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)

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

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)

Assent to medical research or treatment may be an intuitively attractive way to address the area between incapacity and capacity that might otherwise be subject to a best interests assessment. Assent has become a widely disseminated concept in law, research, and clinical ethics, but little conceptual work on assent has so far occurred. An exploration of use of assent in treatment and research in children and people with dementia suggests that at least five claims are made on behalf of assent. (...) Since at least some of these may lead to tensions with others, assent requires firmer conceptual underpinning. Whether assent remains primarily a local approach to research in children in the United States, where it appears to fit with legal background conditions, or develops its promise to overturn the dominant, binary, approach to (in)capacity will depend on the strength of future philosophical work to improve the theoretical foundations to assent. (shrink)

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

Philosophy & Social Criticism, Ahead of Print. An ongoing debate between ‘procedural’ and ‘substantive’ theorists of personal autonomy addresses the following question: should agents have the final say on their own autonomy or should the objective circumstances in which agents live take prevalence when assessing their autonomy? Proceduralists favour the first strategy and substantive theorists restrict more explicitly the conditions under which autonomy is possible. I focus on forms of heteronomy which derive from oppressive circumstances and accept that substantive theorists (...) are correct in contending that forms of oppression common in contemporary liberal societies tend to increase heteronomy; and the heteronomy which derives from social oppression tends to fly below the radar of procedural accounts. Still, I argue that a revised procedural strategy could limit these forms of heteronomy as long as it avoids the injunctions to ‘authenticity’ common in procedural models. I proceed by reconstructing John Christman’s model which, I argue, constitutes the most promising procedural account to assess autonomy under oppression. Christman’s theory, however, needs to be reinforced to ensure self-problematisation in light of a social perspective. I show that the latter is necessary to experience the forms of alienation which are markers of heteronomy according to Christman. (shrink)

Philosophy & Social Criticism, Ahead of Print. An ongoing debate between ‘procedural’ and ‘substantive’ theorists of personal autonomy addresses the following question: should agents have the final say on their own autonomy or should the objective circumstances in which agents live take prevalence when assessing their autonomy? Proceduralists favour the first strategy and substantive theorists restrict more explicitly the conditions under which autonomy is possible. I focus on forms of heteronomy which derive from oppressive circumstances and accept that substantive theorists (...) are correct in contending that forms of oppression common in contemporary liberal societies tend to increase heteronomy; and the heteronomy which derives from social oppression tends to fly below the radar of procedural accounts. Still, I argue that a revised procedural strategy could limit these forms of heteronomy as long as it avoids the injunctions to ‘authenticity’ common in procedural models. I proceed by reconstructing John Christman’s model which, I argue, constitutes the most promising procedural account to assess autonomy under oppression. Christman’s theory, however, needs to be reinforced to ensure self-problematisation in light of a social perspective. I show that the latter is necessary to experience the forms of alienation which are markers of heteronomy according to Christman. (shrink)

An ongoing debate between ‘procedural’ and ‘substantive’ theorists of personal autonomy addresses the following question: should agents have the final say on their own autonomy or should the objective circumstances in which agents live take prevalence when assessing their autonomy? Proceduralists favour the first strategy and substantive theorists restrict more explicitly the conditions under which autonomy is possible. I focus on forms of heteronomy which derive from oppressive circumstances and accept that substantive theorists are correct in contending that (i) forms (...) of oppression common in contemporary liberal societies (e.g. gender or racial oppression) tend to increase heteronomy; and (ii) the heteronomy which derives from social oppression tends to fly below the radar of procedural accounts. Still, I argue that a revised procedural strategy could limit these forms of heteronomy as long as it avoids the injunctions to ‘authenticity’ common in procedural models. I proceed by reconstructing John Christman’s model which, I argue, constitutes the most promising procedural account to assess autonomy under oppression. Christman’s theory, however, needs to be reinforced to ensure self-problematisation in light of a social perspective. I show that the latter is necessary to experience the forms of alienation which are markers of heteronomy according to Christman. (shrink)

An ongoing debate between ‘procedural’ and ‘substantive’ theorists of personal autonomy addresses the following question: should agents have the final say on their own autonomy or should the object...

