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)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

The development of highly humanoid sex robots is on the technological horizon. If sex robots are integrated into the legal community as “electronic persons”, the issue of sexual consent arises, which is essential for legally and morally permissible sexual relations between human persons. This paper explores whether it is conceivable, possible, and desirable that humanoid robots should be designed such that they are capable of consenting to sex. We consider reasons for giving both “no” and “yes” answers to these three (...) questions by examining the concept of consent in general, as well as critiques of its adequacy in the domain of sexual ethics; the relationship between consent and free will; and the relationship between consent and consciousness. Additionally we canvass the most influential existing literature on the ethics of sex with robots. (shrink)

Even though respect for integrity is hailed in several authoritative legal and ethical documents, and is typically presented as a complement to respect for autonomy, it is largely neglected in many leading works in ethics. Is such neglect warranted, or does it express a prejudice? This article argues that the latter is the case, and that this is due to misplaced conceptual concerns. It offers some proposals as regards the conceptualization of integrity in social ethics in general and in biomedical (...) ethics in particular. Five main directions of interpretation of “integrity” are discerned and shown to be relevant for different areas of biomedical ethics. The defense of respect for integrity is served by a softening of principlism and by greater attention to context among the initial critics of this principle. (shrink)

I argue that we can interpret the stories told by near-death experiences in a naturalistic way. Thus, the profound significance of NDEs need not come from a supernaturalistic conception of them, according to which in an NDE the individual is in touch with a heavenly realm. We can respect the sincerity of NDE reports, but we can capture their meaning in a naturalistic framework.

Three widely accepted principles – autonomy, beneficence and justice – provide a useful analytic framework for considering controversies and conflicts in bioethics. Since these principles capture key concepts found in diverse normative theories they provide a starting point from which consistent ethical analysis and comparison can begin. While justice is commonly discussed in the business ethics literature, the other two principles are not widely discussed. This paper investigates whether the principles of autonomy and beneficence provide a framework that is equally (...) useful for framing issues in business ethics. It is argued that they do. First, the principle of autonomy, with its associated notions of informed consent, privacy, confidentiality, voluntariness, self-mastery, and so on, provides a consistent approach to the analysis of diverse issues that arise in business ethics from market research to recruitment practices. Second, it is argued that the relationships between a business and its stakeholders ground duties of beneficence. The principle of beneficence provides a framework for considering the issues that arise in these relationships. (shrink)

Various authors hold that what is wrong with risk imposition is that being at risk diminishes the opportunities available to an agent. Arguably, even when risk does not result in material or psychological damages, it still represents a setback in terms of some legitimate interests. However, it remains to be specified what those interests are. This article argues that risk imposition represents a diminishment of overall freedom. Freedom will be characterized in empirical terms, as the range of unimpeded actions available (...) to an agent. After briefly outlining the main characteristics of overall freedom as defended by Hillel Steiner and Ian Carter, the article shows that this notion is able to capture many of our intuitions about when and how risk imposition disadvantages an agent, without reference to welfare indicators. The article argues that if this non-welfarist perspective can be defended, then it would be easier to approach a number of applied questions about risk, including the questions of when risk imposition is permissible or legitimate, in which ways risk can be an object of distributive justice and how one can be compensated for being subject to a risk. (shrink)

Strategies for improving individual decision making have attracted attention from a range of disciplines. Surprisingly, neuroscience has been largely absent from this conversation, despite the fact that it has recently begun illuminating the neural bases of how and why we make decisions, and is poised for further such advances. Here we address empirical and normative questions about “nudging” through the lens of neuroscience. We suggest that the neuroscience of decision making can provide a framework for understanding how nudges work, and (...) how they can be improved. Towards this end, we first examine how nudges can be incorporated into a leading model of decision making supported by neurobiological data, and use the model to make predictions about the relative effectiveness of different classes of nudges. We then use the model to demonstrate how nudges can both infringe upon and promote autonomy. Finally, we explore the normative implications of the converging consensus from neuroscience and related fields that many everyday decisions are susceptible to covert external influences. (shrink)

Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes to the systematic differentiation of (...) soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism. (shrink)

This article proposes a theoretical re-conceptualization of power dynamics and their legitimation in contemporary business–society relations using the prism and metaphor of parentalism. The paper develops a typology of forms of parentalism along two structuring dimensions: care and control. Specifically, four ideal-types of parentalism are introduced with their associated practices and power-legitimation mechanisms. As we consider current private governance and authority through this analytical framework, we are able to provide a new perspective on the nature of the moral legitimation of (...) power dynamics in contemporary business–society relations. And we weave the threads between this conceptual frame and historical antecedents, suggesting that business ethicists need to revive old debates on paternalism in light of the current pervasive trend of modernized and subtler forms of parentalism. Implications for business ethics and political CSR are discussed. (shrink)

