Harry Frankfurt had insightfully pointed out that an agent acts freely when he acts in accord with the mental states with which he identifies. The concept of identification rightly captures the ownership condition (something being one’s really own), which plays a significant role in the issues of freedom and moral responsibility. For Frankfurt, identification consists of one’s forming second-order volitions, endorsing first-order desires, and issuing in his actions wholeheartedly. An agent not only wants to φ but also fully embraces his (...) desire to φ (and φ). Frankfurt’s official theory above encounters some serious problems, especially since it is believed that his concept of wholehearted identification is too strong to be necessary for freedom. In this paper, I propose that we can uncouple identification from wholeheartedness and thus get two different senses of identification: weak identification and strong identification. Then, I argue that this distinction does a better job than Frankfurt’s official theory. On the one hand, weak identification is enough for ownership and freedom and thus more promising than strong identification; on the other hand, this distinction has an attractive implication that it fits well with our intuition about the degree of freedom and responsibility. (shrink)

In this paper, I discuss a subset of preferences in which a person desires the fulfillment of a choice they have made, even if it involves the violation of their desires, as in rape fantasies. I argue that such cases provide us with a unique insight into personal autonomy from a proceduralist standpoint. In its first part, I analyze some examples in light of Frankfurt's endorsement theory and argue that even when we cannot endorse a practical decision that involves being (...) violated, we nonetheless regard those cases as instances of autonomy. Therefore, autonomy does not necessarily require endorsement. Instead, I propose that the nature of the relevant highest-order volition dictates the procedure that should be established in one’s desire structure for its fulfillment. In the second part, I discuss how an agent may effectively consent to the violation of their decision by another person. Ordinary consent typically refers to actions but fails to communicate one's higher-order desires or commitments. To address this limitation, I propose a practical tool that accomplishes this by signaling shifts in the normative context where the agents are interacting. (shrink)

This article argues in favour of voluntary active euthanasia in human beings on the grounds that we (society in general) perform euthanasia on valued companion animals when their suffering is considered great. I argue that suffering is a morally relevant criterion that should be considered in all cases (human and animal) of euthanasia. I further argue that human beings possess autonomy, a morally relevant difference to companion animals, that allows them to reason about their futures in a way that animals (...) cannot, which gives us more reason to grant euthanasia, if requested autonomously by terminally ill patients who are experiencing extreme suffering. I consider objections around the sanctity of human life and sufficient palliation. I argue that neither of these objections give sufficient reason to deny competent human beings euthanasia if autonomously requested. (shrink)

I present an account of epistemic autonomy as a distinctively wide-ranging epistemic virtue, one that helps us to understand a range of phenomena that might otherwise seem quite disparate – from the appropriate selection of epistemic methods, stances and topics of inquiry, to the harms of epistemic oppression, gaslighting and related phenomena. The account draws on four elements commonly incorporated into accounts of personal autonomy: (i) self-governance, (ii) authenticity, (iii) self-creation and (iv) independence. I further argue that for a distinctively (...) epistemic virtue of autonomy; the above elements must ultimately reliably lead to valuable epistemic goods (for the agent herself and others). I then turn to the domains or ways in which epistemic autonomy so understood, can be made manifest. I suggest that epistemic autonomy is a virtue that allows us to appropriately choose (i) subject matters and areas of inquiry, (ii) methods, sources, and processes of belief formation, (iii) epistemic goals and (iv) epistemic stances or frameworks. So understood, epistemic autonomy has a role to play in shaping most every aspect of our epistemic lives. (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)

In this open access book, Timothy Aylsworth and Clinton Castro draw on the deep well of Kantian ethics to argue that we have moral duties, both to ourselves and to others, to protect our autonomy from the threat posed by the problematic use of technology. The problematic use of technologies like smartphones threatens our autonomy in a variety of ways, and critics have only begun to appreciate the vast scope of this problem. In the last decade, we have seen a (...) flurry of books making “self-help” arguments about how we could live happier, more fulfilling lives if we were less addicted to our phones. But none of these authors see this issue as one involving a moral duty to protect our autonomy. (shrink)

