin to articulate my own strong substantive theory by focusing specifically on the problem of internalized oppression. In the final section, I briefly address some (...) of the concerns raised by procedural theorists who are leery of a substantive approach. (shrink)

The concept of autonomy is one of Kant's central legacies for contemporary moral thought. We often invoke autonomy as both a moral ideal and a human right, especially a right to determine oneself independently of foreign determinants; indeed, to violate a person's autonomy is considered to be a serious moral offence. Yet while contemporary philosophy claims Kant as the originator of its notion of autonomy, Kant's own conception of the term seems to differ in important respects (...) from our present-day interpretation. Kant on Moral Autonomy brings together a distinguished group of scholars who explore the following questions: what is Kant's conception of autonomy? What is its history and its influence on contemporary conceptions? And what is its moral significance? Their essays will be of interest both to scholars and students working on Kantian moral philosophy and to anyone interested in the subject of autonomy. (shrink)

John Christman, in 'Autonomy and Personal History,' advances a novel genetic or historical account of individual autonomy.1 He formulates 'the conditions of the [i.e., his] new model of autonomy' as follows: (i) A person Pis autonomous relative to some desireD if it is the case that P did not resist the development of D when attending to this process of development, or P would not have resisted that development had P attended to the process; (ii) The lack (...) of resistance to the development of D did not take place (or would not have) under the influence of factors that inhibit self-reflection; and (iii) The self-reflection involved in condition (i) [sic] is (minimally) rational and involves no self-deception. (11) Although Christman makes a telling case for the relevance of personal history to personal autonomy, I shall argue that he has gone too far in that direction. (shrink)

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The (...) terrain can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

In autonomous action the agent herself directs and governs the action. But what is it for the agent herself to direct and to govern? One theme in a series of articles by Harry G. Frankfurt is that we can make progress in answering this question by appeal to higher-order conative attitudes. Frankfurt's original version of this idea is that in acting of one's own free will, one is not acting simply because one desires so to act. Rather, it is also (...) true that this desire motivates one's action because one desires that this desire motivate one's action. This latter desire about the motivational role of one's desire is a second-order desire. It is, in particular, what Frankfurt calls a second-order “volition.” And, according to Frankfurt's original proposal, acting of one's own free will involves in this way such second-order, and sometimes yet higher order, volitions. (shrink)

In recent years, an increasing number of theoretical biologists and philosophers of biology have been opposing reductionist research agendas by appealing to the concept of biological autonomy which draws on the older concept of autopoiesis. In my paper, I investigate some of the ontological implications of this approach. The emphasis on autonomy and autopoiesis, together with the associated idea of organisational closure, might evoke the impression that organisms are to be categorised ontologically as substances: ontologically independent, well-individuated, discrete (...) particulars. However, I argue that this is mistaken. Autopoiesis and biological autonomy, properly understood, require a rigorous commitment to a process ontological view of life. (shrink)

This volume describes features of biological autonomy and integrates them into the recent discussion of factors in evolution. In recent years ideas about major transitions in evolution are undergoing a revolutionary change. They include questions about the origin of evolutionary innovation, their genetic and epigenetic background, the role of the phenotype, and of changes in ontogenetic pathways. In the present book, it is argued that it is likewise necessary to question the properties of these innovations and what was qualitatively (...) generated during the macroevolutionary transitions. The author states that a recurring central aspect of macroevolutionary innovations is an increase in individual organismal autonomy whereby it is emancipated from the environment with changes in its capacity for flexibility, self-regulation and self-control of behavior. The first chapters define the concept of autonomy and examine its history and its epistemological context. Later chapters demonstrate how changes in autonomy took place during the major evolutionary transitions and investigate the generation of organs and physiological systems. They synthesize material from various disciplines including zoology, comparative physiology, morphology, molecular biology, neurobiology and ethology. It is argued that the concept is also relevant for understanding the relation of the biological evolution of man to his cultural abilities. Finally the relation of autonomy to adaptation, niche construction, phenotypic plasticity and other factors and patterns in evolution is discussed. The text has a clear perspective from the context of systems biology, arguing that the generation of biological autonomy must be interpreted within an integrative systems approach. (shrink)