When is it legitimate for a government to ‘nudge’ its citizens, in the sense described by Thaler and Sunstein (2008)? In their original work on the topic, Thaler and Sunstein developed the _‘as judged by themselves’ (or AJBT) test_ to answer this question (Thaler and Sunstein 2008, p. 5). In a recent paper, Paul and Sunstein (2019) raised a concern about this test: it often seems to give the wrong answer in cases in which we are nudged to make a (...) decision that leads to what Paul calls a _personally transformative experience_, that is, one that results in our values changing (Paul 2014). In those cases, the nudgee will judge the nudge to be legitimate after it has taken place, but only because their values have changed as a result of the nudge. In this paper, I take up the challenge of finding an alternative test. I draw on my _aggregate utility account_ of how to choose in the face of what Ullmann-Margalit (2006) calls _big decisions_, that is, decisions that lead to these personally transformative experiences (Pettigrew 2019, Chapters 6 and 7). (shrink)

Can Artificial Intelligence be more effective than human instruction for the moral enhancement of people? The author argues that it only would be if the use of this technology were aimed at increasing the individual's capacity to reflectively decide for themselves, rather than at directly influencing behaviour. To support this, it is shown how a disregard for personal autonomy, in particular, invalidates the main proposals for applying new technologies, both biomedical and AI-based, to moral enhancement. As an alternative to these (...) proposals, this article proposes a virtual assistant that, through dialogue, neutrality and virtual reality technologies, can teach users to make better moral decisions on their own. The author concludes that, as long as certain precautions are taken in its design, such an assistant could do this better than a human instructor adopting the same educational methodology. (shrink)

Our values change. What we value, want, desire, prefer, and how much; for nearly everyone, these will be different at different times in their life. These changes can be gradual or abrupt; they can be long-lasting or short-lived; and they can be induced by forces outside yourself or they can come from within or they can have no specific catalyst at all. Such preference change raises a number of questions for our theorising about rational choice, and these have been discussed (...) at length. In §2 and §3, I’ll outline two of these questions along with some of the putative solutions that have been proposed. But preference change also raises questions for our theorising about autonomy, and these have hardly been considered at all. In §4, I’ll outline three problems for personal autonomy; and in §5, I’ll outline one problem for political autonomy. In §6, I conclude. (shrink)

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

I give an account of the structure of “oppressive double binds,” the double binds that exist in virtue of oppression. I explain how these double binds both are a product of and serve to reinforce o...

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

The Western focus on personal autonomy as the normative basis for securing persons’ consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor’s wish to donate after she (...) has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept. (shrink)

Autonomy, the ability to make decisions for ourselves about ourselves, is among the most prized of human liberties. In this review we reconsider the key conditions necessary for autonomous decision making, long debated by moral philosophers and ethicists, in light of current neuroscientific evidence. The most widely accepted criteria for autonomy are that decisions are made by a rationally deliberative and reflective agent and that these decisions are free of undue external influences. The corpus of neuroscientific data suggest that human (...) brains are capable of the hierarchical control required for reflective thought, but that decisions conventionally perceived as autonomous may not be rational with respect to the deliberative process itself, and are rarely free from covert external influences. These findings cast doubt upon the capacity for autonomy as traditionally defined, and suggest that we reconsider valorizing the right to autonomy in order to align our moral values with neuroscientific naturalism. (shrink)

The problem of the ‘mountain man’, the caricature of self-sufficiency and individualism, is not a new one for autonomy theorists. It seems plausible that there is genuine value in self-direction according to one’s deeply-held principles. If autonomy involves something like this, then anyone concerned with autonomy as a social rather than individualistic phenomenon must explain what the mountain man gets wrong when he denies that his autonomy admits of being placed under obligations to others. In particular, the mountain man challenges (...) autonomy-minded social anarchists: if his denial of legitimate non-voluntary obligations is correct, then it is not just the state we should reject, but any organising body with coercive powers. This may be consistent with individualist anarchism or right-libertarianism, but it sits ill with the social anarchist intuition that we can have genuine political obligations. My thesis addresses this problem in three stages. First, I argue for a functional analysis of authority and autonomy: the concepts are not pre-existing “immovable objects”, but rather are defined by the role that they are intended to play in our discourse. I suggest that we need a concept of political or institutional authority in order to resolve co-ordination problems and pursue collaborative social goods, and a concept of autonomy to explain when and why self-direction is valuable. Second, I defend a social-relational conception of autonomy. The autonomous agent is powerful and authoritative, where this power and authority is in large part constituted, rather than merely affected, by the social structures and relations that we stand in. We are powerful and authoritative, I argue, when we stand in relations of non-domination: we are not vulnerable to arbitrary interference in our lives, and this non-vulnerability is defended in virtue of recognition respect for us as agents. There are two important implications of this account: that autonomy comes with a built-in equality condition whereby everybody’s autonomy is threatened if anybody’s is, and that there is no principled distinction to be drawn between ‘personal’ and ‘political’ autonomy. In the last three chapters, I suggest an autonomy-justified conception of authority. I argue for autonomy as the crucial collaborative good which authoritative institutions help us to pursue, and suggest that such institutions may legitimately claim authority if they act or effect actions in ways which are likely to promote or defend autonomy-constituting relations, and act or effect actions in ways consistent with maximal equal autonomy. Finally, I return to the anarchist argument, showing that while my accounts of autonomy and authority give us a plausible picture of how autonomy is compatible with genuinely authoritative institutions, this picture still has no room for the state. (shrink)