This paper argues that praise is governed by a norm of standing, namely the evaluative commitment condition. Even when the target of praise is praiseworthy and known to be so by the praiser, praise can be inappropriate owing to the praiser’s lacking the relevant evaluative commitment. I propose that uncommitted praisers lack the standing to praise in that, owing to their lack of commitment to the relevant value, they have not earned the right to host the co-valuing that is the (...) communicative aim of praise. (shrink)

Feminists debate whether women can autonomously embrace their own subordination. Some argue that it is the process of identifying with desires and values that matters; others, that it is the content of the desires and values that matters. In this paper, I introduce a novel class of cases of ‘thwarted autonomy,’ in which women pursue autonomy but in ways that reinforce gendered subordination, and draw on these cases to develop an expressivist view of women’s autonomy. On this view, agents must (...) embody desires and values in the social world if they are to achieve self-understanding, such that the social world mediates the relation-to-self. Oppressive meanings and norms can channel this expressive activity in ways that violate women’s physical integrity and involve self-abnegation that is incompatible with autonomy. (shrink)

This paper identifies, develops, and argues for an interpretation of Mary Astell’s understanding of self-government. On this interpretation, what is essential to self-government, according to Astell, is an agent’s responsiveness to her own reasoning. The paper identifies two aspects of her theory of self-government: an ‘authenticity’ criterion of what makes our motives our own and an account of the capacities required for responsiveness to our own reasoning. The authenticity criterion states that when our motives arise from some external source without (...) validation by our own understanding of the reasons supporting them, then they are not our own. The capacities requisite for responsiveness to our own reasoning are those of examining and evaluating our own motives and of resisting the social pressure to conform to others’ opinions. An upshot of this interpretation of Astell’s theory of self-government is that it reveals her insights into the ways ‘custom’ can undermine an individual’s ability to govern oneself. (shrink)

Makins1 formulates a deference principle which states that patients’ attitudes towards the health outcomes associated with different treatment options should drive decision-making and not physicians’ attitudes towards these health outcomes. Although this deference principle is widely agreed on, it is less obvious which role patients’ risk attitudes should play. Makins takes patients’ attitudes towards health outcomes to be sufficiently analogous to patients’ risk attitudes in order to extend his deference principle. His extended deference principle states that patients’ attitudes towards the (...) health outcomes and risks associated with different treatment options should drive decision-making and not physicians’ attitudes towards these health outcomes and risks. This extension is not only taken to be ethically preferable, but also practically realisable as one can reliably trace patients’ (risk) attitudes. Problematic situations arise when patients exhibit risk attitudes they do not reflexively endorse. For instance, patients might systematically make more risky choices than they think they should make. In response to these kinds of situations, Makins proposes to revise his deference …. (shrink)

Suppose that a patient is receiving treatment options from her doctor. In one case, the doctor says, “the surgery has a 90% survival rate.” Now, suppose the doctor instead said, “the procedure has a 10% mortality rate.” Predictably, the patient is more likely to consent on the first description and more likely to dissent on the second. This is an example of a framing effect. A framing effect occurs when “the description of [logically-equivalent] options in terms of gains (positive frame) (...) rather than losses (negative frame) elicits systematically different choices.” Framing effects are ubiquitous, but they are particularly troublesome in medicine. Many worry that there is tension between valuing informed consent and using framing effects in clinical settings. In this paper, I answer this question: if an individual is subject to a framing effect when she gives her consent, does this undermine the validity of her consent? I argue that framing effects do not undermine consent in general. (shrink)

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to date. I critically (...) review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates. (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption (...) in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Behavioural techniques or ‘nudges’ can be used for various purposes. In this paper, we shift the focus from government nudges to nudges used by for-profit market agents. We argue that potential worries about nudges circumventing the deliberative capacities or diminishing the control of targeted agents are greater when it comes to market nudges, given that these (1) are not constrained by the principles that regulate government nudges (mildness, sensitivity to people’s interests and public justifiability) and (2) are often ‘stacked’ – (...) they come in great numbers that overwhelm agents. In addition, we respond to possible objections and derive several policy suggestions. (shrink)

