This paper suggests a framework for determining the ethicality of disguised and obtrusive advertising. While most discussions of advertising ethics deal with deception or fraud, the proposed framework is based on the way messages are presented to audiences. Suggestions for measurement and future research are given.

There is a remedy available for many of our ailments: Psychopharmacology promises to alleviate unsatisfying memory, bad moods, and low self-esteem. Bioethicists have long discussed the ethical implications of enhancement interventions. However, they have not considered relevant evidence from psychology and economics. The growth in autonomy in many areas of life is publicized as progress for the individual. However, the broadening of areas at one’s disposal together with the increasing individualization of value systems leads to situations in which the range (...) of options asks too much of the individual. I scrutinize whether increased self-determination and unbound possibilities are really in a person’s best interests. Evidence from psychology and economics challenges the assumption that unlimited autonomy is best in all cases. The responsibility for autonomous self-formation that comes with possibilities provided by neuro-enhancement developments can be a burden. To guarantee quality of life I suggest a balance of beneficence, support, and respect for autonomy. (shrink)

This paper addresses the issue of paternalism in child-rearing. Since the parent–child relationship seems to be the linguistic source of the concept, one may be tempted to assume that raising a child represents a particularly appropriate sphere for paternalism. The parent–child relationship is generally understood as a relationship that is supposed to promote the development and autonomy-formation of the child, so that the apparent source of the concept is a form of autonomy-oriented paternalism. Far from taking paternalism to be overtly (...) unproblematic in such paradigmatic, pedagogical settings, this article analyzes how an effort should be made to understand a child’s capacities and which standards parents should be held to when deciding whether interference truly serves the child’s interests. (shrink)

Many arguments have been advanced in favor of employee participation in firm decision-making. Two of the most influential are the "interest protection argument" and the "autonomy argument." I argue that the case for granting participation rights to some other stakeholders, such as suppliers and community members, is at least as strong, according to the reasons given in these arguments, as the case for granting them to certain employees. I then consider how proponents of these arguments might modify their arguments, or (...) views, in response to this conclusion. (shrink)

This paper argues that autonomy is an educational ideal. Since personal autonomy is essentially a matter of the person governing herself, a plausible account of autonomy presupposes an account of u person's identity. I support a conception of autonomy which presupposes a hierarchical theory of the self, yet allows rationality a significant place in a person's identity. I defend this conception of autonomy as an educational ideal from recent criticisms by Stone (1990) and Cuypers (1992).

South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders’ perspectives on ethical guidance related to prevention and care in HIV vaccine trials.

In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable ‘statistical victims’ into ‘real people’ with whom we can identify and feel empathy: the so-called ‘identifiable victim effect’, which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: institutionally organized campaigns based on historical cases aimed at (...) promoting non-directed altruistic donation; personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two. (shrink)

Choice architecture is heralded as a policy approach that does not coercively reduce freedom of choice. Still we might worry that this approach fails to respect individual choice because it subversively manipulates individuals, thus contravening their personal autonomy. In this article I address two arguments to this effect. First, I deny that choice architecture is necessarily heteronomous. I explain the reasons we have for avoiding heteronomous policy-making and offer a set of four conditions for non-heteronomy. I then provide examples of (...) nudges that meet these conditions. I argue that these policies are capable of respecting and promoting personal autonomy, and show this claim to be true across contrasting conceptions of autonomy. Second, I deny that choice architecture is disrespectful because it is epistemically paternalistic. This critique appears to loom large even against non-heteronomous nudges. However, I argue that while some of these policies may exhibit epistemically paternalistic tendencies, these tendencies do not necessarily undermine personal autonomy. Thus, if we are to find such policies objectionable, we cannot do so on the grounds of respect for autonomy. (shrink)

This paper argues that specific individual informed consent and other forms of consent predicated on a right to autonomy may not in all circumstances be appropriate for the establishment and use of large data sets of health information. We suggest that there are inherent failings in such an approach, shortcomings that we analyse below. We argue that individuals share an obligation to contribute their data, as doing so is cost-free and benefits accrue to the population as a whole. Large health (...) data sets can be considered public goods – goods that are non-rival in consumption and in some cases non-exclusive in use – and contributing to these goods may be an obligation, the meeting of which allows citizens to invest in knowledge infrastructure. The approach argued for here is a variation of a communitarian ethic in which people have an obligation to contribute their data but have no correlative right to expect or receive an individual benefit. (shrink)

This article explores the significance of agents’ histories for directly free actions and actions for which agents are directly morally responsible. Candidates for relevant compatibilist historical constraints discussed by Michael McKenna and Alfred Mele are assessed, as is the bearing of manipulation on free action and moral responsibility.

