Recommender Systems (RecSys) have been around since the early days of the Internet, helping users navigate the vast ocean of information and the increasingly available options that have been available for us ever since. The range of tasks for which one could use a RecSys is expanding as the technical capabilities grow, with the disruption of Machine Learning representing a tipping point in this domain, as in many others. However, the increase of the technical capabilities of AI-powered RecSys did not (...) come with a thorough consideration of their ethical implications and, despite being a well-established technical domain, the potential impacts of RecSys on their users are still under-assessed. This paper aims at filling this gap in regards to one of the main impacts of RecSys: personal autonomy. We first describe how technology can affect human values and a suitable methodology to identify these effects and mitigate potential harms: Value Sensitive Design (VSD). We use VSD to carry out a conceptual investigation of personal autonomy in the context of a generic RecSys and draw on a nuanced account of procedural autonomy to focus on two components: competence and authenticity. We provide the results of our inquiry as a value hierarchy and apply it to the design of a speculative RecSys as an example. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper (...) is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (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)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty (...) in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (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)

This chapter will explore the dynamics of power underpinning ethical issues within smart cities via a new paradigm derived from Systems Theory. The smart city is an expression of technology as a socio-technical system. The vision of the smart city contains a deep fusion of many different technical systems into a single integrated “ambient intelligence”. ETICA Project, 2010, p. 102). Citizens of the smart city will not experience a succession of different technologies, but a single intelligent and responsive environment through (...) which they move. Analysis of such an environment requires a framework which transcends traditional ontologically-based models in order to accommodate this deep fusion. This chapter will outline a framework based on Latour’s Actor-Network Theory and Luhmann’s treatment of society as an autopoetic system. We shall use this framework to map the influence of relevant factors on ethical issues, irrespective of their composition or type. For example, under this treatment, both human praxis and technical design can be viewed as comparable tools of domination. This chapter will provide a framework for the analysis of relations between any elements of the smart city, ranging from top-level urban management processes down to individual device operations. While we will illustrate the use of this schema through examination of ethical issues arising from power dynamics within the smart city, it is intended that this example will demonstrate the wider utility of the model in general. (shrink)

An increasingly popular solution to the anti-scientific climate rising on social media platforms has been the appeal to more critical thinking from the user's side. In this paper, we zoom in on the ideal of critical thinking and unpack it in order to see, specifically, whether it can provide enough epistemic agency so that users endowed with it can break free from enclosed communities on social media (so called epistemic bubbles). We criticise some assumptions embedded in the ideal of critical (...) thinking online and, instead, we propose that a better way to understand the virtuous behaviour at hand is as critical engagement, namely a mutual cultivation of critical skills among the members of an epistemic bubble. This mutual cultivation allows members within an epistemic bubble (in contrast, as we will show, with the authority-based models of epistemic echo chambers) to become more autonomous critical thinkers by cultivating self-trust. We use the model of relational autonomy as well as resources from work on epistemic self-trust and epistemic interdependence to develop an explanatory framework, which in turn may ground rules for identifying and creating virtuous epistemic bubbles within the environments of social media platforms. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in her Natural (...) Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation of situational vulnerability (...) and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (shrink)

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions (...) of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research. (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)

Gerald Dworkin provides an insightful starting point for determining acceptable paternalism through his commitment to protecting our future autonomy and health from lasting damage. Dworkin grounds his argument in an appeal to inherent goods, which this paper argues is best considered as a commitment to human flourishing. However, socialconnectedness is also fundamental to human flourishing and an important consideration when determining the just limits of paternalistic drug controls, a point missing from Dworkin’ essay. For British philosopher Thomas Hill Green, regulation (...) of alcohol sales emerged from the social ideal. Green argued that policy interventions, including restricted opening hours and locations, improved the conditions for humans to flourish. Green offers a compelling political vision but fails to account for the fact pleasure is also an inherent good. He focused excessively on our social nature, excluding our more pleasure-seeking and egoistic characteristics. In contrast, a more realistic and complete vision of human flourishing can be found in an amended version of Gerald’s Dworkin’s arguments. In conclusion, this paper argues drug policy makers should remain committed to the harm principle as applied to criminal law whereby a person should never be criminalized for self-harm. Such a limit on paternalistic interventions is deemed necessary when eudaimonia is the end of government action. In practical terms, this means that the criminalization of drug use, as opposed to drug production, is always unjust. (shrink)

