This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background (...) of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)

The article presents a doctor–patient relationship model based on the assumptions of a holistic approach to the patient. The author draws attention to selected patients’ needs, ones taken into account in this model. These are the right to autonomy and an individualised approach to the patient. These issues, considered in relation to philosophy, show a conflict between patients’ values and aspirations and doctors’ values and their experience. Nowadays, patients’ needs are protected by consumer rights as well as being strengthened by (...) postmodern philosophy, which shapes society’s awareness of various definitions of health and underlines the right of the individual to self‐determination. This situation creates an incredible challenge for doctors because attempts to assist is, according to medical knowledge, associated with an inevitable collision with the subjective perception of a patient’s health. Because of this issue, the author considers it necessary to enquire about the needs and aspirations of not so much patients as doctors themselves. It is assumed that the definition of what is currently important for this group determines the scope of any possible admission or intentional ignorance of patients’ needs. (shrink)

In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will to (...) another’s authority or because it precludes the agent from acting effectively in pursuit of their ends. I shall argue that providing an agent with false beliefs is not inimical to their autonomy if they are only able to effectively pursue their autonomously chosen ends by virtue of holding those particular false beliefs. Finally, I show that deceptive placebo use need only involve this latter sort of deception. (shrink)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (shrink)

Ageism within the context of care has attracted increasing attention in recent years. Similarly, autonomy has developed into a prominent concept within health care law and ethics. This paper explores the way that ageism, understood as a set of negative attitudes about old age or older people, may impact on an older person’s ability to make maximally autonomous decisions within health care. In particular, by appealing to feminist constructions of autonomy as relational, I will argue that the key to establishing (...) this link is the concept of self-relations such as self-trust, self-worth and self-esteem. This paper aims to demonstrate how these may be impacted by the internalisation of negative attitudes associated with old age and care. In light of this, any legal or policy response must be sensitive to and flexible enough to deal with the way in which ageism impacts autonomy. (shrink)

Where ethical or regulatory questions arise about an individual’s interests in accessing bioinformation about herself, the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the “personal utility” of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in (...) itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research. (shrink)

In this article we provide an in-depth description of a new model of informed consent called ‘meta consent’ and consider its practical implementation. We explore justifications for preferring meta consent over alternative models of consent as a solution to the problem of secondary use of health data for research. We finally argue that meta consent strikes an appropriate balance between enabling valuable research and protecting the individual.

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)

This article discusses what level of consent is needed from a child or parent before a primary-school medical can take place . It also considers whether there are occasions when a doctor can see a child if the parents have failed to give consent or have explicitly refused consent.Primary-school children are considered incompetent to make decisions about their own medical treatment and so their consent does not need to be gained before a medical takes place, although it is highly desirable (...) to obtain it. However, a doctor cannot justify a decision to see a child purely in terms of the benefit conferred on the child. Parents can be wronged if their wishes are ignored and usually those wishes should be considered overriding. Normally, general consent, which need not be fully informed, is needed before a school medical. However, if a child is considered to be in danger of being harmed significantly or suspected to have a major medical condition, a medical should go ahead regardless of the level of consent obtained from the parent, so that a reasonable standard of health is maintained for the child. (shrink)

The paper examines how technology challenges conventional borders of national legal systems, as shown by cases that scholars address as a part of their everyday work in the fields of information technology (IT)-Law, i.e., computer crimes, data protection, digital copyright, and so forth. Information on the internet has in fact a ubiquitous nature that transcends political borders and questions the notion of the law as made of commands enforced through physical sanctions. Whereas many of today’s impasses on jurisdiction, international conflicts (...) of law and diverging interpretations of statutes can be addressed by embedding legal safeguards in ICT and other kinds of technology, to overcome the ineffectiveness of state action by design entails its own risks, e.g., threats of paternalism hinging on the regulatory tools of technology. Rather than modelling people’s behaviour by design, the article suggests that design policies should respect individual and collective autonomy by decreasing the impact of harm-generating behaviour (e.g., security measures and default settings for data protection), or by widening the range of people’s choices (e.g., user friendly interfaces). (shrink)

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain (...) can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude (...) that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates. (shrink)

This article seeks to demonstrate a particular application of Foucault's philosophical approach to a particular issue in education: that of personal autonomy. The paper surveys and extends the approach taken by James Marshall in his book Michel Foucault: Personal autonomy and education. After surveying Marshall's writing on the issue I extend Marshall's approach, critically analysing the work of Rob Reich and Meira Levinson, two contemporary philosophers who advocate models of personal autonomy as the basis for a liberal education.