One objection to enhancement technologies is that they might lead us to live inauthentic lives. Memory modification technologies (MMTs) raise this worry in a particularly acute manner. In this paper I describe four scenarios where the use of MMTs might be said to lead to an inauthentic life. I then undertake to justify that judgment. I review the main existing accounts of authenticity, and present my own version of what I call a “true self” account (intended as a complement, rather (...) than a substitute, to existing accounts). I briefly describe current and prospective MMTs, distinguishing between memory enhancement and memory editing . Moving then to an assessment of the initial scenarios in the light of the accounts previously described, I argue that memory enhancement does not, by its very nature, raise serious concerns about authenticity. The main threat to authenticity posed by MMTs comes, I suggest, from memory editing. Rejecting as inadequate the worries about identity raised by the President’s Council on Bioethics in Beyond Therapy , I argue instead that memory editing can cause us to live an inauthentic life in two main ways: first, by threatening its truthfulness, and secondly, by interfering with our disposition to respond in certain ways to some past events, when we have reasons to respond in such ways. This consideration allows us to justify the charge of inauthenticity in cases where existing accounts fail. It also gives us a significant moral reason not to use MMTs in ways that would lead to such an outcome. (shrink)

According to relational views of autonomy, some social relations or forms of dependence are necessary for autonomous agency. Recent relational theorists have primarily focused on autonomy of action or practical autonomy, and the result has been a shift away from individualistic conceptions of autonomy in the practical realm. Despite these trends, individualistic conceptions are still the default when it comes to autonomy of belief or intellectual autonomy. In this paper, I argue for a relational account of intellectual autonomy. Specifically, I (...) claim that intellectual autonomy requires a sense of one’s standing as an equal member of the epistemic community. (shrink)

Das von Cass Sunstein und Richard Thaler ausgearbeitete Projekt eines Libertären Paternalismus stellt fraglos einen der zurzeit meistdiskutierten neopaternalistischen Theorieentwürfe dar. Als hybride Mischung zwischen Theorieprogramm, politischer Bewegung und praxis- und anwendungsorientiertem Policy-Manual, das zuweilen Züge eines populären philosophischen Lebensratgebers trägt, hat Libertärer Paternalismus viel Zuspruch, aber auch heftige Kritik auf sich gezogen, die in diesem Aufsatz auf ihre Plausibilität geprüft werden. Zu diesem Zweck geben die Autoren zunächst einen kurzen Überblick über Ausgangspunkte, Leitorientierungen und Problemvorgaben des Theorie- und Politikprogramms (...) des Libertären Paternalismus. In einem zweiten Schritt werden zentrale Konzepte und Unterscheidungen des libertär paternalistischen Rationales vorgestellt und problematisiert. Daran anschließend werden drei der prominentesten Kritikpunkte an Libertärem Paternalismus auf den Prüfstand gestellt. Hierzu gehören der Manipulationseinwand, Kritiken, die sich auf grundlegende Rechtfertigungsprobleme des Libertären Paternalismus beziehen, und Einwände, die auf langfristige negative Folgen des Nudging verweisen. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

The “right not to know” has generated significant discussion, especially regarding genetic information. In this paper, I argue that this purported right is better understood as a preference and that treating it as a substantive right has led to confusion. To support this claim, I present three critiques of the way the right not to know has been characterized. First, I demonstrate that the many conceptualizations of this right have hampered debate. Second, I show that the way autonomy is conceptualized (...) in this literature is also problematic. Third, I examine the notion of a right in more detail, to support my third critique: that the right to know and the right not to know genetic information are often erroneously treated as having equivalent status. On my understanding, the claim being made is better thought of as a preference, not a right, and a preference not to know certain information becomes only one of several considerations relevant to medical decision making. (shrink)

Resting as it does on the principle of freedom, today’s global economic system is in need of a global economic ethos of responsibility so as to assure its social and ecological sustainability. Not all ideas of freedom, however, are equally amenable to conceptions of cosmopolitan responsibilities. This article examines how quantitative versus qualitative notions of freedom respectively respond to this challenge. Simply put, quantitative models hinder the integration of responsibility into models of economic rationality whereas qualitative conceptions advance it. As (...) a consequence, efforts to promote a humanistic paradigm of economics and management fare better when oriented at a qualitative idea of freedom. Cast along the lines of a qualitative conception of freedom, corporate responsibility more readily takes on a cosmopolitan dimension apt to meet the needs of the current age of globality. (shrink)