In the debates regarding the ethics of human enhancement, proponents have found it difficult to refute the concern, voiced by certain bioconservatives, that cognitive enhancement violates the autonomy of the enhanced. However, G. Owen Schaefer, Guy Kahane and Julian Savulescu have attempted not only to avoid autonomy-based bioconservative objections, but to argue that cognition-enhancing biomedical interventions can actually enhance autonomy. In response, this paper has two aims: firstly, to explore the limits of their argument; secondly, and more importantly, to develop (...) a more complete understanding of autonomy and its relation to cognitive enhancement. By drawing a distinction between the capacity for autonomy and the exercise and achievement of autonomy and by exploring the possible effects of cognitive enhancement on both competence and authenticity conditions for autonomy, the paper identifies and explains which dimensions of autonomy can and cannot, in principle, be enhanced via direct cognitive interventions. This allows us to draw conclusions regarding the limits of cognitive enhancement as a means for enhancing autonomy. (shrink)

Feminist socially constitutive conceptions of autonomy make the presence of idealized social conditions necessary for autonomy. I argue that such conceptions cannot, when applied under nonideal conditions, play two key feminist theoretical roles for autonomy: the roles of anti-oppressive character ideal and paternalism-limiting concept. Instead, they prescribe action that reinforces oppression. Treated as character ideals, socially constitutive conceptions of autonomy ask agents living under nonideal ones to engage in self-harm or self-subordination. Moreover, conceptions of autonomy that make idealized social conditions (...) a requirement of autonomy yield the conclusion that oppressed agents are appropriate objects of paternalism. (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)

When and why do socially constructed norms—including the laws of the land, norms of etiquette, and informal customs—generate moral obligations? I argue that the answer lies in the duty to respect others, specifically to give them what I call “agency respect.” This is the kind of respect that people are owed in light of how they exercise their agency. My central thesis is this: To the extent that (i) existing norms are underpinned by people’s commitments as agents and (ii) they (...) do not conflict with morality, they place moral demands on us on agency-respect grounds. This view of the moral force of socially constructed norms, I suggest, is superior to views that deny the moral force of such norms, and it elegantly explains certain instances of wrongdoing that would otherwise remain unaccounted for. (shrink)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting (...) patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

This paper challenges the view that contentment leads to personal freedom and autonomy and argues for a relational and exercise concept of de facto freedom in the Zhuangzi 莊子. I first review influential interpretations of freedom in the Zhuangzi that equate freedom with contentment and nonfrustration, starting with Guo Xiang's 郭象 (d. 312 CE). By putting these interpretations in dialog with contemporary social philosophy (Christman, Meyers, Pettit, Elster, and Khader), I reflect on the two seminal problems of the psychologizing causal (...) and procedural approaches that allow the interpretation of freedom as contentment: the “happy slave” problem and the “sour grapes” problem. Proving this account of freedom inadequate, I argue for a different interpretation of freedom in the Zhuangzi that resembles a weakly substantive and constitutive account of freedom and autonomy in modern‐day social philosophy terms, such as Marina Oshana's. The theory of freedom that I analyze in the Zhuangzi, however, helps us correct the risk of material determinism of the constitutive account, offering a description of relational freedom and autonomy as constituted by socio‐material conditions but not determined by them. (shrink)

In the 1980s and 1990s, a series of attempts were made to put into U.S. law a civil rights ordinance that would make it possible to sue the makers and distributors of pornography for doing so (under certain conditions). One defence of such legislation has come to be called "the free speech argument against pornography." Philosophers Rae Langton, Jennifer Hornsby and Caroline West have supposed that this defence of the legislation can function as a liberal defence of the legislation: in (...) particular, a defence of the legislation based on the value of women's liberty. This would be somewhat unexpected given MacKinnon's own antipathy toward liberalism. In this paper, I argue that the free speech argument against pornography cannot be used as a liberal defence of the ordinances. The legislation is, to some extent, self-defeating insofar as it understood in terms acceptable to a fairly standard kind of liberal. This becomes apparent when we consider the value pornography can have for women, which we can see if we consider what female makers, distributors and consumers of pornography have to say about why they make, distribute and consume it. (shrink)

Fair skin is often regarded as a beauty ideal in many parts of the world. Genetic selection for non-disease traits may allow reproducers to select fair skin for the purposes of beauty, and may be justified under various procreative principles. In this paper I assess the ethics of genetic selection for fair skin as a beauty feature. In particular, I explore the discriminatory aspects and demands of such selection. Using race and colour hierarchies that many would find objectionable, I argue (...) that selection for beauty that is underpinned by such hierarchies is not a trivial selection. Given this, I claim that we should not make such selections. (shrink)

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a “good” pregnant woman and to be a “good” mother. Activities in the medical field of reproduction contribute to “kinning”, (...) that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: informed consent in prenatal care, obstetric sonogram, and birth plan. Their widespread application issupposed to serve the moral goal of effecting patient autonomy. A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework. (shrink)

