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)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

In “How the Neuroscience of Decision Making Informs Our Conception of Autonomy,” Gidon Felsen and Peter Reiner (2011) argue that decisions typically regarded as rational and autonomous are in fact...

Sartre and Kant are not often compared, especially because the former is frequently considered a theorist of a totally arbitrary free will. Nevertheless, this is not a fair interpretation of Sartre. Starting already from Being and Nothingness, he conceived an ethical difference between bad faith and authenticity. More unequivocally, in Notebooks for an Ethics he developed an existentialist ethics, which is more Kantian than expected. In that text, the ethical ideal of authenticity is not so different from the ethical ideal (...) of autonomy in Kant. The aim of this article is to characterize Sartrean authenticity as a radicalization of Kantian autonomy. In both cases, there is a normative criterion, which implies a correct exercise of freedom towards oneself and others. This correct exercise of freedom implies for Kant the exclusion of the will determined by material conditions. For Sartre, this correct exercise means the rejection of bad faith. There is also a similar connection between autonomy and respect in Kant, and between authenticity and generosity in Sartre. Highlighting this little‐known affinity between the two most radical philosophers of freedom could also reveal a non‐ideological Sartre, ready to dialogue with contemporary ethical debate. (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.

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 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)

This is critical review of Richard Dean’ book, The Value of Humanity in Kant’s Moral Theory. Dean’s book was evaluated, and some of his interpretations of Kant were critiqued. However, it concludes that Dean’s book is illuminating especially, as regards the distinction he made between consent and informed consent and their roles in biomedical practice.

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

Obesity is a public health problem influenced by behavioral patterns that span an ecological spectrum of individual-level factors, social network factors and environmental factors. Both individual and environmental approaches necessarily include significant influences from social networks, but how and under what conditions social networks influence behavior change is often not clearly mapped out either in the obesity literature or in many intervention designs. In this paper, we provide an analysis of recent empirical work in obesity research that explicates social network (...) influences on eating behaviors. We argue that a relational rather than individualistic view of personhood should help us better understand the content and context of social network relations that inform health behavior choices. We introduce the concept of ‘identity-constitutive affiliations’ as the glue that binds these social relationships together. Finally, we outline the implications for public health ethics in the development of effective interventions to address overweight and obesity, leveraging the content and context of social network ties to reinforce healthy (or alter unhealthy) eating. More complex treatment of positive and negative behaviors stemming from social network connections should lead to more comprehensive theoretical models of health behavior change and more effective public health interventions. (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)

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)

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)

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)

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)

Paternalistic interference in autonomous decisions is typically impermissible. This has several explanations, among which is a view I call theagent-constitution of the good: that the autonomous agent not onlyknowswhat is best for herself, butdetermineswhat is best for herself through her desires, goals and so on (heraims). For instance, it might seem that if an autonomous person does choose not to take insulin for her diabetes, then not only is it inappropriate to force treatment upon her, it is also not in (...) her best interest to take insulin. Here I argue that agent-constitution, though appealing, is false. In fact, autonomous agents can be mistaken about their good, even when it seems to depend only upon their aims. Agent-constitution appears true only because we typically fail to notice constraints on a person's good in private, self-regarding decisions where paternalism might be considered. (shrink)

In recent years, compatibilism has been the target of two powerful challenges. According to the consequence argument, if everything we do and think is a consequence of factors beyond our control (past events and the laws of nature), and the consequences of what is beyond our control are themselves beyond our control, then no one has control over what they do or think and no one is responsible for anything. Hence, determinism rules out responsibility. A different challenge--here called the manipulation (...) argument--is that by allowing agents to be fully determined compatibilist accounts of practical freedom and responsibility are unable to preclude those who are subject to global manipulation from being free and responsible. (shrink)

Do neurosurgical procedures ever result in the patient prior to the procedure not being identical with the individual who wakes up postsurgery in the hospital bed? We address this question by offering an analysis of the persistence of persons that emphasizes narrative, rather than numerical, identity. We argue that a narrative analysis carries the advantage of highlighting what matters to patients in their ordinary lives, explaining the varying degrees of persistence of personal identity, and enhancing our understanding of patients' experiences. (...) We illustrate these points in cases involving temporal lobectomy for treatment of refractory epilepsy and deep brain stimulation for refractory Parkinson's disease. (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...

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

The aim of this paper is to suggest that a necessary condition of autonomy has not been sufficiently recognized in the literature: the capacity to critically reflect on one’s practical attitudes (desires, preferences, values, etc.) in the light of new experiences . It will be argued that most prominent accounts of autonomy—ahistorical as well as history-sensitive—have either altogether failed to recognize this condition or at least failed to give an explicit account of it.

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)

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)

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...