Für die Argumentation von Moralphilosophen, die die Legalisierung der aktiven Sterbehilfe befürworten, spielt das Autonomieprinzip eine wichtige Rolle. Ihrer Auffassung nach verlangt der Respekt vor der Autonomie, die Entscheidung eines schwer kranken Menschen gegen die Fortsetzung des Lebens vorbehaltlos anzuerkennen. Dagegen haben verschiedene Theoretiker auf Gefahren hingewiesen, die die rechtliche Zulassung der Tötung auf Verlangen für die individuelle Autonomie mit sich bringt. Sobald der Kranke über die Möglichkeit der aktiven Sterbehilfe verfüge, falle ihm die Verantwortung für die Inanspruchnahme von Pflegeleistungen (...) zu. In der Folge könne u. a. von Seiten der Familie die Forderung an ihn gestellt werden, den vom Gesetzgeber eröffneten Ausweg zu nutzen und sie von der Last seiner Pflege zu befreien. Die Bedenken erscheinen insofern berechtigt, als Formen sozialen Zwangs vorstellbar sind, die eine freie Entscheidung des Patienten verhindern. Allerdings vermag weder das Verbot noch die Zulassung der aktiven Sterbehilfe eine autonome Entscheidung aller Individuen zu gewährleisten. Die Abwägung der Risiken, mit denen beide Optionen behaftet sind, spricht im Ergebnis für die Legalisierung der Tötung auf Verlangen. (shrink)

Ethical consumerism is the thesis that we should let our values determine our consumer purchases. We should purchase items that accord with our values and refrain from buying those that do not. The end goal, for ethical consumerism, is to transform the market through consumer demand. The arm of this movement associated with food choice embraces the slogan “Vote with Your Fork!” As in the more general movement, the idea is that we should let our values dictate our choices. In (...) this paper, I offer a critique of the Vote with Your Fork campaign (hereafter VWYF) that focuses on the agency of individuals. For VWYF to be effective, minimally, individuals must act _intentionally_ when making food choices. In the ideal case, individuals adopt and endorse the values implicit in VWYF and exhibit _autonomous agency_ when they purchase and consume food. The problem, though, is that a number of things can go wrong along the way. I argue that very few of us are in the position to exhibit autonomous agency with respect to our food choices. Because of this, VWYF could very well undermine its own goals. (shrink)

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, (...) in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis. (shrink)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in her Natural (...) Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

The phenomenon of weakness of will – not doing what we perceive as the best action – is not recognized by neoclassical economics due to the axiomatic assumptions of the revealed preference theory (RPT) that people do what is best for them. However, present bias shows that people have different preferences over time. As they cannot be compared by the utility measurements, economists need to normatively decide between selves (short- versus long-term preferences). A problem is that neoclassical economists perceive RPT (...) as value-free and incorporate present bias within the economic framework. The axiomatic assumption that people do what is best for them leads to theoretical and practical dilemmas. This work examines weakness of will to resolve some shortcomings of RPT. The concept of intention is used to provide multiple self conception with the framework to decide between selves, which had not been done before. The paper concludes that individuals should not always follow their revealed preferences (desires) but the intentions (reason) because the latter indicates what people really want. (shrink)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