Questions of individuality are traditionally predicated upon recognizing discrete entities whose behavior can be measured and whose value and agency can be meaningfully ascribed. We consider a series of challenges to the metaphysical concept of individuality as the ground of the self. We argue that an ecological conception of individuality renders ascriptions of autonomy to selves highly improbable. We find conceptual resources in the work of environmental philosopher Arne Naess, whose distinction between shallow and deep responses helps us rethink the (...) notion of individuality and, thus, assess whether the conceptual and normative coherence of human autonomy could, at least partially, be salvaged. (shrink)

ABSTRACTThe aim of this paper is to draw attention to an issue which has been largely overlooked in contemporary just war theory – namely the impact that the conditions under which an army is assembled are liable to have on the judgments that are made with respect to traditional principles of jus ad bellum and jus in bello. I argue that the way in which an army is assembled can significantly alter judgments regarding the justice of a war. In doing (...) so, I present and defend a principle of ‘just assembly’ and argue that satisfying this principle is an essential part of any deliberation regarding the justice of a particular conflict. (shrink)

This article looks at how and why addiction should be understood as a ‘sociorelational’ disorder, and what this implies on a policy level in terms of the treatment and prevention of addiction. In light of scientific research, we argue that the neurobiological changes that underlie addiction are heavily influenced by sociorelational processes. We thereby advocate for a conceptual approach in which autonomy in addiction is a sociorelational concept, and social environments are considered autonomy undermining or autonomy promoting. We then discuss (...) the various implications this should have on policies. (shrink)

Whistle-blowing would appear to involve a conflict between employee loyalty and protection of public interest. Several business ethicists have, however, argued that this conflict is indeed merely apparent. According to the central argument to that effect, when the nature of employee loyalty is understood correctly, it becomes clear that whistle-blowing does not threaten employees' loyalty to their employer. This is because blowing the whistle about one's employer's wrongdoing and being loyal to them serves the same goal, the moral good of (...) the employer. In this article, I assess this philosophical argument for the conclusion that the moral problem of whistle-blowing is not real. I argue that the way of defending the view that whistle-blowing is not morally problematic is implausible. (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)

Development ethicists see reducing intrahousehold gender inequality as an important policy aim. However, it is unclear that a minimalist cross-cultural consensus can be formed around this goal. Inequality on its own may not bring women beneath a minimal welfare threshold. Further, adherents of complementarian metaphysical doctrines may view attempts to reduce intrahousehold inequality as attacks on their worldviews. Complicating the justificatory task is the fact that familiar arguments against intrahousehold inequality, including those from agency and self-esteem, depart from premises that (...) complementarians reject—premises about the value of independence or the moral irrelevance of gender. I propose that development ethicists should offer complementarianism-compatible arguments against the norms and practices constitutive of intrahousehold inequality. I develop arguments against two intrahousehold inequality-supportive practices that depart from complementarian premises. Specifically, I argue that patriarchal risk and gender schemas that devalue women's labor prevent men from discharging complementarian duties to promote women's welfare. (shrink)

Controversial and provocative, To Be Real is a blueprint for the creation of a new political force.

Ageism within the context of care has attracted increasing attention in recent years. Similarly, autonomy has developed into a prominent concept within health care law and ethics. This paper explores the way that ageism, understood as a set of negative attitudes about old age or older people, may impact on an older person’s ability to make maximally autonomous decisions within health care. In particular, by appealing to feminist constructions of autonomy as relational, I will argue that the key to establishing (...) this link is the concept of self-relations such as self-trust, self-worth and self-esteem. This paper aims to demonstrate how these may be impacted by the internalisation of negative attitudes associated with old age and care. In light of this, any legal or policy response must be sensitive to and flexible enough to deal with the way in which ageism impacts autonomy. (shrink)

In this paper I propose and develop a social account of global autonomy. On this view, a person is autonomous simply to the extent to which it is difficult for others to subject her to their wills. I argue that many properties commonly thought necessary for autonomy are in fact properties that tend to increase an agent’s immunity to such interpersonal subjection, and that the proposed account is therefore capable of providing theoretical unity to many of the otherwise heterogeneous requirements (...) of autonomy familiar from recent discussions. Specifically, I discuss three such requirements: (i) possession of legally protected status, (ii) a sense of one’s own self-worth, and (iii) a capacity for critical reflection. I argue that the proposed account is not only theoretically satisfying but also yields a rich and attractive conception of autonomy. (shrink)

This paper presents a relational account of autonomy showing that a technological imperative impedes autonomy through undermining women’s capacity to resist use of technology in the context of labor and birth. A technological imperative encourages dependence on technology for reassurance whenever possible through creating a (i) separation of maternal and fetal interests; and (ii) perceived need to use technology whenever possible. In response I offer an account of how women might promote autonomy through cultivating self-trust and self-confidence. Autonomy is not (...) simply a matter of choosing freely and acting on our choices, it is also a matter of possessing the ability to resist social contexts undermining choice and action. An important implication of this view is that respecting autonomy requires more than simply respecting persons’ ability to make and act on choices. Respecting patient autonomy requires a recognition of patients’ need to resist factors impeding autonomy and support for that resistance. (shrink)

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a (...) specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility. (shrink)

Within the context of applied bioethical reasoning, various conceptions of the human body are focused upon by the author in relation to normative notions of autonomy.