Nudging works through dispositions to decide with specific heuristics, and has three component parts. A nudge is a feature of an environment that enables such a disposition; a person is nudged when such a disposition is triggered; and a person performs a nudged action when such a disposition manifests in action. This analysis clarifies an autonomy-based worry about nudging as used in public policy or for private profit: that a person’s ability to reason well is undermined when she is nudged. (...) Reasoning well is a component of self-guidance, which is an aspect of autonomy and so something there is reason to promote, preserve, or respect. However, a person can reason well when she is nudged: Many of these heuristics are good rules to reason with, and she can be flexible with respect to them when she takes there to be a better way to reason. Along the way, this paper uncovers several design specifications for responsible nudging, and discusses open empirical questions. However, nudging’s being compatible with reasoning well crystallizes a distinct worry about manipulation: that nudge designers can rely on nudged people guiding themselves toward the designers’ own ends. Manipulation of this sort exploits one aspect of autonomy (namely, self-guidance) to undermine autonomy in other respects. (shrink)

Advancements in machine learning have fuelled the popularity of using AI decision algorithms in procedures such as bail hearings, medical diagnoses and recruitment. Academic articles, policy texts, and popularizing books alike warn that such algorithms tend to be opaque: they do not provide explanations for their outcomes. Building on a causal account of transparency and opacity as well as recent work on the value of causal explanation, I formulate a moral concern for opaque algorithms that is yet to receive a (...) systematic treatment in the literature: when such algorithms are used in life-changing decisions, they can obstruct us from effectively shaping our lives according to our goals and preferences, thus undermining our autonomy. I argue that this concern deserves closer attention as it furnishes the call for transparency in algorithmic decision-making with both new tools and new challenges. (shrink)

It is seemingly bad for animals to have their desires modified in at least some cases, for instance where brainwashing or neurological manipulation takes place. In humans, many argue that such modification interferes with our positive liberty or undermines our autonomy but this explanation is inapplicable in the case of animals as they lack the capacity for autonomy in the relevant sense. As such, the standard view has been that, despite any intuitions to the contrary, the modification of animals’ desires (...) is not harmful (at least not in itself). In this article, I offer a different perspective on this issue, laying the foundations of a novel argument in defence of the view that animals _can_ be harmed by desire modification directly. I suggest that the modification of an animal’s desires (under certain circumstances) is harmful for that animal because it undermines their agency. (shrink)

How social media impacts the autonomy of its users is a topic of increasing focus. However, much of the literature that explores these impacts fails to engage in depth with the philosophical literature on autonomy. This has resulted in a failure to consider the full range of impacts that social media might have on autonomy. A deeper consideration of these impacts is thus needed, given the importance of both autonomy as a moral concept and social media as a feature of (...) contemporary life. By drawing on this philosophical literature, we argue that autonomy is broadly a matter of developing autonomy competencies, having authentic ends and control over key aspects of your own life, and not being manipulated, coerced, and controlled by others. We show how the autonomy of users of social media can be disrespected and harmed through the control that social media can have over its users’ data, attention, and behaviour. We conclude by discussing various recommendations to better regulate social media. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes for which (...) a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

The attention economy — the market where consumers’ attention is exchanged for goods and services — poses a variety of threats to individuals’ autonomy, which, at minimum, involves the ability to set and pursue ends for oneself. It has been argued that the threat wireless mobile devices pose to autonomy gives rise to a duty to oneself to be a digital minimalist, one whose interactions with digital technologies are intentional such that they do not conflict with their ends. In this (...) paper, we argue that there is a corresponding duty to others to be an attention ecologist, one who promotes digital minimalism in others. Although the moral reasons for being an attention ecologist are similar to those that motivate the duty to oneself, the arguments diverge in important ways. We explore the application of this duty in various domains where we have special obligations to promote autonomy in virtue of the different roles we play in the lives of others, such as parents and teachers. We also discuss the consequences of our arguments for employers, software developers, and policy makers. (shrink)