This thesis explores the relationship between the capability approach to justice and liberal philosophy. I argue that the most compelling articulation of the capability approach—one given by Martha Nussbaum—suffers from an unattractive kind of inconsistency. On the one hand, Nussbaum is committed to formulating a robust account of a dignified human life which can give rise to a range of individual entitlements which ought to be guaranteed to all individuals. On the other hand, Nussbaum is committed to political liberalism which (...) requires state institutions to uphold strict neutrality between a variety of reasonable conceptions of the good. Nussbaum’s first commitment results in the formulation of a list of ten central human capabilities. However, I argue that the content and justification of this list cannot be successfully established in a way that is consistent with Nussbaum’s second commitment. Therefore, in this thesis, I propose a novel capability approach: a two-step approach which consists of two principles arranged in lexical priority. First, governments have a moral obligation to secure individuals with a meta-capability of autonomy. That is to say, governments must provide the conditions which are conducive to individuals exercising a range of agentic competencies which are constitutive of autonomous judgement. Second, governments have a moral obligation to provide opportunities for individuals to exercise this meta-capability in six domains of well-being: health, politics, knowledge, relationships, self-expression, and work. I argue that exercising autonomous choice in the pursuit of welfare is necessary for a good life, regardless of the specific choices individuals eventually make, and even if they choose to forgo some supposedly valuable choices altogether. My proposal has two striking features which set it apart from other articulations of the capability approach. First, my proposal is comprehensive in that it relies on a particular view about what is a valuable way of life. In my view, a way of life is valuable if it is pursued autonomously, that is to say, if it involves an individual exercising a set of agentic competencies and standing in appropriate relations with other people. And second, by virtue of being based in this particular comprehensive claim, my account of justice is anti-perfectionist. That is to say, my proposal does not aim to compel people to make valuable choices. Rather, it aims to equip people with the means to live the kind of life they find valuable and worth living. I then apply this capability approach to the domain of education, and I argue it can be useful in formulating an ambitious and transformative approach to education. In particular, I develop a program of civic education aimed at responding to the problems associated with disinformation and ‘post-truth’ trends in politics. (shrink)

Several authors have recently advocated a so-called new case for paternalism, according to which empirical findings from distinct decision sciences provide compelling reasons in favour of paternalistic interference. In their view, the available behavioural and neuro-psychological findings enable paternalists to address traditional anti-paternalistic objections and reliably enhance the well-being of their target agents. In this paper, I combine insights from decision-making research, moral philosophy and evidence-based policy evaluation to assess the merits of this case. In particular, I articulate and defend (...) three complementary arguments that, I claim, challenge even the best available calls for such case. In doing so, I identify the main justificatory challenges faced by the new paternalists and explicate the implications of these challenges for the ongoing philosophical debate about the justifiability of paternalistic interference. (shrink)

Philosophical work on free will, contemporary as well as historical, is inevitably framed by the problem of free will and determinism. One of my goals in what follows is to give a feel for the main lines of that debate in philosophy today. I will also be outlining a particular perspective on free will. Many working philosophers consider themselves Compatibilists; the perspective outlined, building on a number of arguments in the recent literature, is a contemporary form of such a view. (...) It cannot, however, claim to be the contemporary philosophical perspective. There is no such thing. Against a background of the perennial problem of free will and determinism, through ongoing argument and debate, philosophers continue to try to work toward an understanding of precisely what it means for an action to be free. (shrink)

Being autonomous depends on the kind of relations we enjoy in the different domains of our lives, but the impact of decision-making and the power exercise that takes place in the political sphere, makes political relations crucial to our development and enjoyment of autonomy. This dissertation develops a novel view of political participation by interrogating its connection to our personal autonomy. According to this view, our political relations are partially constitutive of our personal autonomy, which in other words means there (...) is a political aspect of our autonomy. The kind of political relations we should hold to fully enjoy our autonomy is what I call Relations of Mutual Recognition. It is the mutual recognition of each agent’s autonomous standing—translated into a proper distribution of political power— that will face dominating political relations. The basis for that domination comes from our democracies’ power imbalances that condition influence over political decision-making to each individual’s economic, social or cultural standing. Consequently, there are political conditions for our autonomy to thrive. Relations of Mutual Recognition require two main conditions: non-domination and control. I take these two neo-republican ideals and redefine them to shape what a proper distribution of political power amounts to. Political participation comes in precisely to identify a way to challenge power imbalances. Therefore, my definition of political participation, which I call Collective Self-Government, requires a particular sort of implementation. Accordingly, I suggest a deliberative and inclusive arrangement that involves direct and innovative forms of decision-making, and more importantly, grants relevant shares of authority to all actors, i.e., common citizens, legislators, technocrats, etcetera. This project could rightly belong to both a relational approach to autonomy and be labelled as a version of deliberative democracy. However, relational accounts focus on our social relations, whilst I claim that we cannot be “less” or non-autonomous in the political sphere and still enjoy an autonomous life. Likewise, the participatory focus—in the sense of inclusion of all actors—of this proposal more accurately turn it into either a participatory version of deliberative democracy or a deliberative version of participatory democracy. (shrink)