There are few moral convictions that enjoy the same intuitive plausibility and level of acceptance both within and across nations, cultures, and traditions as the conviction that, normally, it is morally wrong to kill people. Attempts to provide a philosophical explanation of why that is so broadly fall into three groups: Consequentialists argue that killing is morally wrong, when it is wrong, because of the harm it inflicts on society in general, or the victim in particular, whereas personhood and human (...) dignity accounts see the wrongness of killing people in its typically involving a failure to show due respect for the victim and his or her intrinsic moral worth. I argue that none of these attempts to explain the wrongness of killing is successful. Consequentialism generates too many moral reasons to kill, cannot account for deeply felt and widely shared intuitions about the comparative wrongness of killing, and gives the wrong kind of explanation of the wrongness of killing. Personhood and human dignity accounts each draw a line that is arbitrary and entirely unremarkable in terms of empirical reality, and hence ill-suited to carry the moral weight of the difference in moral status between the individuals below and above it. Paying close attention to the different ways in which existing accounts fail to convince, I identify a number of conditions that any plausible account of the wrongness of killing must meet. I then go on to propose an account that does. I suggest that the reason that typically makes killing normal human adults wrong equally applies to atypical human beings and a wide range of non-human animals, and hence challenge the idea that killing a non-human animal is normally easier to justify than killing a human being. This idea has persisted in Western philosophy from Aristotle to the present, and even progressive moral thinkers and animal advocates such as Peter Singer and Tom Regan are committed to it. I conclude by discussing some important practical implications of my account. (shrink)

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

In contemporary debates about justice, political philosophers take themselves to be engaged with a subject that’s narrower than the whole of morality. Many contemporary liberals, notably John Rawls, understand this narrowness in terms of context specificity. On their view, justice is the part of morality that applies to the context of a society’s institutions, but only has indirect application to the context of citizens’ personal lives. In contrast, many value pluralists, notably G.A. Cohen, understand justice’s narrowness in terms of singularity (...) against a plural background. On their view, justice is one fundamental value amongst a plurality of fundamental values. The purpose of my thesis is to establish that the pluralist conception of justice’s narrowness is theoretically significant and true. To establish its theoretical significance, I argue that proper attention to the ways in which different understandings of narrowness inform the work of contemporary egalitarians explains a considerable amount of disagreement between them concerning the content and scope of distributive justice. On the one hand, I’ll argue that if we understand justice’s narrowness in the manner Cohen and other pluralists do, i.e., understand a conception of justice to be a conception of a particular fundamental value, then both luck-egalitarianism and the claim that justice extends to the personal context are compelling. On the other hand, I’ll argue that if we understand justice’s narrowness in a contextual manner, i.e., understand justice to comprise one or more all-things-considered principles adopted for the institutional context, then both luck-egalitarianism and the claim that justice extends to the personal context prove implausible. To establish the truth of the pluralist conception of narrowness, I argue first, that the contextual understanding is only plausible if fairness should be understood procedurally instead of substantively; and second, that substantive fairness cannot be eliminated, as specifying the content of procedural fairness requires a substantive criterion. The upshot is that justice’s narrowness is best understood in terms of singularity against a plural background, rather than in terms of context specificity. (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)