This is an open-access textbook designed for introduction to philosophy courses that contain a section on ethics, or for introductory courses in moral theory. In this edited work, chapter authors explore both historical and contemporary approaches to understanding and justifying moral and ethical norms. The chapters cover a wide range of topics, including moral relativism, the relationship between ethics and religion, virtue ethics in the Western and Eastern traditions, the question of self-interest and ethics, utilitarianism, Kantian deontological ethics, and recent (...) work in feminist ethics and evolutionary ethics. -/- Introduction to Philosophy: Ethics, edited by George Matthews (Plymouth State University), is one of a series of open-access textbooks for introduction to philosophy courses edited by Christina Hendricks (University of British Columbia), published with the support of The Rebus Community. (shrink)

Duties to oneself are allegedly incoherent: if we had duties to ourselves, we would be able to opt out of them. I argue that there is a constraint on one’s ability to release oneself from duties to oneself. The release must be autonomous in order to be normatively transformative. First, I show that the view that combines the division of the self with the second-personal characterization of morality is problematic. Second, I advance a fundamental solution to the problem of the (...) incoherence of duties to oneself, one that does not rely on any division of the self, temporal or otherwise. I build upon the prevalent idea that, in releasing others from duties, we exercise the power of consent. The transformative force of consent partly derives from our autonomy. Invoking a plausible characterization of autonomy, I argue that release from duties requires the right kind of mental state. (shrink)

Mobile health applications that promise the user to help her with some aspect of her health are very popular: for-profit apps such as MyFitnessPal, Fitbit, or Headspace have tens of millions of users each. For-profit health apps are designed and run as optimization systems. One would expect that these health apps aim to optimize the health of the user, but in reality they aim to optimize user engagement and, in effect, conversion. This is problematic, I argue, because digital health environments (...) that aim to optimize user engagement risk being manipulative. To develop this argument, I first provide a brief analysis of the underlying business models and the resulting designs of the digital environments provided by popular for-profit health apps. In a second step, I present a concept of manipulation that can help analyze digital environments such as health apps. In the last part of the article, I use my concept of manipulation to analyze the manipulative potential of for-profit health apps. Although for-profit health can certainly empower their users, the conditions for empowerment also largely overlap with the conditions for manipulation. As a result, we should be cautious when embracing the empowerment discourse surrounding health apps. An additional aim of this article is to contribute to the rapidly growing literature on digital choice architectures and the ethics of influencing behavior through such choice architectures. I take health apps to be a paradigmatic example of digital choice architectures that give rise to ethical questions, so my analysis of the manipulative potential of health apps can also inform the larger literature on digital choice architectures. (shrink)

En los sectores políticos democráticos liberales, el principio del respeto a la autonomía es ampliamente aceptado —en teoría, si no siempre en la práctica— como un valor moral cardinal que debería guiar tanto la deliberación política, la política pública y las prácticas, como nuestras actitudes respecto a nuestros conciudadanos. En términos simples, respetar la autonomía es respetar los intereses de cada persona de vivir su vida según su propia concepción del bien. En la base del requisito normativo de respetar la (...) autonomía de otro está la presunción de que la autonomía confiere autoridad normativa sobre la propia vida; la autoridad para tomar decisiones de importancia práctica para la propia vida, por razones propias, cualesquiera que sean. Se asume que las personas autónomas tienen la capacidad, el derecho y la responsabilidad de ejercer esta autoridad, incluso si no siempre lo hacen sabiamente. (shrink)

This paper proposes a distinctive kind of agency that can vindicate the agency of members of marginalised groups while accommodating the autonomy-undermining influences of oppression. Socially-embedded agency—the locus of which is in the exercise of our ability to negotiate between different social features—is compatible with, and can explain, various phenomena, including double-consciousness and white fragility. Moreover, although socially-embedded agency is neither necessary nor sufficient for autonomy, exercising it is practically necessary for autonomy, at least for members of marginalised groups in (...) our non-ideal world. (shrink)

Formal views of autonomy rule out substantive rational capacities (reasons-responsiveness) as a condition of autonomous agency. I argue that such views face a number of underappreciated problems: they have trouble making sense of how autonomous agents could be robustly responsible for their choices, face the burden of explaining why there should be a stark distinction between the importance of factual and evaluative information within autonomous agency, and leave it mysterious why autonomy is the sort of thing that has value and (...) ought to be promoted. Moreover, I argue that the alternative view that includes substantive rational capacities need not have the unacceptable political implications it is sometimes thought to have. (shrink)