Do non-human animals have an interest in sociopolitical freedom? Cochrane has recently taken up this important yet largely neglected quest ion. He argues that animal freedom is not a relevant moral concern in itself, because animals have a merely instrumental but not an intrinsic interest in freedom (Cochrane 2009a, 2012). This paper will argue that even if animals have a merely instrumental interest in freedom, animal freedom should nonetheless be an important goal for our relationships with animals. Drawing on recent (...) work on the value of freedom, it will be argued that freedom is non-specifically instrumentally valuable. Accordingly, freedom is a means to other goods, but often it is not possible to identify those goods in advance or aim for them directly. Some of the reasons that make freedom non-specifically valuable for human relationships, it will be argued, also apply to relationships between humans and animals. Amongst other implications, it will be shown how this argument provides a response to those who fear that stricter animal protection policies might undermine people’s freedom: A concern for freedom actually requires stricter protection policies rather than speak against them. (shrink)

Amartya Sen, the initiator of the Capability Approach, rejects perfectionism and the idea that theorists can, or ought to, predefine what capabilities we have reason to value. Instead he insists that the route to social justice stay true to the liberal ideal of value pluralism and human diversity and demands a content-neutral procedure of reflective scrutiny. This paper investigates the theoretical underpinnings assumed in such a procedural account. Can it avoid perfectionistic assumptions? I think it cannot for two reasons. First, (...) it is clear that a deliberative process is taken to be valuable without it being a product of such a process. It is thus taken to be a priori valuable. Consequently, the capabilities that enable citizens to successfully partake in such a process are taken to be what we have reason to value. Second, I argue, Sen’s procedural approach is primarily aimed at enhancing freedom understood as personal autonomy. I then ask if Sen successfully can deflect perfectionistic allegations by referring to a formal and content-neutral account of autonomy. Again, I conclude he cannot. This suggests that Sen’s rejection of perfectionism is untenable. (shrink)

In recent decades politicians and policy-makers have emphasised the need to shift from a “passive” to an “active” welfare state. This has resulted in policies that reduce compensation rates in social insurance or make compensation conditional on different requirements such as participation in rehabilitation or vocational training. This article argues that such policies are justified if they tend to ensure an adequate level of personal autonomy. To that effect, a ‘thick’ conception of personal autonomy is spelled out based on Norman (...) Daniels’ extension of the principle of fair equality of opportunity. Some objections to policies limiting entitlement to social insurance are discussed. It is argued that although the objections fail to show that limited entitlement to social insurance is always unjustified, they identify considerations that must be taken into account for an overall assessment of such policies. (shrink)

Drawing on empirical evidence in medicine, economics, law, and anthropology, I argue that a market is uniquely capable of meeting the demand for transplantable kidneys, and that it may be arranged so as to operate safely. The welfare gains, expected to accrue to both vendors and recipients, are sufficient to justify sales. Having spelled out the considerations recommending a kidney market, I address the most forceful objections facing the proposal. Despite its currency, the claim that incentives will crowd out altruistic (...) donors and result in a decrease in supply is empirically unsupported and predicated on an implausible view of donorsâ motives. A host of objections claim vendorsâ will not give informed consent. Many such objections identify easily remediable problems, or impose unreasonable standards â standards that would rule out morally permissible kidney donation. And all presuppose a model of morally transformative consent that, I argue, is deficient. Two further challenges point to harms inflicted on those who do not participate in the market. Some claim that those in poverty will be subject to harmful social and legal pressure to vend. This objection fails to distinguish between being pressured to perform a specific act, and being under general economic pressure and having the option to perform an act. It, moreover, presupposes vending more common than is possible. Others worry that the market will give rise to unfair pecuniary externalities. This objection also presupposes that kidney sales will occur more often than is possible. But more importantly, the normative consideration that is supposed to make such externalities especially objectionable, in fact, recommends allowing sales. I also make a political case for kidney sales. I offer an account of the stateâs proper role in the market. I begin with a conception of democratic equality according to which the state is responsible to secure for its citizens the preconditions for democratic participation. I then show that this end would be promoted were the state to end the current prohibition on sales. (shrink)

