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)

The article distinguishes two models of self-realization. The independence model claims that self-realization is compatible with leading a non-moral life, whereas the dependence model argues the converse. Hegel′s influential version of the dependence model aims at showing why and how self-realization must be embedded in a complex structure of reasonable social relations. I argue that Hegel′s dependence model abrogates the „Recht der Besonderheit, sich befriedigt zu finden” and is thus not convincing. What I call Hegel′s “inofficial theory”, however, concedes an (...) infusible conflict between modernity and self-realization; philosophy has to reconcile the individual with the impossibility of being a „ganzer Mensch” in modern societies. After an interlude with Michael Theunissen′s indpendence model, I turn to T. H. Green′s theory of self-realization. Green provides a richer explanatory story than Hegel as to why other-regarding acts contribute to self-realization; however, this story leaves not enough conceptual room for interpersonal conflict and is vulnerable to similar objections to Hegel′s account. (shrink)

This article joins in and extends the contemporary debate on the right to privacy. We bring together two strands of the contemporary discourse on privacy. While we endorse the prevailing claim that norms of informational privacy protect the autonomy of individual subjects, we supplement it with an argument demonstrating that privacy is an integral element of the dynamics of all social relationships. This latter claim is developed in terms of the social role theory and substantiated by an analysis of the (...) role of privacy in intimate relationships, in professional relationships and in social interactions between strangers in public. We conclude by arguing that it is not always reasonable to assume a conflict between individual privacy on the one hand and society on the other. Legislators and participants in public debate also have to take into account the consequences of limiting privacy on social interaction and the integration of the society. (shrink)

Offering the first developed account of political liberal education, this book combines a thorough analysis of the theoretical groundwork of political liberal education with application-oriented approaches to contemporary educational challenges. Following in depth engagement with the shortcomings of Rawls’ theory and addressing some key objections to neutrality-based restrictions in education, the volume moves on to provide an insightful discussion of topics such as same-sex relations in sex-education, the position of migrant children and the rights of religious parents to determine the (...) education of their children. This book outlines a political liberal account of education which provides a useful contribution to the current debates about liberalism and education in a way unprecedented in the literature on political liberalism so far. It is of interest to anyone working at the intersection of political philosophy and philosophy of education as well as for scholars with a broader interest in how liberalism can respond to the challenges of value pluralism. (shrink)

In recent work, Peter Railton, Julia Annas, and David Velleman aim to reconcile the phenomenon of “flow”—broadly understood as describing the “unreflective” aspect of skilled action—with one or another familiar conception of agency. While there are important differences between their arguments, Railton, Annas, and Velleman all make, or are committed to, at least one similar pivotal claim. Each argues, directly or indirectly, that agents who perform skilled unreflective actions can, in principle, accurately answer “Anscombean” questions—”what” and “why” questions— about what (...) they do. I argue against this claim and explore the ramifications for theories of skilled action and agency. (shrink)

In recent times, informed consent has been adopted worldwide as a cornerstone to ensure autonomy during HIV testing. However, there are still ongoing debates on whether the edifice on which informed consent requirements are grounded, that is, personal autonomy, is philosophically, morally, and practically sound, especially in countries where HIV is an epidemic and/or may have a different ontological perspective or lived reality. This study explores the views of participants from Zambia. In-depth and focus group discussions were conducted at various (...) locations in Lusaka and Chongwe, Zambia. Participants came from various demographics, including people living with HIV, healthcare professionals and workers, policymakers, pregnant women, churchgoers, teachers, rural-based persons, and police officers. Data were manually analysed by conducting inductive and deductive thematic analyses. Results show that participants were not in favour of HIV policies that promote personal autonomy at the expense of pursuit of the common good. Participants viewed interdependence, not autonomy, as an essential characteristic of being human. The participants’ views have a realistic potential to provide a contextual and appropriate ethical, respectful, and realistic foundation for HIV testing policies. (shrink)

In a recent article in this journal, Rolf Ahlzén treats a moral problem related to physician-assisted suicide and the notion of authenticity. The problem is whether considerations of a patient’s “true self” should be included in judgments of PAS. In this short commentary, it is argued that Ahlzén neglects to attend to central contributions to the philosophy of authenticity, provides an internally inconsistent theory thereof, and conflates crucial distinctions in the debate.

