This paper explores the value of respect for personal autonomy in relation to clearly immoral and irrational acts committed freely and intentionally by competent people. Following Berlin's distinction between two kinds of liberty and Darwall's two kinds of respect, it is argued that coercive suppression of nonautonomous, irrational, and self-harming acts of competent persons is offensive to their human dignity, but not disrespectful of personal autonomy. Irrational and immoral choices made by competent people may claim only the negative liberty to (...) be left alone. Lives disposed to autonomy are worthy of solidarity and active support in addition to the right of free choice and action. Autonomous premeditated desires (distinguished from mere consent) may embody transcendental choices, which transcend consideration of physical and psychological well-being. Choices made by incompetent persons (e.g., children and the mentally disabled) are not related to autonomy, but to self-directedness. The value of human dignity confers protection to self-directedness, but not at the expense of other vital interests. (shrink)

Virtually any appraisal of a person’s welfare, integrity, or moral status, as well as the moral and political theories built on such appraisals, will rely crucially on the presumption that her preferences and values are in some important sense her own. In particular, the nature and value of political freedom is intimately connected with the presupposition that actions one is left free to do flow from desires and values that are truly an expression of the ‘self-government’ of the agent. However, (...) we all know that no person is self-made in the sense of being a fully formed and intact ‘will’ blossoming out of nowhere. Our values and preferences are explained by essential reference to a variety of influences that have come to bear on our development throughout our personal histories. What is needed, then, is to establish an account of self-determination or autonomy that would help determine just when and if the values and preferences we find ourselves with deserve the centrality that moral and political theories place on them. (shrink)

With the publication of A Theory of Justice in 1971, John Rawls not only rejuvenated contemporary political philosophy but also defended a Kantian form of Enlightenment liberalism called “justice as fairness.” Enlightenment liberalism stresses the development and exercise of our capacity for autonomy, while Reformation liberalism emphasizes diversity and the toleration that encourages it. These two strands of liberalism are often mutually supporting, but they conflict in a surprising number of cases, whether over the accommodation of group difference, the design (...) of civic education, or the promotion of liberal values internationally. During the 1980’s, however, Rawls began to jettison key Kantian characteristics of his theory, a process culminating in the 1993 release of Political Liberalism and completing the transformation of justice as fairness into a Reformation liberalism. -/- Reconstructing Rawls argues that this transformation was a tragic mistake because it jeopardized the most important features of his theory, viz. the lexical priorities of right, liberty, and fair equality of opportunity as well as the difference principle. Controversially, this book contends that Rawls’s so-called “political turn,” motivated by a newfound interest in diversity and the accommodation of difference, has been unhealthy for autonomy-based liberalism and has pushed liberalism more broadly towards cultural relativism, be it in the guise of liberal multiculturalism or critiques of cosmopolitan distributive-justice theories. The book then demonstrates that the central elements of justice as fairness can only be defended within the context of a Kantian Enlightenment liberalism and that Rawls’s hope for a more pluralistic grounding for his theory, endorsed by a wide variety of belief systems present in modern democratic societies, is illusory. -/- Reconstructing Rawls is the first book to systematically compare Rawls’s and Kant’s theories and the first to offer an internal critique and reconstruction of justice as fairness, reconceiving it as a comprehensive, universalistic Kantian liberalism. By doing so, it gives us both the vision of a liberal world order—“a republicanism of all states, together and separately,” as Kant put it—and a mode of justification addressed to all men and women, not as members of particular nations, races, and faiths, but as human beings, as citizens of the world. In short, it reclaims Rawls for the Enlightenment. (shrink)

Psychiatric patients may try (or express a desire) to injure themselves in hospital in order to cope with overwhelming emotional pain. Some health care practitioners and patients propose allowing a controlled amount of self-injury to occur in inpatient facilities, so as to prevent escalation of distress. Is this approach an example of professional assistance with harm? Or, is the approach more likely to minimise harm, by ensuring safer self-injury? In this article, I argue that health care practitioners who use harm-minimisation (...) can be considered to be helping physical injury to occur, although they do not encourage the act. I consider why there are compelling reasons to believe that a patient who self-injures is not maximally autonomous in relation to that choice. However, I then move onto argue that allowing a degree of self-injury may enable engagement with psychotherapy (enhancing autonomy) and behavioural change. In these circumstances, allowing injury (with precautions) may not be harm, all things considered. (shrink)