Incompatibilists and compatibilists (mostly) agree that there is a strong intuition that a manipulated agent, i.e., an agent who is the victim of methods such as indoctrination or brainwashing, is unfree. They differ however on why exactly this intuition arises. Incompatibilists claim our intuitions in these cases are sensitive to the manipulated agent’s lack of ultimate control over her actions, while many compatibilists argue that our intuitions respond to damage inflicted by manipulation on the agent’s psychological and volitional capacities. Much (...) hangs on this issue because manipulation-based arguments are among the most important for defending incompatibilist views of free will. In this paper, I investigate this issue from a experimental perspective, using a set of statistical methods well suited for identifying the features of hypothetical cases people’s intuitions are responding to. Results strongly support the compatibilist view—subjects’ tendency to judge that a manipulated agent is unfree was found to depend on their judgments that the agent suffers impairments to certain psychological/volitional capacities that compatibilists say are the basis for free will. I discuss the significance of these results for the use of manipulation cases in the philosophical debate about free will. (shrink)

Metaphysicians, ethical theorists and philosophers of law squabble endlessly about what it is for a person to act — or perhaps even to ‘will’ — more or less freely. A vital issue in this controversy is how we should analyse two obvious but surprisingly problematical contrasts. The first antithesis is between things we do because we are forced, and deeds we perform because we want to — sometimes after having discovered preponderant reasons in their favour. The other polarity is more (...) general. In most situations, if I act on my desire, I act more freely than if I had not had the desire. But what if my attitude is the product of childhood conditioning — or later brainwashing, brain surgery, hypnosis, behaviour modification, alcoholisim, narcotics addiction, neurosis, psychosis or worse? Then isn't my autonomy diminished? What is it about these latter desires, or their origin, that differentiates them from their unthreatening congeners? (shrink)

In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

The principle aim of this thesis is to provide an account of the nature of health. The starting-point is that health is a normative concept: health implies a standard or norm in relation to which an organism’s state is evaluated. Many philosophers take this to imply that health must be defined in subjective terms. They either think health consists in a certain type of subjective experience, or that health is relative to subjective values and goals. I argue that subjective definitions (...) of health fail to capture the essential properties of health and attempt to show that health is something normative and yet entirely objective. This would imply that there are normative facts in the world, and to support this claim I turn to debates in contemporary meta-ethics. I develop a meta-ethical theory according to which a subset of non-moral goods is grounded in objective features of living beings, and argue that this meta-ethical theory opens the possibility for an objective account of health. I then proceed to develop a theory of health that aims to capture what it means for any living to be healthy. I argue that the concept of health latches onto organisms’ capacities : the greater an organism’s range of capacities, i.e. the more it is capable of doing, the healthier it is. The norm relative to which an organism’s range of capacities is measured in evaluations of health, I go on to argue, is the maximum range of capacities possible for the species. Accordingly, an organism is healthy if it is capable of performing all species-specific activities. A closer analysis of this claim yields the formal definition that health consists in a multiplicity of potential activity vis-à-vis factual limitations set by the species. This definition of health is defended against various objections and potential counterexamples. In the context of human health, I attempt to show this definition of health captures both physical and mental dimensions of health; that it establishes a direct link between health and individual autonomy; and that it supports a Nietzschean account of ‘the greathealth’—the idea that being able to give up the concern for one’s health constitutes a superior kind of health. In the conclusions, I reflect on whether this conception of health could function as an ethical ideal, and consider the form that a health-based ethics could take. (shrink)

Dans cet article, je considère l’influence possible des recherches récentes sur les attitudes en psychologie sociale, principalement dans le paradigme des théories des processus duaux [dual process theories], sur notre compréhension de la responsabilité. La thèse que je soutiens est que certaines révisions à notre façon de comprendre la responsabilité et nos pratiques d’attribution de la responsabilité pourraient être justifiées par ces travaux. Avant de présenter les révisions que j’introduis, je décris les grandes lignes du paradigme que j’utiliserai, soit celui (...) des théories processus duaux tel qu’appliqué aux attitudes. Puis, m’inspirant de Vargas (2004, 2005), je présente les différentes formes que peuvent prendre le révisionnisme. Parce que ces révisions s’appliquent à des notions qui sont utilisées à la fois par le commun des mortels et par les philosophes (qui tentent soit de les reconstruire rationnellement, soit de les modifier), je présente ce que l’on présume que pense chacun des groupes sur la question. Finalement, je présente trois révisions, plutôt « locales », que ces travaux pourraient inspirer. (shrink)