In the past three decades a number of narrative self-concepts have appeared in the philosophical literature. A central question posed in recent literature concerns the embodiment of the narrative self. Though one of the best-known narrative self-concepts is a non-embodied one, namely Dennett’s self as ‘a center of narrative gravity’, others argue that the narrative self should include a role for embodiment. Several arguments have been made in support of the latter claim, but these can be summarized in two main (...) points. Firstly, a logical one: without taking the body into account Dennett’s theory becomes self-refuting. Secondly, a more practical/phenomenological point: a disembodied self-concept overlooks how personal the body is, and as such should be considered part of the self. In this paper I endorse these criticisms of non-embodied narrative self-concepts, but I argue that the relationship between the narrative self and the body is far from sufficiently fleshed out. I claim that the narrative self and the body are much more interwoven than the above criticisms suggest. What I aim to show in this paper is that the relationship between the body and the narrative self is interactive rather than unidirectional: not only does our body shape our narrative self, but our narrative self also shapes our body. The upshot of this is a better conception of the self is as a dynamic interaction between its various aspects. (shrink)

John Christman has recently objected to substantive conceptions of autonomy on the grounds that they introduce unwanted perfectionism into political thinking. I defend substantive conceptions of autonomy against Christman’s critique on two fronts. First, I defend substantive conceptions of autonomy against the charge that their utilisation in political theory would result in the inappropriate exclusion from democratic respect of individuals in oppressive relations. Second, I defend substantive conceptions of autonomy from the charge that they fail the ‘endorsement constraint’, i.e. that (...) incorporating a substantive conception of autonomy into the concept of the person at the heart of a political theory would be alienating for citizens. (shrink)

The majority of current attention on the question of autonomy has focused on the internal reflection of the agent. The quality of an agent’s reflection on her potential action (or motivating desire or value) is taken to determine whether or not that action is autonomous. In this paper, I argue that there is something missing in most of these contemporary accounts of autonomy. By focusing overwhelmingly on the way in which the agent reflects, such accounts overlook the importance of what (...) the agent is reflecting upon. Whichever of these current formulations of autonomy we accept, reflection could be undertaken in full accordance with the conditions set, and yet the action fail to be autonomous. This will occur, I argue, if the agent is mistaken about the object of her reflection. More precisely, if she has a particular kind of false belief about the action she is contemplating undertaking, then no amount of reflection can render that action autonomous. This suggests the need for externalist conditions to be incorporated into an account of autonomy. (shrink)

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal (...) autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

Risk is implicit in economic development. When does a course of economic development ethically balance risk and likely benefit? This paper examines the view of risk we find in Amartya Sen’s work on development. It shows that Sen’s capabilities approach leads to a more sensitive understanding of risk than traditional utility theory. Sen’s approach also supplies the basis of an argument for risk aversion in interventions that affect economic development. Sen’s approach describes development as aiming at freedom. The paper shows (...) how this claim can be made compatible with the social and relational basis of African communitarianism. (shrink)

Questions about the nature of self and self-consciousness are closely aligned with questions about the nature of autonomy. These concepts have deep roots in traditional philosophical discussions that concern metaphysics, epistemology and ethics. They also have direct relevance to practical considerations about informed consent in medical contexts. In this paper, with reference to understanding specific side effects of deep brain stimulation treatment in cases of, for example, Parkinson’s Disease, Obsessive Compulsive Disorder, and Major Depressive Disorder, I’ll argue that it is (...) best to frame discussions of informed consent in terms of relational autonomy and a pattern theory of self. (shrink)

Mental capacity and autonomy are often understood to be normatively neutral? the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders (such as depression, anorexia nervosa and schizophrenia) that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and (...) functional tests requiring consistency, expression of identity, reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty. (shrink)

On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her (‘hard paternalism’). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not (...) to respect a person’s decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person’s own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism. (shrink)

In the theoretical literature on moral responsibility, one sometimes comes across cases of manipulated agents. In cases of this type, the agent is a victim of wholesale manipulation, involving the implantation of various pro-attitudes (desires, values, etc.) along with the deletion of competing pro-attitudes. As a result of this manipulation, the agent ends up performing some action unlike any that she would have performed were it not for the manipulation. These sorts of cases are sometimes thought to motivate historical views (...) of responsibility, on which the agent’s past is relevant to whether she is responsible for a specific action. In a recent paper, Daniel Sharp and David Wasserman bring these theoretical discussions on moral responsibility to bear on practical issues regarding neurological modifications of individuals. After proposing and arguing for a historical view, Sharp and Wasserman offer some insight into how such a view may help us in determining the responsibility of subjects who have undergone Deep Brain Stimulation. This paper aims to join this discussion, by arguing that the correct historical view to be applied will also appeal to the agent’s control over her mental life and the fact that this was bypassed. I conclude with some brief comments on the practical implications of such a historical view. (shrink)

Recent philosophy has developed an overblown concept of autonomy. In fact we do not have moral autonomy, and personal autonomy we only have in the sense of being able to decide some things that affect the course of our lives, not in the sense of shaping these lives and being master over them; nor ought we to have autonomy in the latter sense, or come closer to having it. As for our political institutions, they do not presuppose, as prevailing doctrines (...) claim they do, citizens’ autonomy in a more demanding sense. Freedom and democracy as understood for instance in the German constitution only assume subordinates capable of deciding some matters on their own. Current talk of autonomy is just gilding people’s real dependence. (shrink)