BackgroundMany medical emergency practices are regulated by written procedures that normally provide reliable guidelines for action. In some cases, however, the consequences of following rule-based instructions can have unintended negative consequences. The article discusses a case - described on a type level - where the consequences of following a rule formulation could have been fatal.Case presentationA weak and elderly patient has cardiac arrest, and a Do Not Resuscitate clause is written in the patient’s medical record. Paramedics at the scene cannot (...) see that the patient’s general appearance match conditions which would indicate the DNR clause, so they start cardiopulmonary resuscitation, and the patient survives. This turns out to be a crucial decision. The DNR clause is from an earlier bout with serious disease from which the patient has recovered, against all odds, and someone has forgotten to remove the clause from the medical record.AnalysisIn order to be able to interpret the validity of written guidelines, paramedics and other health workers need to develop personal skills that transcend the ability simply to follow written instructions. Within traditional virtue ethics, personal judgment is conceived of as crucial for being able to make ‘good’ autonomous decisions. Virtue ethical analyses, decision-making abilities and non-technical communication skills are important as conceptual tools when health workers need to make difficult clinical decisions.ConclusionThe case study accentuates the significance of prudent judgment in medical practice. In the case described, the consequence of trusting the written advance directive could have been fatal, but the point is general: for the purpose of achieving excellent organizational performance, it is insufficient for health workers to rely uncritically on rules and procedures. Even the clearest rule formulations must be interpreted contextually in order to determine ethically correct behavior and avoid potential negative consequences that are not in the patient’s best interests. (shrink)

BackgroundThis case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention in the literature on prehospital ambulance work.Case presentationThe patient had chest pains that were consistent with serious heart disease, but she wanted to (...) catch her plane and was unwilling to let paramedics assess her heart activity by means of an electrocardiogram (ECG). The paramedics had to decide, there and then, whether the patient’s refusal to submit to an ECG should be respected, or whether they should set the patient’s expressed wishes aside by exercising verbal power and persuasive communication techniques. The paramedics chose to do the latter. It later turned out that the patient was grateful that the paramedics had been very direct, almost brutal, in their communication. When the patient regained her autonomy, she saw clearly that taking time to obtain and monitor an ECG was the best option for her.ConclusionLooking forward in time might be a good professional strategy for deciding whether ethical paternalism in communication is justified. If there is good reason to believe that patients who later regain their autonomy will agree that paternalistic verbal actions were in their best interests, and if acting in accordance with patients’ preferences can have severe negative health consequences for them, then paramedics have good reason to believe that ethical paternalism is justified. (shrink)

Given the ubiquity and centrality of social and relational influences to the human experience, our conception of self-governance must adequately account for these external influences. The inclusion of socio-historical, externalist considerations into more traditional internalist accounts of autonomy has been an important feature of the debate over personal autonomy in recent years. But the relevant socio-temporal dynamics of autonomy are not only historical in nature. There are also important, and under-examined, future-oriented questions about how we retain autonomy while incorporating new (...) values into the existing set that guides our interaction with the world. In this paper, we examine these questions from two complementary perspectives: philosophy and neuroscience. After contextualizing the philosophical debate, we show the importance to theories of autonomous agency of the capacity to appropriately adapt our values and beliefs, in light of relevant experiences and evidence, to changing circumstances. We present a plausible philosophical account of this process, which we claim is generally applicable to theories about the nature of autonomy, both internalist and externalist alike. We then evaluate this account by providing a model for how the incorporation of values might occur in the brain; one that is inspired by recent theoretical and empirical advances in our understanding of the neural processes by which our beliefs are updated by new information. Finally, we synthesize these two perspectives and discuss how the neurobiology might inform the philosophical discussion. (shrink)

Advances in psychology and neuroscience have elucidated the social aspects of human agency, leading to a broad shift in our thinking about fundamental concepts such as autonomy and responsibility. Here, we address a critical aspect of this inquiry by investigating how people consider the socio-relational nature of their own agency, particularly the influence of others on their perceived control over their decisions and actions. Specifically, in a series of studies using contrastive vignettes, we examine public attitudes about when external influences (...) on everyday decisions are perceived as " undue " – that is, as undermining the control conditions for these decisions to be considered autonomous – vs. when they are perceived as appropriate and even supportive of autonomous decision-making. We found that the influence of preauthorized agents – individuals and institutions with whom we share a worldview – was judged to be less undue than non-preauthorized agents, even after controlling for the familiarity of the agent. These effects persisted irrespective of the extent to which respondents identified as communitarian or individualistic, and were consistent across two distinct scenarios. We also found that external influences that were rational were perceived as less undue than those that were arational. Our study opens new avenues of inquiry into the " folk conception " of autonomy, and we discuss the implications of our findings for the ethics of public policies designed to influence decisions and for information sharing in social networks. (shrink)

Status inequalities seem to play a fairly big role in creating inequalities in health. This article assumes that there can be good reasons to fight status inequalities in order to reduce inequalities in health. It examines whether the neorepublican ideal of non-dominance does a better job as a theoretical foil for this as compared to a liberal notion of non-interference. The article concludes that there is a prima facie case for incorporating non-dominance into our thinking about public health, but that (...) it needs to go hand in hand with a more traditional liberal ideal of non-interference. (shrink)

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)

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)

Whatever its implications for the other features of human agency at its best — for moral responsibility, reasons-responsiveness, self-realization, flourishing, and so on—addiction is universally recognized as impairing autonomy. But philosophers have frequently misunderstood the nature of addiction, and therefore have not adequately explained the manner in which it impairs autonomy. Once we recognize that addiction is not incompatible with choice or volition, it becomes clear that none of the Standard accounts of autonomy can satisfactorily explain the way in which (...) it undermines fully autonomous agency. In order to understand to what extent and in what ways the addicted are autonomy-impaired, we need to understand autonomy as consisting, essentially, in the exercise of the capacity forextended agency.It is because addiction undermines extended agency, so that addicts are not able to integrate their lives and pursue a Single conception of the good, that it impairs 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)

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)