Autonomy seems to be a core issue for lifelogging technology as it can influence our understanding as well as our personal freedom but a comprehensive discussion on the effect of it on the autonomy of the lifelogger and others affected seems still missing in the current academic debate. In this article we provide a preliminary inquiry into this topic. First, the concept of lifelogging will be briefly clarified. In a lifelog, different data sources are combined in an archive that can (...) be used to retrieve information about the lifelogger and the environment in which the lifelogger is situated. Second, we will discuss the effect of lifelogs on an element of autonomy, namely understanding. Lifelogs can both advance understanding as well as hinder it. Information of lifelogs is the result of social processes that can bias information and can be used to manipulate lifeloggers. Third, we will discuss another aspect of autonomy, namely being free from controlling influences. Also on this level the effect of lifelogs is ambiguous. Fourth, we will discuss the conditions under which prospective lifelogger become lifeloggers. By discussing both the effect of lifelogs on autonomy as well as joining the community of lifeloggers we aim to show the many ways in which lifelogs can compromise and advance autonomy. Fifth, some recommendations are provided that aim to address the above mentioned concerns. (shrink)

There is always a debate around consent in the context of research. Given the expansion of different approaches to qualitative research within dementia care, there is increasing consideration around consent in this context; particularly in research concerning the experiences of living with dementia and the care of persons with dementia. Specifically there is a drive to directly involve persons with dementia as they offer specific expertise concerning living with dementia. Additionally, capacity legislation strengthens the case for ensuring that persons with (...) dementia are actively enabled to make their own decisions for as long as possible. This paper discusses an approach and method that can enable more persons who are living with dementia to participate in some types of research should they want to. Currently, most researchers rely on an extension of the traditional competency-based informed consent method and/or proxy consent or assent. However, related to the development of so-called person-centred and participatory research in dementia, there are now a number of academic publications on approaches and practical methods of ‘inclusionary’ consent. This paper considers the broader contextual influences on inclusionary consent and outlines the key aspects of such approaches based on the development of one specific method for including persons with dementia in consent processes. The method is based on the premise that, for persons with a dementia, informed consent becomes increasingly redundant and consequently exclusionary to them as persons. And even where capacity is said to no longer exist, persons with dementia are often able to make choices and make known their preferences about participating in research where the consent process is made specifically dementia-sensitive. Ethics committees can facilitate researchers both by supporting them when they need to and want to include persons with dementia in gerontological research and by challenging them to ensure that participation is genuine and starts with process consent. (shrink)

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions (...) are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training. (shrink)

Recent liberal moral and political philosophy has placed great emphasis on the good of self-respect. But it is not always evident what is involved in self-respect, nor is it evident how societies can promote it. Assuming that self-respect is highly desirable, I begin by considering how people can live in a self-respecting fashion, and I argue that autonomous envisaging and fulfillment of one's own life plans is necessary for self-respect. I next turn to the question of how societal implementation of (...) rights may affect self-respect, and I urge that discretionary rights, which allow people to decline the benefits they confer, support self-respect more effectively than mandatory rights, which forbid people to refuse the benefits they confer. I conclude by examining the import of these contentions for feminist theory. I believe that my arguments are of particular concern to women because women have traditionally been victimized by a mandatory right to play a distinctively "feminine" role which has undermined their self-respect. (shrink)

James Stacy Taylor advances a thorough argument for the legalization of markets in current (live) human kidneys. The market is seemly the most abhorrent type of market, a market where the least well-off sell part of their body to the most well off. Though rigorously defended overall, his arguments concerning exploitation are thin. I examine a number of prominent bioethicists’ account of exploitation: most importantly, Ruth Sample’s exploitation as degradation. I do so in the context of Taylor’s argument, with the (...) aim of buttressing Taylor’s position that a regulated kidney market is morally allowable. I argue that Sample fails to provide normative grounds consistent with her claim that exploitation is wrong. I then reformulate her account for consistency and plausibility. Still, this seemingly more plausible view does not show that Taylor’s regulated kidney market is prohibitively exploitative of impoverished persons. I tack into place one more piece of support for Taylor’s conclusion. (shrink)

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)

