Autonomy and valuing are two significant practical phenomena that have been analysed in terms of higher-order wanting. I argue that reference to higher-order capacities is indeed required to make sense of both concepts, but also that such analyses need a more differentiated understanding of "wanting to want" than has hitherto been proposed. Central for autonomy is the instantiation of four types of optative relationship by an accountable agent under conditions of rationality. Valuing requires the disposition to instantiate only one of (...) the relevant structures. Clarity on this allows an analysis of the precise relationships between the two phenomena. (shrink)

It has been argued - most prominently in Harry Frankfurt's recent work - that the normative authority of personal commitments derives not from their intrinsic worth but from the way in which one's will is invested in what one cares about. In this essay, I argue that even if this approach is construed broadly and supplemented in various ways, its intrasubjective character leaves it ill-prepared to explain the normative grip of commitments in cases of purported self-betrayal. As an alternative, I (...) sketch a view that focuses on intersubjective constraints of intelligibility built into social practices and on the pragmatics of how those norms are contested in an ongoing fashion. (shrink)

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

For decades, the greater part of efforts to improve regulatory frameworks for research ethics has focused on informed consent procedures; their design, codification and regulation. Why is informed consent thought to be so important? Since the publication of the Belmont Report in 1979, the standard response has been that obtaining informed consent is a way of treating individuals as autonomous agents. Despite its political success, the philosophical validity of this Belmont view cannot be taken for granted. If the Belmont view (...) is to be based on a conception of autonomy that generates moral justification, it will either have to be reinterpreted along Kantian lines or coupled with a something like Mill’s conception of individuality. The Kantian interpretation would be a radical reinterpretation of the Belmont view, while the Millian justification is incompatible with the liberal requirement that justification for public policy should be neutral between controversial conceptions of the good. This consequence might be avoided by replacing Mill’s conception of individuality with a procedural conception of autonomy, but I argue that the resulting view would in fact fail to support a non-Kantian, autonomy-based justification of informed consent. These difficulties suggest that insofar as informed consent is justified by respect for persons and considerations of autonomy, as the Belmont report maintained, the justification should be along the lines of Kantian autonomy and not individual autonomy. (shrink)

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

Most recent accounts of personal autonomy acknowledge that the social environment a person lives in, and the personal relationships she entertains, have some impact on her autonomy. Two kinds of conceptualizing social conditions are traditionally distinguished in this regard: Causally relational accounts hold that certain relationships and social environments play a causal role for the development and on-going exercise of autonomy. Constitutively relational accounts, by contrast, claim that autonomy is at least partly constituted by a person’s social environment or standing. (...) The central aim of this paper is to raise the question how causally and constitutively relational approaches relate to the fact that we exercise our autonomy over time. I argue that once the temporal scope of autonomy is opened up, we need not only to think differently about the social dimension of autonomy. We also need to reconsider the very distinction between causally and constitutively relational accounts, because it is itself a synchronic (and not a diachronic) distinction. (shrink)

Leading accounts of personal autonomy are content-neutral: they insist that there are no a priori constraints on the content of the desires or values that might motivate an autonomous action. In Gerald Dworkin's provocative words, ‘the autonomous person can be a tyrant or a slave, a saint or sinner, a rugged individualist or champion of fraternity, a leader or follower.’ ‘There is nothing in the idea of autonomy that precludes a person from saying, “I want to be the kind of (...) person who acts at the command of others. I define myself as a slave and endorse those attitudes and preferences. My autonomy consists in being a slave.” ’ John Christman similarly claims that ‘any desire, no matter how evil, self-sacrificing, or slavish it might be’ could be autonomously formed. The same seems to apply to Harry Frankfurt's view, that actions are autonomous if they stem from second-order volitions that reflect what the agent cares about; it puts no constraints on the content of what a person might care about. All of these accounts hold that the mere content of a desire or value is never sufficient to rule out that it might be autonomously acted on by someone. (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)

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995.

Leading accounts of personal autonomy arecontent-neutral:they insist that there are noa prioriconstraints on the content of the desires or values that might motivate an autonomous action. In Gerald Dworkin's provocative words, ‘the autonomous person can be a tyrant or a slave, a saint or sinner, a rugged individualist or champion of fraternity, a leader or follower.’ ‘There is nothing in the idea of autonomy that precludes a person from saying, “I want to be the kind of person who acts at (...) the command of others. I define myself as a slave and endorse those attitudes and preferences. My autonomy consists in being a slave.” ’ John Christman similarly claims that ‘any desire, no matter how evil, self-sacrificing, or slavish it might be’ could be autonomously formed. The same seems to apply to Harry Frankfurt's view, that actions are autonomous if they stem from second-order volitions that reflect what the agent cares about; it puts no constraints on the content of what a person might care about. All of these accounts hold that the mere content of a desire or value is never sufficient to rule out that it might be autonomously acted on by someone. (shrink)