Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes to the systematic differentiation of (...) soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism. (shrink)

De moderne filosofie lijdt aan muziekvergetelheid. Opvallend is echter dat filosofen, wanneer ze toch aandacht schenken aan muziek, hun aandacht bij voorkeur op één bepaald genre richten, namelijk de opera. Filosofen zoals Søren Kierkegaard en Friedrich Nietzsche lieten hun gedachten over Don Giovanni, Parsifal en Carmen gaan, terwijl omgekeerd de filosofie van Arthur Schopenhauer de opera heeft beïnvloed via Wagner. Diens werk lijkt zich op het snijpunt van het grensverkeer tussen moderne filosofie en moderne muziek te bevinden. Het was zijn (...) ambitie de menselijke existentie en de menselijke geschiedenis in één panoramisch oeuvre te vatten, vanaf het primordiale begin tot en met de dramatische finale die ophanden leek: een catastrofale apotheose die een geheel nieuwe toekomst mogelijk zou maken. Dat is althans de verhaallijn van zijn meesterwerk Der Ring des Nibelungen. Aan het slot van Götterdämmerung lijkt zich een algehele verwoesting te hebben voltrokken: ‘Everything is destroyed and there is an enigmatic kind of hovering over the scene of destruction’ (Badiou 2010, p. 106), een ambivalente stemming van hoop en destructie zette Wagner op muziek. Voor Wagner is dan ook een hoofdrol in deze studie weggelegd: voor zijn muziektheoretische geschriften (waarin hij over een ‘muziek van de toekomst’ filosofeerde), maar meer nog voor de muzikale totaalkunstwerken die hij daadwerkelijk componeerde. (shrink)

Ethical concerns surrounding medical research in resource-poor settings. including the 'pharming' out or outsourcing or ‘offshoring’ of clinical trials, and how these relate to the economic, historical and political dimensions of the global scientific field, are a recurrent theme across the different social science disciplines.

Values such as respect for autonomy, safety, enablement, independence, privacy and social connectedness should be reflected in the design of social robots. The same values should affect the process by which robots are introduced into the homes of older people to support independent living. These values may, however, be in tension. We explored what potential users thought about these values, and how the tensions between them could be resolved. With the help of partners in the ACCOMPANY project, 21 focus groups (...) were convened in France, the Netherlands and the UK. These groups consisted of: older people, informal carers and formal carers of older people. The participants were asked to discuss scenarios in which there is a conflict between older people and others over how a robot should be used, these conflicts reflecting tensions between values. Participants favoured compromise, persuasion and negotiation as a means of reaching agreement. Roles and related role-norms for the robot were thought relevant to resolving tensions, as were hypothetical agreements between users and robot-providers before the robot is introduced into the home. Participants’ understanding of each of the values—autonomy, safety, enablement, independence, privacy and social connectedness—is reported. Participants tended to agree that autonomy often has priority over the other values, with the exception in certain cases of safety. The second part of the paper discusses how the values could be incorporated into the design of social robots and operationalised in line with the views expressed by the participants. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

The objective of this article is to investigate ethical aspects of technology through the moral term “paternalism”. The field of investigation is medicine. The reason for this is twofold. Firstly, “paternalism” has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients’ autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of technology, but that its (...) traditional conception is not adequate to address the challenges of modern technology. A modification towards a “technological paternalism” is necessary. That is, “technological paternalism” is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology. (shrink)

This article defines the nature of paternalistic interventions in psychotherapy and discusses reasons why the client's right to consent to treatment is important. We describe a reasoning process developed by Culver and Gert (1982) that can be used to determine when paternalistic actions are and are not ethically justifiable in mental health practice. We demonstrate how this procedure may be applied to psychotherapy by using a number of case illustrations.

It is possible to retrieve viable sperm from a dying man or from a recently dead body. This sperm can be frozen for later use by his wife or partner to produce his genetic offspring. But the technical feasibility alone does not morally justify such an endeavour. Posthumous semen retrieval raises questions about consent, the respectful treatment of the dead body, and the welfare of the child to be.We present two cases, discuss these three issues, and conclude that such requests (...) should generally not be honoured unless there is convincing evidence that the dead man would want his widow to carry and bear his child. Even with consent, the welfare of the potential child must be considered. (shrink)

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. (...) In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit. (shrink)

This article analyzes the moral reasoning implied in a very commonly used expression, namely, "What the eye doesn't see, the heart doesn't grieve over", or "What you don't know won't hurt you." It especially deals with situations in which it is used for trying to justify acts that are, in themselves, reprehensible. For instance, when a cheating husband tries to justify his adultery by appealing to the alleged fact that he does not tell his wife about it and thus she (...) is not harmed by it: "If you are not informed, you are not hurt" (NINH). The components of NINH reasoning are unfolded, as well as its grounds, starting from a consequentialistic, deontological, or virtue ethics perspective. Two special characteristics of NINH reasoning are discussed, namely, that it tries to bridge deontological and consequentialistic approaches of morality in a commonsense way and that it contains a special type of paternalism. Finally, some ethical implications are discussed. (shrink)

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon demonstration of (...) competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to acquire knowledge, use instrumental rationality, and form and revise a life plan. (shrink)

Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives , it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised.Ulysses (...) contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition. (shrink)

Tom Beauchamp and I were asked by the editors of The Journal of Medicine and Philosophy to prepare “intellectual autobiographies,” with particular attention to sources and influences on our work, including but not limited to Principles of Biomedical Ethics. Of course, it is artificial and even impossible to try fully to separate the “intellectual” from other aspects of our lives. So, while emphasizing the “intellectual” aspects of my autobiography, I have attended to other aspects, too. The huge debts of gratitude (...) I owe also mix the “intellectual” and other aspects of life. (shrink)