Strict akratic actions, by definition, are performed freely. However, agents may seem not to be selfgoverned with respect to such actions and therefore not to perform them autonomously. If appearance matches reality here, freedom and autonomy part company in this sphere. Do they? That is this article's guiding question. To make things manageable, it is assumed that there are free actions, including strict akratic actions. Two theses are defended. First, the combination of (i) an intentional action's being uncompelled and (ii) (...) its being - or executing - in appropriate informational circumstances, a sane decision that, as the agent recognizes, is for a course of action that she believes to be inferior to an alternative course of action open to her is sufficient for the action's being freely performed. (Condition (i) provides elbow room allegedly needed for free action, and (ii) encompasses freedom-level psychological sophistication.) Second, the same combination is sufficient for an intentional action's being autonomously performed. (shrink)

Manipulation arguments for incompatibilism all build upon some example or other in which an agent is covertly manipulated into acquiring a psychic structure on the basis of which she performs an action. The featured agent, it is alleged, is manipulated into satisfying conditions compatibilists would take to be sufficient for acting freely. Such an example used in the context of an argument for incompatibilism is meant to elicit the intuition that, due to the pervasiveness of the manipulation, the agent does (...) not act freely and is not morally responsible for what she does. It is then claimed that any agent's coming to be in the same psychic state through a deterministic process is no different in any relevant respect from the pertinent manner of manipulation. Hence, it is concluded that compatibilists' proposed sufficient conditions for free will and moral responsibility are inadequate, and that free will and moral responsibility are incompatible with determinism. One way for compatibilists to resist certain manipulation arguments is by appealing to historical requirements that, they contend, relevant manipulated agents lack. While a growing number of compatibilists advance an historical thesis, in this paper, I redouble my efforts to show, in defense of nonhistorical compatibilists like Harry Frankfurt, that there is still life left in a nonhistorical view. The historical compatibilists, I contend, have fallen shy of discrediting their nonhistorical compatibilist rivals. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. (...) However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine. (shrink)

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

Actually possible and conceivable future uses of preimplantation genetic diagnosis (PGD) and germ-line genetic intervention in assisted reproduction seem to offer increasing possibilities of choosing the kind of persons that will be brought to existence. Many are troubled by the idea of these technologies being used for enhancement purposes. How can we make sense of this worry? Why are our thoughts about therapeutic genetic interventions and non-genetic enhancement (for instance education) not accompanied by the same intuitive uneasiness? I argue that (...) the concepts of autonomy and freedom of choice, typically invoked to delimit the morally acceptable uses of reproductive technologies, cannot fully answer these questions. Instead, I suggest that an alternative answer might begin with reflections on the notion of interfering with nature. Drawing on Martin Heidegger’s critique of modern technology and Hans Jonas’s moral philosophy, I outline an argument that attempts to capture what might be particularly troubling about the idea of “designing” future persons. At the core of the argument is the suggestion that enhancing selections and modifications on embryos might be bound up with an instrumentalising, non-responsive perspective on the future persons into which they are intended to grow. (shrink)

This paper is a theoretical and empirical investigation into whether persons in subordinate social contexts possess agency and if they do, how do we recognise and recover their agency given the oppressive conditions of their lives. It aims to achieve this through forging closer links between the philosophical arguments and the ethnographic evidence of women's agency. Through such an exercise, this paper hopes to bridge the existing gap between feminist theoretical interventions and feminist politics as well as to increase 'sociological (...) awareness' within feminist philosophical arguments. In order to think about women's agency in oppressive social contexts, the paper evaluates the suitability of existing theoretical frameworks for examining, describing and capturing the autonomy of persons and concludes that a new and a more complex thinking is required to facilitate thinking about human agency within oppressive transcultural contexts. The social context of subordination, the exhibition of agency within and oppressive context and the application of the new theoretical framework is illustrated in an extensive empirical study of the contact with modernity and its accompanying ideas of autonomy and individual rights of rural women belonging to two districts in Rajasthan, North western India. (shrink)

