In this dissertation, I respond to the feminist critique of traditional theories of autonomy, which revolves around the charge that such theories are too individualistic. Feminists argue against the liberal atomism that they see at the center of traditional autonomy theories. Their resulting theory of relational autonomy is meant to remedy that traditional theories of autonomy posit an individualistic conception of both the self and autonomy. Instead, feminists have argued for a theory of autonomy that takes account of the ways (...) in which persons are irreducibly social, and the ways in which autonomy itself is only possible within certain types of social relationships. I separate the feminist charges against liberalism from the feminist charges against traditional autonomy, since it is at least prima facie possible to consider personal autonomy separately from political autonomy. I thus isolate the feminist critique of liberal atomism from the feminist critique of individualistic autonomy. The first chapter examines the feminist critique of liberalism to determine why it is that the charge of liberal atomism continues to stick, even though it has been clearly established by both feminist and mainstream liberals that liberalism is not guilty of such a charge. While I do not provide a full defense of liberalism, I do argue that such a defense is possible, and possible in a way that upholds feminist goals. Having separated the critiques of liberalism from the critiques of traditional autonomy, the rest of the dissertation focuses exclusively on the autonomy debate. I present an argument against the most robustly relational feminist accounts of autonomy those which accept a relational account of both the self and autonomy. I argue that, although such theories are explicitly designed to vindicate the normative commitments of feminism, their implications yield unwelcome results from this very same feminist perspective. I then present my own procedural account of autonomy. Because it is not constitutively social, it is unlikely to be characterized as a relational account at all. I argue, however, that it is this very feature which allows my account to vindicate the feminist normative commitments espoused by constitutively relational accounts. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

Consider that an individual improves her capacities by neuroscientific means. It turns out that, besides altering her in the way(s) she intended, the enhancement also changes her personality in significant way(s) she did not foresee. Yet the person endorses her new self because the neuroenhancement she underwent changed her. Can the person’s approval of her new personality be autonomous? While questions of autonomy have already gathered a significant amount of attention in philosophical literature on human enhancement, the problem just described—henceforth (...) referred to as the question whether selfvalidating neuroenhancement can be autonomous—would not appear to have received due consideration. This article takes a step towards remedying the shortage. I start by explicating the main points of departure of its argument. In the subsequent sections of the article, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with autonomy. On the basis of the consideration, I propose that self-validating neuroenhancement can be autonomous. (shrink)

This paper discusses the relation between medical ethics and general moral theory, the argument being that medical ethics is best seen as independent from general moral theory. According to this independence thesis, here explicated in terms of what is called a disunitarian stance, the very idea of applied ethics, which is often seen as underlying medical ethics (as well as many other more specific fields of ethics), is misguided. We should instead think of medical ethics as a domain-specific ethical inquiry (...) among other domain-specific ethical inquiries. On this alternative kind of picture, such ethical inquiries should start with looking at the particularities of the domain under consideration and then proceed from there. Some possible consequences of this idea for medical ethics are then identified and discussed. (shrink)

In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and (...) products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient autonomy. These different manifestations of (...) autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

Many argue that consumers possess a “right to know” when products contain ingredients derived from genetically modified organisms, on the grounds that it would protect consumer autonomy. In this paper, I critically evaluate that claim. I begin by providing a version of the “consumer autonomy” argument, showing that its success relies on ambiguities in the notion of autonomy. I then distinguish four approaches to autonomy and articulate the circumstances under which they would support active disclosure of a product property. I (...) argue that none of these conceptions would support active disclosure of the presence of ingredients derived from genetically modified organisms. (shrink)

Some recent arguments for paternalist government interventions have been based in empirical results in psychology and behavioral economics that would seem to show that adult human beings are far removed from the ideals of rationality presupposed by much of philosophical and economic theory. In this paper it is argued that we need to move to a different conception of human decision-making competence than the one that lies behind that common line of philosophical and economic thinking, and which actually still lies (...) in the background of some of these recent approaches to paternalist interventions. An alternative picture of human decision-making competence is outlined and four criteria for identifying areas where paternalist interventions have a basic moral and political legitimacy are then identified on the basis of this picture. (shrink)