Critics of persuasive advertising argue that it undermines the autonomy of consumers by manipulating their desires in morally problematic ways. My aim is this paper is to refine that argument by employing a conception of autonomy that is not at odds with certain forms of manipulation. I argue that the charge of manipulation is not sufficient for condemning persuasive advertising. On my view, manipulation of an agent’s desires through advertising is justifiable in cases where the agent accepts the process through (...) which the desires were developed. I show how the standard manipulation objection proves too much as it would also condemn cases of that kind. I argue that this distinction is especially important when we consider the implications of “new media.” In addition to increasing vulnerability to manipulation, new media have considerable impacts on well-being. By siding with the traditional autonomy argument, we would be compelled to take an implausible stand against all forms of manipulation through advertising, but I suggest that only a proper subset of those cases are morally problematic. This conclusion opens up a space for persuasive advertising that is permissible while nevertheless condemning cases that violate consumers’ autonomy. (shrink)

The philosophical significance of attitudinal autonomy—viz., the autonomy of attitudes such as beliefs—is widely discussed in the literature on moral responsibility and free will. Within this literature, a key debate centres around the following question: is the kind of attitudinal autonomy that’s relevant to moral responsibility at a given time determined entirely by a subject’s present mental structure at that time? Internalists say ‘yes’, externalists say ’no’. In this essay, I motivate a kind of distinctly epistemic attitudinal autonomy, attitudinal autonomy (...) that is relevant to knowledge. I argue that regardless of whether we are externalists or internalists about the kind of attitudinal autonomy that is relevant for moral responsibility, we should be externalists about the kind of autonomy that a belief must have to qualify as knowledge. (shrink)

The starting point regarding consent has to be that it is both extremely important, and that it is often suspicious. In this article, the author tries to make sense of both of these claims, from a largely liberal perspective, tying consent, predictably, to the value of autonomy and distinguishing between autonomy as sovereignty and autonomy as nonalienation. The author then discusses adaptive preferences, claiming that they suffer from a rationality flaw but that it's not clear that this flaw matters morally (...) or politically. What matters is whether they suffer from an autonomy flaw. To answer this question, the author develops an account of autonomy failure, according to which a preference is nonautonomous if an injustice played an appropriate role in its causal history. The author then discusses the moral implications—and in an initial way, the political ones as well—of proclaiming a preference, or consent based on it, nonautonomous in this way. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

This chapter first introduces naturalistic approaches to ethics more generally and distinguishes methodological ethical naturalism (the focus of this chapter), from metaphysical ethical naturalism. The second part then discusses evolutionary ethics as a specific variant of methodological ethical naturalism. After introducing the concepts of evolutionary theory that are relevant for evolutionary ethics, I will sketch the history of evolutionary ethics, which offers an interesting lesson about why it became a controversial topic, and then focus on four central questions about ethics (...) that can be approached from within the framework of evolutionary ethics: 1. What should we do? 2. Why are we moral? 3. Are there moral facts? 4. Can we have justified moral beliefs and moral knowledge? (shrink)

According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

How should we punish criminal offenders? One prima facie attractive punishment is administering a mandatory neurointervention—interventions that exert a physical, chemical or biological effect on the brain in order to diminish the likelihood of some forms of criminal offending. While testosterone-lowering drugs have long been used in European and US jurisdictions on sex offenders, it has been suggested that advances in neuroscience raise the possibility of treating a broader range of offenders in the future. Neurointerventions could be a cheaper, and (...) more effective method of punishment. They could also be more humane. Nevertheless, in this paper we provide an argument against the use of mandatory neurointerventions on offenders. We argue that neurointerventions inflict a significant harm on an offender that render them a morally objectionable form of punishment in a respect that incarceration is not. Namely, it constitutes an objectionable interference with the offender’s mental states. However, it might be thought that incarceration also involves an equally objectionable interference with the offender’s mental states. We show that even if it were the case that the offender is harmed to the same extent in the same respect, it does not follow that the harms are morally equivalent. We argue that if one holds that intended harm is more difficult to justify than harm that is unintended but merely foreseen, this means neurointerventions could be morally objectionable in a significant respect that incarceration is not. (shrink)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