En los sectores políticos democráticos liberales, el principio del respeto a la autonomía es ampliamente aceptado —en teoría, si no siempre en la práctica— como un valor moral cardinal que debería guiar tanto la deliberación política, la política pública y las prácticas, como nuestras actitudes respecto a nuestros conciudadanos. En términos simples, respetar la autonomía es respetar los intereses de cada persona de vivir su vida según su propia concepción del bien. En la base del requisito normativo de respetar la (...) autonomía de otro está la presunción de que la autonomía confiere autoridad normativa sobre la propia vida; la autoridad para tomar decisiones de importancia práctica para la propia vida, por razones propias, cualesquiera que sean. Se asume que las personas autónomas tienen la capacidad, el derecho y la responsabilidad de ejercer esta autoridad, incluso si no siempre lo hacen sabiamente. (shrink)

The autonomous person is one who has, in some sense, mastery over their desires. The prevailing way to understand such personal autonomy is in terms of a hierarchy of desires. For Harry Frankfurt, persons not only have first-order desires, but possess the additional capacity to form second-order desires. Second-order desires are formed through reflection on first-order desires and are thus expressive of the rational capacity which is characteristic of persons. Frankfurt's account of freedom of the will is founded on his (...) analysis of persons. It is only because persons possess second-order desires, resulting from their capacity for rational evaluation of first-order desires, that persons (and not those Frankfurt calls 'wantons') are well placed to possess freedom of will. Various objections have been raised in the literature against such second-order desire accounts of freedom of the will or autonomy. In my article, I raise the problem of instrumental second-order desires. I discuss the forms instrumental second-order desires can take and attempt to show that these cannot be the second-order desires that Frankfurt has in mind in his account. I then extend my critique by looking at non-instrumental second-order desires. I consider various forms which non-instrumental second-order desires can take and advance the argument that Frankfurt cannot have second-order desires such as these in mind either. Finally, I note that none of the suggestions considered will deliver a second-order desire account of autonomy, and that it is baffling just what Frankfurt does have in mind. (shrink)

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

The article defends ubuntu against the assault by Enslin and Horsthemke (Comp Educ 40(4):545–558, 2004 ). It challenges claims that the Africanist/Afrocentrist project, in which the philosophy of ubuntu is central, faces numerous problems, involves substantial political, moral, epistemological and educational errors, and should therefore not be the basis for education for democratic citizenship in the South African context. The article finds coincidence between some of the values implicit in ubuntu and some of the values that are enshrined in the (...) constitution of South Africa and that on that basis argues that ubuntu has the potential to serve as a moral theory and a public policy. The educational upshot of this article’s argument is that South Africa’s educational policy framework not only places a high premium on ubuntu, which it conceives as human dignity, but it also requires the schooling system to promote ubuntu-oriented attributes and dispositions among the learners. The article finds similarities between ubuntu and bildung, whose key advocates, among others was German scholar and intellectual Wilhelm von Humboldt. It argues that it would be ethnocentric, and indeed silly to suggest that the ubuntu ethic of caring and sharing is uniquely African when some of the values which it seeks to promote can also be traced in various Eurasian philosophies. (shrink)

Legal coercion seems morally problematic because it is susceptible to the Hegelian objection that it fails to respect individuals in a way that is ‘due to them as men’. But in what sense does legal coercion fail to do so? And what are the grounds for this requirement to respect? This paper is an attempt to answer these questions. It argues that legal coercion fails to respect individuals as reason-responsive agents; and individuals ought to be respected as such in virtue (...) of the fact that they are human beings. Thus it is in this sense that legal coercion fails to treat individuals with the kind of respect ‘due to them as men’. (shrink)