The significance of teaching to the evolution of human culture is under debate. We contribute to the discussion by using a quantitative, cross-cultural comparative approach to investigate the role of teaching in the lives of children in two small-scale societies: Aka foragers and Ngandu farmers of the Central African Republic. Focal follows with behavior coding were used to record social learning experiences of children aged 4 to 16 during daily life. “Teaching” was coded based on a functional definition from evolutionary (...) biology. Frequencies, contexts, and subtypes of teaching as well as the identity of teachers were analyzed. Teaching was rare compared to observational learning, although both forms of social learning were negatively correlated with age. Children received teaching from a variety of individuals, and they also engaged in teaching. Several teaching types were observed, including instruction, negative feedback, and commands. Statistical differences in the distribution of teaching types and the identity of teachers corresponded with contrasting forager vs. farmer foundational cultural schema. For example, Aka children received less instruction, which empirically limits autonomous learning, and were as likely to receive instruction and negative feedback from other children as they were from adults. Commands, however, exhibited a different pattern suggesting a more complex role for this teaching type. Although consistent with claims that teaching is relatively rare in small-scale societies, this evidence supports the conclusion that teaching is a universal, early emerging cognitive ability in humans. However, culture structures the nature of teaching. (shrink)

To operate in an unpredictable environment, a vehicle with advanced driving assistance systems, such as a robot or a drone, not only needs to register its surroundings but also to combine data from different sensors into a world model, for which it employs filter algorithms. Such world models, as this article argues with reference to the SLAM problem in robotics, consist of nothing other than probabilities about states and events arising in the environment. The model, thus, contains a virtuality of (...) possible worlds that are the basis for adaptive behavior. The article shows that the current development of these technologies requires new concepts because their complex adaptive behaviors cannot be explained by referring them to mere algorithmic processes. Instead, it proposes the heuristic instrument of microdecisions to designate the temporality of decisions between alternatives that are created by probabilistic procedures of world modeling. Microdecisions are more than the implementation of deterministic processes—they decide between possibilities and, thus, always open up the potential of their otherness. By describing autonomous adaptive technologies with this heuristic, the question of sovereignty inevitably arises. It forces us to re-think what autonomy means when decisions can be automated. (shrink)

Weak emergence has been offered as an explication of the ubiquitous notion of emergence used m complexity science After outlining the problem of emergence and comparing weak emergence with the two other weak objectivist approaches to emergence, the paper explains a version of weak emergence and illustrates at with cellular automata Then it explains the sort of downward causation and explanatory autonomy involved m weak emergence.

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions (...) of autonomy such as authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general. (shrink)

Looking is a fundamental exploratory behavior by which infants acquire knowledge about the world. In theories of infant habituation, however, looking as an exploratory behavior has been deemphasized relative to the reliable nature with which looking indexes active cognitive processing. We present a new theory that connects looking to the dynamics of memory formation and formally implement this theory in a Dynamic Neural Field model that learns autonomously as it actively looks and looks away from a stimulus. We situate this (...) model in a habituation task and illustrate the mechanisms by which looking, encoding, working memory formation, and long-term memory formation give rise to habituation across multiple stimulus and task contexts. We also illustrate how the act of looking and the temporal dynamics of learning affect each other. Finally, we test a new hypothesis about the sources of developmental differences in looking. (shrink)