This article offers an account of the information condition on morally valid consent in the context of sexual relations. The account is grounded in rights. It holds that a person has a sufficient amount of information to give morally valid consent if, and only if, she has all the information to which she has a claim-right. A person has a claim-right to a piece of information if, and only if, a. it concerns a deal-breaker for her; b. it does not (...) concern something that her partner has a strong interest in protecting from scrutiny, sufficient to generate a privilege-right; c.i. her partner is aware of the information to which her deal-breaker applies; or c.ii. her partner ought to be held responsible for the fact that he is not aware of the information to which her deal-breaker applies; and finally, d. she has not waived or forfeited her claim-right. Although we present this account in the context of sexual relations, we believe a virtue of the account is that it can be easily translated into other contexts. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

In this essay, I argue that the daily practice of expert nurses goes far toward enacting the kind of patient autonomy feminist bioethicists envision. Nursing theorists often utilize philosophical theories in their work, but bioethicists have not paid much attention to nursing theory and what it means to be an expert nurse. This is unfortunate because expert nurses do much in their daily practice to make the ideals for autonomy put forth by feminist bioethicists a reality. With this in mind, (...) I bring these two literatures together in what I hope is a fruitful dialogue. (shrink)

Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is at (...) stake since a technological imperative undermines patients’ ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates. (shrink)

Some proponents of compatibilist moral responsibility have proposed an historical theory which requires that agents deploy character control in order to be morally responsible. An important type of argument for the character control condition is the manipulation argument, such as Mele’s example of Beth and Chuck. In this paper I show that Beth can be exonerated on various conditions other than her failure to execute character control—I propose a new character, Patty, who meets these conditions and is, I argue, morally (...) responsible for her actions despite lacking character control. Thus the character control condition is unmotivated. I suggest there may be an alternative basis for an historical theory of moral responsibility nonetheless. (shrink)

In this paper I argue that to understand minded agency – the capacity we typically find instantiated in instances of human behaviour that could sensibly be questioned by asking “What did you do?” – one needs to understand childhood, i.e. the trajectory of learning to act. I discuss two different types of trajectory, both of which seem to take place during childhood and both of which might be considered crucial to learning to act: a growth of bodily control (GBC) and (...) a growth in taking responsibility (GTR). The discussion of GTR takes up about half of the entire paper. In the final two sections I argue that GTR is the most promising trajectory in terms of which to understand a child’s process of learning to act. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact (...) that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

Some experts have argued that patients facing certain types of choices should not be told whether their risk is above or below average, because this information may trigger a bias (Fagerlin et al. 2007). But careful consideration shows that the comparative risk heuristic can usefully guide decisions and improve their quality or rationality. Building on an earlier paper of mine (Schwartz 2009), I will argue here that doctors and decision aids should provide comparative risk information to patients, even while further (...) research is conducted. (shrink)

This collection of new essays examines philosophical issues at the intersection of feminism and autonomy studies. Are autonomy and independence useful goals for women and subordinate persons? Is autonomy possible in contexts of social subordination? Is the pursuit of desires that issue from patriarchal norms consistent with autonomous agency? How do emotions and caring relate to autonomous deliberation? Contributors to this collection answer these questions and others, advancing central debates in autonomy theory by examining basic components, normative commitments, and applications (...) of conceptions of autonomy. Several chapters look at the conditions necessary for autonomous agency and at the role that values and norms -- such as independence, equality, inclusivity, self-respect, care and femininity -- play in feminist theories of autonomy. Whereas some contributing authors focus on dimensions of autonomy that are internal to the mind -- such as deliberative reflection, desires, cares, emotions, self-identities and feelings of self-worth -- several authors address social conditions and practices that support or stifle autonomous agency, often answering questions of practical import. These include such questions as: What type of gender socialization best supports autonomous agency and feminist goals? When does adapting to severely oppressive circumstances, such as those in human trafficking, turn into a loss of autonomy? How are ideals of autonomy affected by capitalism? and How do conceptions of autonomy inform issues in bioethics, such as end-of-life decisions, or rights to bodily self-determination? (shrink)