In political philosophy, the concept of autonomy is often associated with liberalism: it serves as a justification for the liberal values of state neutrality and value pluralism, and seems coherent with the liberal definition of freedom as the absence of interference. Neo-republicans have pointed out that freedom as non-interference fails to acknowledge the fact that one may be unfree while non-interfered with, while on the other hand, not all forms of interference are freedom-limiting. They have proposed to replace the concept (...) by freedom as non-domination, which they define as the absence of actual or possible arbitrary interference. Although their definition is promising, neo-republicans tend to neglect the concept of self-government and therefore, are vulnerable to the same accusations of incompleteness faced by liberals. By focusing on the negative part of freedom as non-domination, they have omitted two aspects: first, that there are other ways to be unfree than to be the subject of mere arbitrary interference, and second, that the real value of non-domination is the capacity to act as a non-dominated being, which requires a level of self-mastery. To fix this problem, I propose an extension of the concept of non-domination and argue that the theory would benefit from including autonomy in the list of its conditions for freedom. Following the republican idea that one is only free in a free state, I propose a definition of republican autonomy that is political in nature, and depends on globalized nondomination. (shrink)

New data-driven technologies yield benefits and potentials, but also confront different agents and stakeholders with challenges in retaining control over their data. Our goal in this study is to arrive at a clear picture of what is meant by data sovereignty in such problem settings. To this end, we review 341 publications and analyze the frequency of different notions such as data sovereignty, digital sovereignty, and cyber sovereignty. We go on to map agents they concern, in which context they appear, (...) and which values they allude to. While our sample reveals a considerable degree of divergence and an occasional lack of clarity about intended meanings of data sovereignty, we propose a conceptual grid to systematize different dimensions and connotations. Each of them relates in some way to meaningful control, ownership, and other claims to data articulated by a variety of agents ranging from individuals to countries. Data sovereignty alludes to a nuanced mixture of normative concepts such as inclusive deliberation and recognition of the fundamental rights of data subjects. (shrink)

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

Autonomy as a personal ideal presupposes a conception of the self who owns and rules in a life that exemplifies the ideal. Philosophical discussion of autonomy continues to be injuenced by the thesis that the governing core of the self resides in our capacities for disengaged rational reflection, even when the thesis is not explicitly avowed. This conception of autonomy is shown to be inadequate because it alienates us from what matters in our lives. An alternative conception of autonomy is (...) presented that accords a substantial role to rejection and choice within an autonomous life without falling preq, to the charge of alienation. Some divergent implications of the two rival conceptions of autonomy for an understanding of liberal education are examined. Finally, the question of the value of autonomy from a social perspective is briefly discussed. (shrink)

In modern law medical paternalism no longer rules. Respect for patient autonomy is now a fundamental principle of both medical law and bioethics. As a result of these developments, and cases such as Rees v Darlington Memorial NHS Trust and Chester v Afshar, there have been suggestions that the law of clinical negligence should be developed so as to recognise diminished autonomy as a form of actionable damage in this area of tort law. Yet in order for the tort of (...) negligence to recognise this new interest, it is first necessary to determine how autonomy should be understood in this context. The purpose of this article is to shed light on this issue and arrive at a suitable definition of the concept. After outlining the different theories of autonomy it is argued that the traditional liberal definition is the most philosophically and legally coherent. (shrink)

Situationist experiments such as the Milgram experiment and the Princeton Seminary experiment have prompted philosophers to warn us against succumbing to fear of embarrassment and sliding down slippery slopes. Yet it would be a mistake to conclude that situationism is all bad news for moral agents. Fear of embarrassment can often motivate right actions, and slippery slopes can slide us away from wrongdoing. The reason that philosophers have seen situationism as bringing all bad news is that they have focused on (...) the very demanding moral goals of virtuous and autonomous action, while ignoring important moral goals that are less demanding. Fear of embarrassment does undermine virtuous and autonomous action, but that very same fear can help us to act resolutely and rightly, and allows us to manipulate would-be wrongdoers into doing the right thing. This is good news. (shrink)