Background Respect for patients’ autonomy is usually considered to be an important ethical principle in Western countries; privacy is one of the implications of such respect. Healthcare professionals frequently encounter ethical dilemmas during their practice. The past few decades have seen an increased use of courts to resolve intractable ethical dilemmas across both the developed and the developing world. However, Chinese and American bioethics differ largely due to the influence of Chinese Confucianism and Western religions, respectively, and there is (...) a dearth of comparative studies that explore cases of ethical dilemmas between China and the United States. Methods This paper discusses four typical cases with significant social impact. First, it compares two cases concerning patient privacy: the “Shihezi University Hospital Case”, in which a patient was used as a clinical teaching object without her permission, and the “New York-Presbyterian Hospital Case”, in which the hospital allowed the filming of a patient’s treatment without his consent. Second, it compares two cases regarding patient autonomy and potentially life-saving medical procedures: the “Case of Ms. L”, concerning a cohabitant’s refusal to sign a consent form for a pregnant woman’s caesarean, and the “Case of Mrs. V”, concerning a hospital’s insistence upon a blood transfusion for a dissenting patient. This paper introduces the supporting and opposing views for each case and discusses their social impact. It then compares and analyses the differences between China and the United States from cultural and legislative perspectives. Conclusions Ethical dilemmas have often occurred in China due to the late development of bioethics. However, the presence of bioethics earlier in the US than in China has not spared the US of ethical dilemmas. This paper highlights lessons and inspiration from the cases for healthcare professionals and introduces readers to the role and weight of privacy and autonomy in China and in the US from the perspectives of different cultures, religions and laws. (shrink)

How to interpret autonomy plays a crucial role that leads to different readings in Kant’s moral metaphysics, philosophy of religion and moral psychology. In this paper I argue for a two-layered conception of autonomy with varying degrees of justification for each: autonomy as a capacity and autonomy as a paragon-like paradigm. I argue that all healthy rational humans possess the inalienable capacity of autonomy, i. e. share the universal ground for the communicability of objective basic (...) moral principles. This initial understanding stands for autonomy as a capacity about which we can talk of universal validity and justification. Nevertheless, the way a person fully actualizes herself, her freedom, namely autonomy, is shaped by her initial conception of autonomy and moral view of the world. Autonomy as an organic experience of real moral agents, which means an ongoing, non-static, irreducible and inexplicable judgmental process concerning one’s actualization of oneself gives way to consider autonomy as a godlike state of the soul even though one cannot provide objective validity for this. (shrink)

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate (...) patients’ competence (apart from decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

Using data obtained during a retrospective interview study of 30 women who had undergone genetic testing—BRCA1/2 mutation searching—this paper describes how women, previously diagnosed with breast/ovarian cancer, perceive their role in generating genetic information about themselves and their families. It observes that when describing their motivations for undergoing DNA testing and their experiences of disclosing genetic information within the family these women provide care based ethical justifications for their actions. Finally, it argues that generating genetic information and disclosing this information (...) to kin raise different types of ethical issues. The implications of these findings for ethical debates about informed choice in the context of genetic testing are discussed. (shrink)

Is there a problem of causal exclusion between micro- and macro-level physical properties? I argue (following Kim) that the sorts of properties that in fact are in competition are macro properties, viz., the property of a (macro-) system of 'having such-and-such macro properties' (call this a 'macro-structural property') and the property of the same system of 'being constituted by such-and-such a micro- structure' (call this a 'micro-structural property'). I show that there are cases where, for lack of reducibility, there is (...) a prima facie intra-level causal competition between the two kinds of properties. The problem can be resolved without giving up on the causal efficacy of the macro-structural properties if we understand instances of macro-structural properties to be parts of micro-structural property instances. The parthood relation between both kinds of property instances can be mapped onto the way physical theory deals with the relation of their descriptions in the framework of perturbation theory. The application of this framework to the problem of emergent properties is discussed. (shrink)

Many philosophers insist that the most plausible solution to the exclusion problem is to adopt the so-called ‘autonomy approach’, which denies either upward or downward causation between mental and physical properties. But the question of whether the autonomy approach is compatible with respectable theories of causation has seldom been discussed in the literature. This paper considers two influential theories of causation, the counterfactual account and the regularity account. I argue that neither the counterfactual theory nor the regularity theory (...) can support the autonomy approach – while the counterfactual approach fails to block downward causation, the regularity approach is unable to refute upward causation. (shrink)