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

The immigration debate in political theory has produced a series of accounts that justify the state’s right to exclude potential immigrants, where the right of self-determination figures prominently. We challenge two prominent accounts of the self-determination-based right to exclude and defend a circumscribed right to exclude and a corollary duty to admit immigrants, based on our ‘people relationship goods’ account of self-determination. Our conception reconciles the moral claims of global opportunity migrants with the well-being and non-alienation interests of the locals. (...) It therefore provides a principled answer to the philosophical question underlying pressing political conflicts today, namely what is the permissible scope of exclusion by self-determining political communities, in light of weighty global moral demands of inclusion. (shrink)

Transparency is now a fundamental principle for data processing under the General Data Protection Regulation. We explore what this requirement entails for artificial intelligence and automated decision-making systems. We address the topic of transparency in artificial intelligence by integrating legal, social, and ethical aspects. We first investigate the ratio legis of the transparency requirement in the General Data Protection Regulation and its ethical underpinnings, showing its focus on the provision of information and explanation. We then discuss the pitfalls with respect (...) to this requirement by focusing on the significance of contextual and performative factors in the implementation of transparency. We show that human–computer interaction and human-robot interaction literature do not provide clear results with respect to the benefits of transparency for users of artificial intelligence technologies due to the impact of a wide range of contextual factors, including performative aspects. We conclude by integrating the information- and explanation-based approach to transparency with the critical contextual approach, proposing that transparency as required by the General Data Protection Regulation in itself may be insufficient to achieve the positive goals associated with transparency. Instead, we propose to understand transparency relationally, where information provision is conceptualized as communication between technology providers and users, and where assessments of trustworthiness based on contextual factors mediate the value of transparency communications. This relational concept of transparency points to future research directions for the study of transparency in artificial intelligence systems and should be taken into account in policymaking. (shrink)

Some of our motives that we act on are not only of unconstrained origin, but we also take them to express who we are and, thus, to "speak for us." Harry G. Frankfurt has maintained that it is the formation of a hierarchical structure by means of an act of wholehearted identification that makes a given motive genuinely one's own. I argue that wholehearted identifications fail to live up to this task. Instead, I demonstrate that only a subtype of wholehearted (...) identifications, namely core identifications, genuinely "speak for us." In addition, I argue that core identifications help explain the peculiar phenomenology that characterizes some of our crucial choices. (shrink)

It seems natural to think of an unwilling addict as having a pattern of preferences that she does not endorse—preferences that, in some sense, she does not ‘identify’ with. Following Frankfurt (1971), Jeffrey (1974) proposed a way of modeling those features of an agent’s preferences by appealing to preferences among preferences.Th„e addict’s preferences are preferences she does not prefer to have. I argue that this modeling suggestion will not do, for it follows from plausible assumptions that a minimally rational agent (...) must prefer those first-order preferences she actually has. I close by considering two different but related ways to think about the initial phenomenon. (shrink)

While “dignity” plays an increasingly important role in contemporary moral and political debates, there is profound dispute over its definition, meaning, and normative function. Instead of concluding that dignity’s elusiveness renders it useless, or that it signals its fundamental character, this paper focuses on illuminating one particular strand of meritocratic dignity. It introduces a number of examples and conceptual distinctions and argues that there is a specific strand of “expressive” meritocratic dignity that is not connected to holding a special office (...) or rank, but that is ascribed to individuals who are able to engage in autonomous self-expression. (shrink)

This paper is a short commentary on Veljko Dubljevic's "Autonomy in Neuroethics: Political and Not Metaphysical.".