In Axel Honneths Recht der Freiheit (RF) dienen persönliche Beziehungen, zu welchen Honneth neben Familien- und Liebesbeziehungen auch die Freundschaft zählt, der Verwirklichung einer „besondere[n], schwer zu charakterisierende[n] Form von Freiheit“ (RF 233). Diese Behauptung fügt sich ein in die Kernthese des Rechts der Freiheit. Demnach vermochte es die „Freiheit im Sinne der Autonomie des Einzelnen“ innerhalb unzähliger „Vorstellung[en] vom Guten“ als einzige, die moderne Gesellschaft nachhaltig zu prägen, wohingegen alle anderen Werte, die in der Moderne wirkmächtig geworden sind, als (...) „Facette[n] der konstitutive[n] Idee der individuellen Autonomie“ (RF 35) verstanden werden müssen. Wir argumentieren, dass Honneths Erörterung des Werts von Freundschaft in dreierlei Hinsicht sein Ziel verfehlt: Erstens zwingt sie Honneth zu einer radikalen Beschneidung des Freundschaftsbegriffs, indem er einen überzogenen Kontrast zwischen antiken und modernen Konzeptionen von Freundschaft zeichnet. Zweitens marginalisiert Honneth mit seiner Betrachtung andere Axiologien der Freundschaft, welche dieser gewichtige instrumentelle, konstitutive und finale Werte zuweisen. Drittens scheint selbst eine schwächer angelegte These, die den Wert, den Freundschaften für die individuelle Freiheit haben, auf die Stellung eines primus inter pares zurückstuft, immer noch den zentralen Wert, den Freundschaften für uns haben sollten, zu verfehlen. Dadurch wird Honneths Kernthese von der Exklusivität des Wertes der Freiheit für unsere Gesellschaft in Frage gestellt. (shrink)

Any ethical argument involving the problems of access to assisted reproductive technologies should entail the discussion of the decision protocol and consider the individual deliberating on the appropriateness of these remedies from the point of view of self and community. Yet, arguments based on patients' own moral calculations are rare in the bioethics literature. The moral voice behind most discourses concerning ARTs is that of an outwardly independent spectator, who nonetheless proceeds to justify a personally significant worldview in the utilization (...) of these resources. Investigators grounded in social and legal sciences have offered relevant arguments in this regard, but because their discourses are derived from research protocols specific to their respective disciplines, they fail to provide a general rationale applicable to moral deliberation. (shrink)

Integrity is one of the leading normative concepts employed in our society. We frequently talk about the degree of integrity of community leaders and famous historical figures, and we highly value integrity in our elected public officials. But philosophers have had a difficult time arriving at consensus about what integrity consists in. Some claim that it is a purely formal relation of consistency, others that it has to do primarily with one‟s identity, and still others that it involves subjective or (...) objective moral requirements. The primarily goal here is to outline the leading facets of integrity in the contemporary philosophical literature. (shrink)

Helen Frowe has recently offered what she calls a “practical” account of self-defense. Her account is supposed to be practical by being subjectivist about permissibility and objectivist about liability. I shall argue here that Frowe first makes up a problem that does not exist and then fails to solve it. To wit, her claim that objectivist accounts of permissibility cannot be action-guiding is wrong; and her own account of permissibility actually retains an objectivist (in the relevant sense) element. In addition, (...) her attempt to restrict subjectivism primarily to “urgent” situations like self-defense contradicts her own point of departure and is either incoherent or futile. Finally, the only actual whole-heartedly objectivist account she criticizes is an easy target; while those objectivist accounts one finds in certain Western European jurisdictions are immune to her criticisms. Those accounts are also clearly superior to hers in terms of action-guidingness. (shrink)

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by (...) environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. (shrink)

Mental capacity and autonomy are often understood to be normatively neutral? the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and functional tests requiring consistency, expression of identity, (...) reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty. (shrink)

Paternalism is not acceptable in dentistry today because it eliminates the patients’ right to choose the treatment they feel is right for them, even if their choice is not what the doctor feels is best. Paternalism violates the patient’s autonomy and self-determination. Dentists accept the ethical principle of non-maleficence and in many countries, are also recognizing the right to informed consent. Most people trust health professionals who serve them. Dentists are among the trusted professionals, and the paper will investigate the (...) attitudes to dentists in several different countries as examples. When patients request inappropriate dental treatment, the dentist must decide how to balance a concern with patients' wellbeing with respect for their choices. It is important for a dentist to keep this in mind and to reflect of its implications, especially when dental practice seems to be changing so much under the influence of the malpractice crises, the changing economic scene, the changing regulatory environment, and so on. A dentist must consider the patient’s values and personal preferences, and must involve the patient in the decision-making process. It is the dentist’s responsibility to determine the decision-making capacity of each patient with the help of appropriate surrogates. For example, patients may be given choices about which type of tooth repair they will choose, given that there are often choices between what an insurance will cover and what an insurance will not cover. Are dental implants only for the rich, and dentures for the poor? Is there a class divide between a silver, gold or white smile? Ethics affect virtually every decision made in a dental office, encompassing activities of both judging and choosing, relationship with patients, the public, office staff, and other professionals. This paper gives an overview of bioethical issues in dental practice and explains the fact that dental ethics cannot support paternalism even in prevention. (shrink)