This article asks whether states have a right to close their borders because of their right to self-determination, as proposed recently by Christopher Wellman, Michael Walzer, and others. It asks the fundamental question whether self-determination can, in even its most unrestricted form, support the exclusion of immigrants. I argue that the answer is no. To show this, I construct three different ways in which one might use the idea of self-determination to justify immigration restrictions and show that each of these (...) arguments fails. My conclusion is that the nature and value of self-determination have to do with the conditions of genuine self-government, not membership of political society. Consequently, the demand for open borders is fully consistent with respect to self-determination. (shrink)

In this dissertation I argue that while hedonism seems to be the correct theory of happiness, happiness does not seem to be the essence of welfare; after all, it appears that a person may be brainwashed over a given duration, may be happy over that same duration, but not also be well off over that duration, all things considered; this suggests that well-being consists of capacity-fulfillment. Hedonism about happiness, maintains that you are happy to the extent that you have pleasure, (...) unhappy to the extent that you have pain. Besides hedonism about happiness, there are three popular theories of happiness: desire-satisfaction, life-satisfaction, and emotional state. I judge these theories both by whether they accord with our commonsense intuitions and whether they have any internal problems. All three conflict with some of our intuitions and have internal problems. HH, however, accords with our intuitions and is not susceptible to the internal problems that the other theories are susceptible to. The relationship between happiness and well-being is a complex one. Happiness does seem intrinsically good for the happy: whenever you experience an episode of happiness, you seem thereby better off. By appealing to the case of brainwashing, however, I show that happiness seems neither necessary nor sufficient for welfare. Before introducing my own theory of welfare, I discuss five alternatives: desire-satisfaction, life-satisfaction, self-fulfillment, perfectionism, and objective list. The first four fail to accord with intuition in the case of brainwashing and the last three have internal problems. My own theory of welfare, capacity-fulfillment about welfare, maintains that you are well off to the extent that you successfully exercise your basic capacities. We possess four basic capacities: affection, cognition, conation, and locomotion. While CFW does not accord with some of our intuitions, it accommodates the case of brainwashing and incorporates some of the strengths of the welfare theories I criticize while remaining immune to the internal problems they have. (shrink)

In this paper, I propose a novel deliberation-based theory of autonomy which grounds an agent’s autonomy in her nature as a rationally-reflective being. I defend that theory against competing approaches to autonomous agency by arguing that the theory I propose is best equipped to handle two of the more troublesome problems that theories of autonomy face: the regress problem and the problem of manipulation. Sarah Buss and Peter Railton have each recently claimed that the regress problem which plagues many prominent (...) accounts of autonomy indicates the need to abandon the notion that autonomous agency is to be understood in terms of deliberation, endorsement, or any other activity on the part of the agent, and adopt instead a “passive” approach to autonomous agency. Against this claim, I argue that despite their shift to the passive mode, the theories offered by Buss and Railton also face a version of the regress problem, and that the general solution to that problem implicit in their passive theories is available also to “active” theories of autonomy, such as the deliberation-based theory I propose. I go on to explain that because the solution to the regress problem I extract from the theories of Buss and Railton requires an “unmoved mover” of autonomy, the history of which is necessarily irrelevant, it invites manipulation objections. I argue that the theory I propose offers the most promising response to such objections, and thus escapes these two prominent problems in better stead than do the competing approaches to autonomous agency. (shrink)

Theories of autonomy commonly make reference to some form of endorsement: an action is autonomous insofar as the agent has a second-order desire towards the motivating desire, or takes it to be a reason for action, or is not alienated from it. In this paper I argue that all such theories have difficulty accounting for certain kinds of agents, what I call ‘Woody Allen cases’. In order to make sense of such cases, I suggest, it is necessary to disambiguate two (...) distinct forms of endorsement, both of which contribute to autonomy. (shrink)