In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

The paper examines Schiller’s argument concerning the subjective experience of adopting a morality based on Kantian principles. On Schiller’s view, such experience must be marked by a continuous struggle to suppress nature, because the moral law is a purely rational and categorically commanding law that addresses beings who are natural as well as rational. Essential for Schiller’s conclusion is the account he has of what it takes to follow the law, that is, the mental states and functions that encapsulate the (...) idea of moral self contained in Kant’s ethics. Focusing on the fundamental psychological elements and processes to which Kant’s theory appeals and on which it depends to have application, the paper defends an alternative idea of moral self to the one Schiller attributes to Kant. (shrink)

The concept of autonomy plays atleast two roles in moral theory. First, itprovides a source of constraints upon action:because I am autonomous you may not interferewith me, even for my own good. Second, itprovides a foundation for moral theory: humanautonomy has been thought by some to producemoral principles of a more general kind.This paper seeks to understand what autonomyis, and whether the autonomy of which we arecapable is able to serve these roles. We wouldnaturally hope for a concept of autonomy (...) thatis value-neutral rather than value-laden. Thatis to say, we would want the judgement that Iam autonomous to depend wholly on, say,structural features of my psychology, and in noway to require us to make ethical judgements, orother value judgements. Being value-neutral isperhaps desirable in a concept of autonomyserving the first role, and plausiblyindispensible in one playing the second. Ishall argue, however, that value-neutral conceptionsof autonomy are impoverished and out of linewith our intuitions; set out and defendan explicitly value-laden conception ofautonomy; and explore the implications of such a view for theability of autonomy to play the rolesmentioned above. (shrink)

Autonomy as a personal ideal presupposes a conception of the self who owns and rules in a life that exemplifies the ideal. Philosophical discussion of autonomy continues to be injuenced by the thesis that the governing core of the self resides in our capacities for disengaged rational reflection, even when the thesis is not explicitly avowed. This conception of autonomy is shown to be inadequate because it alienates us from what matters in our lives. An alternative conception of autonomy is (...) presented that accords a substantial role to rejection and choice within an autonomous life without falling preq, to the charge of alienation. Some divergent implications of the two rival conceptions of autonomy for an understanding of liberal education are examined. Finally, the question of the value of autonomy from a social perspective is briefly discussed. (shrink)

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

Autonomy in bioethics is coming under sustained criticism from a variety of perspectives. The criticisms, which target personal or individual autonomy, are largely justified. Moral conceptions of autonomy, such as Kant’s, on the other hand, cannot simply be applied in bioethical situations without moralizing care provision and recipience. The discussion concludes with a proposal for re-thinking autonomy by focusing on what different agents count as reasons for choosing one rather than another course of action, thus recognising their involvement in the (...) decision process. (shrink)

Among fundamental, widely shared values, there are two which often come into conflict, creating a serious moral dilemma, viz., the value of individual well-being and the value of individual self-direction. These values issue in two fundamental moral principles, one which prescribes the protection of others from harm, and one which proscribes interfering with a person's right to direct his own life and actions. When an individual is doing or choosing something which subjects him to harm or significant risk of harm, (...) the question of paternalistic interference arises.Since John Stuart Mill's On Liberty, there have been a number of attempts to say when such protective interference with adults is morally acceptable. (shrink)

By ‘Liberalism’ or ‘a liberal-democratic theory of justice’ I understand the thesis that a modern, affluent society is just only if it respects and enforces certain rights. Among these are rights to free speech, the liberty to make one's own self-regarding choices, privacy, due process of law, participation in society's political decision-making, and private property in personal posessions. By a ‘justification’ of these core rights of liberalism I understand a moral theory from which they are derivable. A moral theory which (...) justifies the core rights will, ipso facto, condemn slavery, totalitarianism, and other social arrangements incompatible with a liberal-democratic constitution. What shape that moral theory should have is a matter of some dispute. According to philosophers like Ronald Dworkin it must be ‘rights-based.’ The core rights of liberalism in his view are derivable from the fundamental human right to ‘equal respect and consideration.’ A widely held alternative view is that the core rights are simply social rules the existence of which promotes human welfare. (shrink)

Should the `irrational' refusal to consent to ECT of a depressed patient who knows he is thought to be ill, knows that his doctor believes ECT will help him and knows that he is being asked to decide, be respected or overridden? The author of the first paper, an American bioethicist argues that the refusal should be overridden in the interests of fostering the autonomy of the patient by overcoming the impediment to that autonomy which major depression represents. A philosopher (...) and a psychiatrist respond and an editorial discusses the issues. (shrink)