This study examines the normative foundations of early Confucian ethics and suggests that rather than attempting to understand Confucian ethics in the language of ‘morality’ a more productive way would be to appreciate Confucianism as an ethics of propriety that can be articulated in terms of social roles, ritual decorum, and relational dependence. I argue that Western notions of ‘morality’ betray a thicker, more culturally loaded concept that possesses a limited utility in regard to comparative study. We can appeal to (...) a kind of methodological charity where we not only maximize the sense of the text or subject's sayings but also privilege the categories of thought that are native to the text's or speaker's lexicon. With this in mind, we can understand Confucian ethics as an ethics of propriety that departs substantially from Western moral systems, including virtue ethics, and challenges our received views on justice, autonomy, and personal identity. (shrink)

This paper argues that the demands of respect for autonomy in the context of biobanking are fewer and more limited than is often supposed. It discusses the difficulties of agreeing a concept of autonomy from which duties can easily be derived, and suggests an alternative way to determine what respect for autonomy in a biobanking context requires. These requirements, it argues, are limited to provision of adequate information and non-coercion. While neither of these is in itself negligible, this is a (...) smaller set of demands than is often suggested. In particular, it is argued here that securing ‘one time consent’ is consistent with respect for autonomy. Finally, the paper notes that while the demands of respect for autonomy may be less than some suppose, respecting autonomy is not the only way in which biobanks and their users may have moral duties to donors. (shrink)

Many political philosophers argue that interference (or vulnerability to interference) threatens a person’s agency. And they cast political freedom in opposition to interpersonal threats to agency, as non-interference (or non-subjection). I argue that this approach relies on an inapt model of agency, crucial aspects of which emerge from our relationships with other people. Such relationships involve complex patterns of vulnerability and subjection, essential to our constitution as particular kinds of agents: as owners of property, as members of families, and as (...) participants in a market for labor. We should construct a conception of freedom that targets the structures of our interpersonal relations, and the kinds of agents these relations make us. Such a conception respects the interpersonal foundations of human agency. It also allows us to draw morally significant connections between diverse species of unfreedom—between, for instance, localized domination and structural oppression. (shrink)

The objective of this paper is to provide critical analysis of the Kantian notion of freedom ; its significance in the contemporary debate on free-will and determinism, and the possibility of autonomy of artificial agency in the Kantian paradigm of autonomy. Kant's resolution of the third antinomy by positing the ground in the noumenal self resolves the problem of antinomies; however, it invites an explanatory gap between phenomenality and the noumenal self; even if he has successfully established the compatibility of (...) natural causality and non-natural causality through his transcendental argument. This paper is also devoted to establishing the plausibility of the knowledge claim that Kantian reduction of phenomenality has served half of the purpose of the AI scientists on the possibility of Artificial Autonomous Agency. (shrink)

Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical aspects of (...) preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductive medicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice — paradoxically — can hamper couples' choice. (shrink)

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

Gamification is the use of elements and techniques from video game design in non-game contexts. Amid the rapid growth of this practice, normative questions have been under-explored. The primary goal of this article is to develop a normatively sophisticated and descriptively rich account for appropriately addressing major ethical considerations associated with gamification. The framework suggests that practitioners and designers should be precautious about, primarily, but not limited to, whether or not their use of gamification practices: takes unfair advantage of workers (...) ; infringes any involved workers’ or customers’ autonomy ; intentionally or unintentionally harms workers and other involved parties; or has a negative effect on the moral character of involved parties. (shrink)

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals’ formation of choices. In response to this problem, I will present a brief overview of Diana Meyers’s account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, self-knowledge, and self-direction. This (...) account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical ‘self-reading’. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills. (shrink)

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

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

If an individual is morally responsible, then there is a responsibility-foundation that makes him morally responsible, but there is no responsibility-foundation that makes him responsible. This rested on the notion that if there were a responsibility-foundation, it would be either an ungrounded choice or an ungrounded character state and that neither can serve as the foundation. The paper then considered three types of objections. First, moral responsibility does not require a responsibility-foundation. Second, a character state can serve as the foundation. (...) Third, we know people are responsible even if we don't know what the foundation is. These objections fail. (shrink)