In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where issues related (...) to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare. (shrink)

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

One of the most potent motivations for retributivist approaches to punishment has been their apparent connection to an ethical background shaped by the Kantian notion of morally autonomous and rational human agency. The present article challenges the plausibility of this connection. I argue that retributivism subverts, rather than embodies, the normative consequences of moral autonomy, justifying a social practice that conflicts with the considered judgments that the proper recognition of moral autonomy would authorize. The core of my case is the (...) analysis of whether a punishment should be understood as a restriction of a criminal's freedom properly understood. I argue that the affirmative view faces serious difficulties that have not been, and are not likely to be, resolved by retributivist justifications that draw their support from Kantian moral theory. (shrink)

We haveconflictingpre-philosophical intuitions about what it means ‘to be true to ourselves.’ On the one hand, autonomy and authenticity seem closely connected to the lucidity of reflectiveness; on the other, they seem tightly interwoven with the immediacy of unreflectiveness. As opposed to a ‘Platonic’ intuition about the inferiority of the unexamined life, we have an equally strong ‘Nietzschean’ intuition about the corrosiveness of the examined life. Broadly speaking, the first intuition is more akin to the tradition of the Enlightenment, and (...) the second, more to that of Romanticism; the one is reminiscent of Descartes and Hume, the other of Rousseau and Herder.The use of the technical term ‘autonomy’ and the concomitant term ‘self’ is primarily limited to philosophy, while in daily life ‘freedom’ and ‘person,’ respectively, are used instead. Unfortunately, in their deployment of these technical terms philosophers have generally failed to acknowledge the two modes of ‘being true to ourselves’ associated with the Enlightenment and Romanticism, for they usually employ the concept of autonomy in a unitary way. (shrink)

In this paper I present a moral account of the legal notion of deceptive advertising. I argue that no harmful consequences to the consumer need follow from a deceptive advertisement as such, and I suggest instead that one should focus on the consequences of permitting the practise of deceptive advertising on society as a whole. After a brief account of deceptive advertising, I move to discuss the role of the reasonable person standard in its definition. One interpretation of this standard (...) is empirical, aiming to objectify the quality of misleadingness in the advertisement. I offer an alternative normative interpretation which aims to draw the line between the advertiser's responsibility and that of the consumer, between misleading and miscomprehension. I then examine and reject several possible moral grounds for condemning and prohibiting deceptive advertising. These include: harm, in the sense of welfare, to the misled consumer; harm to competitors; and a violation or a reduction of the consumer's autonomy. Finally, I explain how the effect of the practise of deceptive advertising on society as a whole should inform our normative line-drawing between misleading and miscomprehension, and how it provides the basis for the moral evaluation of deceptive advertising. (shrink)

Equality of Opportunity is widely thought of as the normative ideal most relevant to the design of educational institutions. One widely discussed interpretation of this ideal is Rawls' principle of Fair Equality of Opportunity. In this paper I argue that theories, like Rawls, that give priority to the achievement of individual autonomy, are committed to giving that same priority to a principle of sufficient opportunity. Thus, the Rawlsian's primary focus when designing educational institutions should be on sufficiency and not equality. (...) The paper then argues this commitment has at least three attractive implications. Firstly, it enables defenders of Fair Equality of Opportunity to overcome Richard Arneson's powerful objections. Secondly, it suggests a revised version of the principle of Fair Equality of Opportunity that is more plausible. Thirdly, it has attractive practical implications for educational provision. (shrink)

Certain cases emphatically motivate the view that personal autonomy — autonomy as self-government — is a necessary condition of moral blameworthiness. The cases, that is, suggest that one cannot be morally blameworthy for performing an action unless one is autonomous with respect to that action, or one is autonomous with respect to the motivational underpinnings that figure in the etiology of the action. Here is a typical, fanciful example. Unbeknownst to Bond, a minute electronic device has been implanted in his (...) brain. Maxine can use the device to induce desires or intentions in Bond without her electronic manipulations being ‘felt’ or detected by Bond. Suppose Maxine implants in Bond a powerful desire to kill Oskar, a distant associate of Bond, together with the belief that the desire is irresistible. Though the electronically induced desire is not in fact irresistible, Bond could resist it only with a great deal of difficulty and only at the expense of suffering considerable psychological damage; Bond, to his astonishment, acts on this desire and does away with Oskar. This case is one in which Bond, it appears, is not morally blameworthy for killing Oskar. According to one strand of thought, the judgment that Bond is not blameworthy rests squarely on the view that Bond acts on a desire that is not truly his own;1 Bond is not his own master with respect to the implanted desire that causes him to kill Oskar. (shrink)