Relational conceptions of autonomy attempt to take into account the social aspects of autonomous agency. Those views that incorporate not merely causally, but constitutively necessary relational conditions, incorporate a condition that has the form: A necessary condition for autonomous agency is that the agent stands in social relations S. I argue that any account that incorporates such a condition cannot play one of autonomy’s key normative roles: identifying those agents who ought to be protected from paternalistic intervention. I argue, against (...) objections from Oshana, that there are good reasons for maintaining the notion of autonomy in this role, and thus that such relational conceptions should not be accepted. This rejection goes beyond that from John Christman, which holds only for those relational conditions which are value-laden. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. (...) This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (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)

One of liberalism’s core commitments is to safeguarding individuals’ autonomy. And a central aspect of liberal social justice is the commitment to protecting the vulnerable. Taken together, and combined with an understanding of autonomy as an acquired set of capacities to lead one’s own life, these commitments suggest that liberal societies should be especially concerned to address vulnerabilities of individuals regarding the development and maintenance of their autonomy. In this chapter, we develop an account of what it would mean for (...) a society to take seriously the obligation to reduce individuals’ autonomy-related vulnerabilities to an acceptable minimum. In particular, we argue that standard liberal accounts underestimate the scope of this obligation because they fail to appreciate various threats to autonomy. (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)

Personal Information Management Systems (PIMS) aim to facilitate the sharing of personal information and protect privacy. Efforts to enhance privacy management, aligned with established privacy policies, have led to guidelines for integrating transparent notices and meaningful choices within these systems. Although discussions have revolved around the design of privacy-friendly systems that comply with legal requirements, there has been relatively limited philosophical discourse on incorporating the value of privacy into these systems. Exploring the connection between privacy and personal autonomy illuminates the (...) instrumental value of privacy and highlights the importance of intentionally embedding the value of privacy into these systems. To translate the value of privacy into concrete design requirements, this study constructs a values hierarchy consisting of values, norms, and design requirements. After analyzing the relationships between privacy and autonomy and identifying norms, the design requirements translated from the norms associated with the components of personal autonomy are specified at the lowest layer. These requirements include a design to prevent unauthorized access and dark patterns and to provide effective and efficient notices and choices. The findings contribute to expanding the requirements for designing the aspect of privacy as a legal requirement to incorporate the value of privacy into systems. (shrink)

In African philosophical literature, and especially in Afro-communitarianism, there are discussions about the value of the relationship an individual has with her respective community. By community, reference is made to the metaphysical holistic view of community which includes all beings in nature. But since the article deals with gender, which is a social construction, most of the arguments appeal to a narrower version of community, that of human beings. Therefore, discussions about “value” refer to the value that is given to (...) the relationship that surpasses any individual value, and it applies or appeals to human beings. One implication of this understanding and the prioritisation of the relationship is that identity is something that is conferred by this sort of relationship. In this article, we argue that this way of understanding “identity” from an Afro-communitarian world view has something to offer in understanding or conceptualising gender(ed) identity(ies). The assumption is that gender identity will be understood as socially conferred and most importantly, one that takes community as essential. (shrink)

The increasing popularity of artificial cognitive enhancements raises the issue of their impact on the agent’s personal autonomy, and issues pertaining to how the latter is to be secured. The extended mind thesis implies that mental states responsible for autonomous action can be partly constituted by the workings of cognitive artifacts themselves, and the question then arises of whether this commits one to embracing an extended agent thesis. My answer is negative. After briefly presenting the main accounts on the conditions (...) for autonomous agency, and analyzing how the latter can be protected from threats posed by the use of cognitive artifacts, I argue that autonomous agency is essentially tied to conscious experience and intentionality, which in turn can only be attributed to the human part of any extended cognitive system. I present both theoretical (conceptual) and practical arguments against recognizing the entire extended system, composed of one human and an artifact, as an autonomous agent. (shrink)

As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual’s reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one’s reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate (...) the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement. (shrink)

European Journal of Philosophy, EarlyView.

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)