The standard account of informed consent has recently met serious criticism, focused on the mismatch between its implications and widespread intuitions about the permissibility of conducting research and providing treatment under conditions of partial knowledge. Unlike other critics of the standard account, we suggest an account of the relations between autonomy, ignorance, and valid consent that avoids these implausible implications while maintaining the standard core idea, namely, that the primary purpose of the disclosure requirement of informed consent is to prevent (...) autonomy-undermining ignorance. The problem with the standard account, we argue, is that it fails to distinguish between different forms of ignorance–in particular, error and suspending ignorance–that have very different effects on individuals’ ability to provide valid consent. While error often undermines our ability to provide valid consent, suspending ignorance, we argue, does not. Once the moral weight of this distinction is appreciated, it becomes apparent that valid informed consent requires far less knowledge than suggested by the standard account. (shrink)

My central thesis is that philosophers considering questions of epistemic value ought to devote greater attention to the enduring nature of beliefs. I begin by arguing that a commonly drawn analogy between beliefs and actions is flawed in important respects, and that a better, more fruitful analogue for belief would be desire, or a similarly enduring state of an agent. With this in hand, I argue that treating beliefs as enduring, constitutive states of agents allows us to capture the importance (...) of accessible, justified, and true beliefs to sustaining personal identity, autonomy, self-control, and authenticity. We thus arrive at a significant value to such beliefs through their crucial role in our personal, practical identities. (shrink)

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

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

Autonomous e-coaching systems offer their users suggestions for action, thereby affecting the user's decision-making process. More specifically, the suggestions that these systems make influence the options for action that people actually consider. Surprisingly though, options and the corresponding process of option generation --- a decision-making stage preceding intention formation and action selection --- has received very little attention in the various disciplines studying decision making. We argue that this neglect is unjustified and that it is important, particularly for designers of (...) autonomous e-coaching systems, to understand how human option generation works. The aims of this paper are threefold. The first aim is to generate awareness with designers of autonomous e-coaching systems that these systems do in fact influence their users' options. The second is to show that understanding the interplay between a person's options and the e-coaching system's suggestions is important for improving the effectiveness of the system. The third is that the very same interplay is also crucial for designing e-coaching systems that respect people's autonomy. (shrink)

Questions about the normative significance of ‘transparency’ do not receive much attention, even though they were central to Richard Moran’s (2001) original account. Instead, transparency is typically studied because of its epistemic and psychological peculiarities. In this paper, I consider three normative conceptions of transparency: teleological rationalism, procedural rationalism, and relational rationalism. The first is a theory about how transparency might relate to flourishing as a rational agent; the latter two are theories about how transparency relates to non-alienated self-knowledge. All (...) three conceptions, I argue, face serious problems. I end the paper by suggesting where the rationalist might go from here and by highlighting the importance of focusing not on the methods but on the broader circumstances in which self-knowledge is gained or lost. (shrink)

Objective: To examine students’ attitudes and potential behaviour towards informing a 12-year-old patient of her terminal prognosis in a situation in which her parents do not wish her to be told, as they pass through a modern medical curriculum.Design: A cohort study of students entering Glasgow University’s new medical curriculum in October 1996.Methods: Students’ responses obtained before year 1 and at the end of years 1, 3, and 5 to the “childhood leukaemia” vignette of the Ethics in Health Care Survey (...) Instrument were examined quantitatively and qualitatively. Analysis of the students’ multichoice answers enabled measurement of the movement towards professional consensus opinion. An analysis of their written justifications for their answers helped to determine whether their reasoning was consistent with professional consensus and enabled measurement of changes in knowledge content and recognition of the values inherent in the vignette. Themes on the students’ reasoning behind their decision to tell the patient or not were also identified.Results: Unlike other vignettes of the EHCI in which autonomy was a main theme, few students chose the consensus answer before year 1 and there was no significant movement towards consensus at any point during the course. In defence of their decision to withhold information, the students expressed strong paternalistic opinions. The patient’s age was seen as a barrier to respecting her autonomy.Conclusions: It is important to identify students’ perceptions on entry to medical school. Transformative learning theory may provide the basis for an approach to foster doctors who consider the rights of young people. Small-group teaching is most conducive to this approach. The importance of positive role modelling is also emphasised. (shrink)