Our decision-making is often subject to framing effects: alternative but equally informative descriptions of the same options elicit different choices. When a decision-maker is vulnerable to framing, she may consent under one description of the act, which suggests that she has waived her right, yet be disposed to dissent under an equally informative description of the act, which suggests that she has not waived her right. I argue that in such a case the decision-maker’s consent is simply irrelevant to the (...) permissibility of proceeding. I then consider two alternative views. According to the first, people susceptible to framing are able to give valid consent so long as they are sufficiently informed. This suggestion, I argue, maintains an overly narrow focus on mere quantity of information to the exclusion of other choice-affecting factors. A second response, which appeals to hypothetical consent, is likewise of little use in resolving the moral problem posed by framing effects. I conclude that if susceptibility to framing undermines the validity of consent, we may have good reason to reconsider whether consent has the rights-waiving function commonly attributed to it. (shrink)

This essay lays the groundwork for a novel conception of autonomy that may be called “effective autonomy”—a conception designed to be genuinely action guiding in bioethics. As empirical psychology research on the heuristics and biases approach shows, decision making commonly fails to correspond to people’s desires because of the biases arising from bounded cognition. People who are classified as autonomous on contemporary philosophical accounts may fail to be effectively autonomous because their decisions are uncoupled from their autonomous desires. Accordingly, continuing (...) attempts to value patient autonomy must go beyond existing philosophical conceptions of autonomy to consider the background conditions of human decision making. (shrink)

Can we measure and predict character with predictive analytics so a business can better assess, ideally objectively, whether to lend money or extend credit to that person, beyond current objective measures of credit scores and standard financial metrics like solvency and debt ratios? We and the analysts probably do not know enough about character to try to measure it, though it might be more useful to measure and predict a person’s temperance and prudence as virtues, or self-control as psychology, or (...) sense of obligation, particularly a moral commitment or sense of duty to honor a contract and re-pay a loan. The pervasive data surveillance of people that goes with “big data” and predictive analytics is not only an invasion of privacy in general, but an impairment of the aspect of privacy called autonomy that will constrict and alter a person’s choices and development of self. (shrink)

Part I of the dissertation examines the cognitive aspects of autonomy. The central question concerns what kind of cognitive capacity autonomy is. It will be argued that the concept of autonomy is best understood in terms of a metacognitive capacity of the individual. It is argued that metacognition has two components: procedural reflexivity and metarepresentation. Metarepresentation in turn can be divided into inferential reflexivity and other-attributiveness. These two components are essential for autonomy. Particular emphasis is put on procedural reflexivity. Further, (...) since the essential function of metacognition is control, it is argued that the concept of autonomy, understood as a metacognitive capacity, can be interpreted in terms of control. Issues arising from empirical data from neuroscience on functional, as well as impaired, metacognition, and on undermined autonomy, are dealt with. It is argued that autonomy cannot be determined with respect to subjective conditions. Neurological impairments, like Anton’s Syndrome, dementia, and thought insertion in schizophrenia, are put forward in support of this claim. To determine autonomy we require external conditions. In order to determine whether an individual is autonomous, both the metacognitive status of the individual and the external setting must be considered, since they are in interplay and consequently influence each other. In Part II, the analysis put forward in Part I is applied to Swedish healthcare. It is argued that the distinction between autonomy as a right and as a capacity must be explicit in order to understand what autonomy means and to deal with it effectively in healthcare practice. A discussion about whether or not the patient’s right to autonomy sometimes tends to be over-emphasized in healthcare is put forward. Special emphasis is placed on psychitaric issues such as deinstitutionalization and participation. Following the closure of the mental hospitals, deinstitutionalization and community-based care have become central topics in psychiatry. At the same time, the implementation of such care can be demanding for patients suffering from a persistent mental disorder. In part II it is also suggested that the metacognitive account of the concept of autonomy might help clarify the criteria governing coercive care. Finally, some suggestions concerning developments and improvements in Swedish healthcare, especially in psychiatry, where the concept of autonomy is important but problematic, are put forward. (shrink)

Utilitarians are said to be indifferent between interpersonal and intrapersonal transfers. In doing so, they fail to register the separateness of persons. This ‘separateness of persons’ objection has been traditionally used against utilitarianism, but more recently against prioritarianism. In this paper, I examine how yet another distributive view, namely sufficientarianism, fares in this respect. Sufficientarians famously believe that while inequality as such does not matter, what does matter is that all individuals meet some adequate threshold. It is often taken for (...) granted that sufficientarianism does not violate the separateness of persons. In this paper, I seek to show that that is not the case. The main challenge, however, proves to be formulating an accurate understanding of what the separateness of persons precisely means. I offer several interpretations and argue that sufficientarianism, surprisingly, violates them all. Sufficientarianism, just like utilitarianism does not respect the separateness of persons. (shrink)

We have conflicting pre-philosophical intuitions about what it means ‘to be true to ourselves.’ On the one hand, autonomy and authenticity seem closely connected to the lucidity of reflectiveness; on the other, they seem tightly interwoven with the immediacy of unreflectiveness. As opposed to a ‘Platonic’ intuition about the inferiority of the unexamined life, we have an equally strong ‘Nietzschean’ intuition about the corrosiveness of the examined life. Broadly speaking, the first intuition is more akin to the tradition of the (...) Enlightenment, and the second, more to that of Romanticism; the one is reminiscent of Descartes and Hume, the other of Rousseau and Herder.The use of the technical term ‘autonomy’ and the concomitant term ‘self’ is primarily limited to philosophy, while in daily life ‘freedom’ and ‘person,’ respectively, are used instead. Unfortunately, in their deployment of these technical terms philosophers have generally failed to acknowledge the two modes of ‘being true to ourselves’ associated with the Enlightenment and Romanticism, for they usually employ the concept of autonomy in a unitary way. (shrink)

Paternalism is the restriction of a person's autonomy for the good of that person. It embodies a familiar conflict of intuitions: while we cherish individual freedom, we also want to protect/promote what we know to be good. So, every paternalist must meet two challenges: paternalism must be justifiable as a restriction of autonomy as well as effective in terms of well-being. In this essay, I argue that the ‘autonomy’ restricted by paternalism is a Razian brand of free self-authorship and that (...) the ‘good’ protected is captured by Martha Nussbaum's account of personal well-being. I then defend a mild welfare paternalism based on a dichotomy implicit in any defensible description of well-being. I argue that some aspects of the good life do not require endorsement and, therefore, can be justifiably and effectively promoted by autonomy-restricting means. Finally, I discuss why paternalism need not be hostile to ethical independence. (shrink)

Research with psychiatric patients raises frequently discussed, ethical questions, one of which is: Can psychiatric patients give consent to participation in research at all? To answer this and similar questions adequately, it is - according to our thesis - necessary to analyze first, which theoretical assumptions are made in established practice. -/- To solve the question after the possibility of consent, compatible understandings of ‘disease’, ‘illness’ and ‘autonomy’ are crucial, but there is no consensual use of these terms in philosophy. (...) Therefore we first are going to explain different concepts of ‘autonomy’ and ‘disease’. Subsequent to this we will test how the different conceptualizations of ‘autonomy’ and ‘disease’ can be related to each other and how the reasonable combinations shape possible answers to the opening question. It will become apparent that an adequate analysis of ‘autonomy’ and ‘disease’ raises ethical dilemma in psychiatry, for which we shall suggest possible solutions. (shrink)

Charles Taylor's well-known essay, “Atomism”, criticizes libertarian theories of rights like Nozick's that make individual rights independent of any duties to belong to, support, or obey the law in the society in which those rights are to be enjoyed. Taylor argues that if one grounds rights to important liberties on the human capacity for autonomy, this commits one to the view that the development of autonomy in oneself and others is morally obligatory. Further, Taylor argues that most people cannot develop (...) autonomy in the absence of a certain sort of social and political environment. Hence, if it is morally obligatory to try to develop autonomy in oneself and others, it is also obligatory to belong to, support, and give obedience to those institutions which create the environment in which autonomy can be developed. (shrink)