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

Kants Kritik der praktischen Vernunft (1788) steht zu Unrecht oft im Schatten der Kritik der reinen Vernunft und der Grundlegung zur Metaphysik der Sitten. Tatsächlich sind die Grundelemente der Kantischen Moralphilosophie im Gegensatz zu vielen Thesen der ersten Kritik bis heute weitgehend anerkannt, und erst der Nachweis der zweiten Kritik, dass Freiheit wirklich ist, macht "den Schlussstein von dem ganzen Gebäude eines Systems der reinen, selbst der spekulativen Vernunft aus". Entlang der Stichworte reiner Wille, gesetzgebende Form der Maxime, transzendentale Freiheit, (...) Autonomie und Faktum der Vernunft zeigt Kant in der "Analytik", dass reine Vernunft "für sich" praktisch sein, nämlich den Willen bestimmen kann. Die "Dialektik" sichert den Ideen von der Existenz Gottes und der Unsterblichkeit der Seele objektive Realität und untersucht das Verhältnis von theoretischer und praktischer Vernunft. Die "Methodenlehre" schließlich skizziert eine Theorie moralischer Erziehung, die für den heutigen Ethikunterricht noch aktuell ist. Die zwölf Beiträge dieses kooperativen Kommentars, der anlässlich des 300. Jubiläums Immanuel Kants in einer 3., überarbeiteten Auflage erscheint, rekonstruieren die Argumente eines Schlüsseltextes der Moralphilosophie und prüfen die sachliche Überzeugungskraft. Mit Beiträgen von: Karl Ameriks, Reinhard Brandt, Eckart Förster, Otfried Höffe Allen W. Wood Christoph Horn, G. Felicitas Munzel, Onora O'Neill Annemarie Pieper, Friedo Ricken, Nico Scarano. (shrink)

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

Drawing on the built environment concept of “inclusive design” and its emphasis on creating accessible environments for all persons regardless of ability, I suggest that a central task for feminist disability theory is to redesign foundational philosophical concepts to present opportunities rather than barriers to inclusion for people with disability. Accounts of autonomy within liberal philosophy stress self-determination and the dignity of all individual persons, but have excluded people with intellectual disability from moral and political theories by denying their capacity (...) for individual autonomy, seen as a chief marker of moral personhood. This paper modifies and extends feminist theories of relational autonomy by arguing for the need to view autonomy as a feature of persons that is manifested only through relations of support, advocacy, and enablement. An “inclusively designed,” relational account negotiates the tensions encountered in attempts to apply autonomy to people with high support needs, and politicizes the concept as an advocacy tool for people with intellectual disability and their allies. (shrink)

This paper uses John Rawls' theory of justice to defend the patent system against charges that it has an unfair effect on access to medications, from the perspective of national and international justice. The paper argues that the patent system is fair in a national context because it respects intellectual property rights and it benefits the least advantaged members of society by providing incentives for inventors, investors, and entrepreneurs. The paper also argues that the patent system is fair in an (...) international context, provided that developed nations take steps to help disease-stricken countries secure internal justice. Fairness in a national or international context also requires that the patent system should include emergency exceptions to deal with short-term inequities. (shrink)

Personal AI assistants are now nearly ubiquitous. Every leading smartphone operating system comes with a personal AI assistant that promises to help you with basic cognitive tasks: searching, planning, messaging, scheduling and so on. Usage of such devices is effectively a form of algorithmic outsourcing: getting a smart algorithm to do something on your behalf. Many have expressed concerns about this algorithmic outsourcing. They claim that it is dehumanising, leads to cognitive degeneration, and robs us of our freedom and autonomy. (...) Some people have a more subtle view, arguing that it is problematic in those cases where its use may degrade important interpersonal virtues. In this article, I assess these objections to the use of AI assistants. I will argue that the ethics of their use is complex. There are no quick fixes or knockdown objections to the practice, but there are some legitimate concerns. By carefully analysing and evaluating the objections that have been lodged to date, we can begin to articulate an ethics of personal AI use that navigates those concerns. In the process, we can locate some paradoxes in our thinking about outsourcing and technological dependence, and we can think more clearly about what it means to live a good life in the age of smart machines. (shrink)

This chapter will explore the dynamics of power underpinning ethical issues within smart cities via a new paradigm derived from Systems Theory. The smart city is an expression of technology as a socio-technical system. The vision of the smart city contains a deep fusion of many different technical systems into a single integrated “ambient intelligence”. ETICA Project, 2010, p. 102). Citizens of the smart city will not experience a succession of different technologies, but a single intelligent and responsive environment through (...) which they move. Analysis of such an environment requires a framework which transcends traditional ontologically-based models in order to accommodate this deep fusion. This chapter will outline a framework based on Latour’s Actor-Network Theory and Luhmann’s treatment of society as an autopoetic system. We shall use this framework to map the influence of relevant factors on ethical issues, irrespective of their composition or type. For example, under this treatment, both human praxis and technical design can be viewed as comparable tools of domination. This chapter will provide a framework for the analysis of relations between any elements of the smart city, ranging from top-level urban management processes down to individual device operations. While we will illustrate the use of this schema through examination of ethical issues arising from power dynamics within the smart city, it is intended that this example will demonstrate the wider utility of the model in general. (shrink)

It is suggested that the current hierarchical (Frankfurt-Dworkin) model of personal autonomy in philosophical anthropology gives expression to the fundamental presupposition of self-determination in much educational practice and pedagogical theory. Radical criticisms are made of the notions of self-identification and self-evaluation which are of the utmost importance to this model. Instead of relying on such ‘acts of the will’ as decision and choice for the explanation of self-identification and self- evaluation, the non-intentional as well as the non-individualistic character of these (...) processes is stressed and analysed in terms of volitional necessity and social dependence. The consequence of this criticism is the substitution of the concept of extreme personal autonomy by that of caring about oneself as the first principle of education. (shrink)

Some writers suggest that corporations should act in ways which reflect a broad concern for the well-being of others, as opposed to a more narrow (Libertarian) conception of responsibility. But this Broad View of moral responsibility puts us on a collision course with our considered intuitions about paternalistic acts. This paper discusses several aspects of this issue: the neutrality of the Standard View of Paternalism, the nature of the defenses of paternalistic interventions allowed by the Standard View of Paternalism and (...) their reliance on consent; and the sort of position on paternalism the Board View would have to endorse in order to justify the benevolence-motivated orientation required by its conception of moral responsibility.The conclusion is that unless we are prepared to take a different, non-standard view of paternalism the Board View of corporate moral responsibility will be untenable. (shrink)

The report from the Organ Donation Taskforce looking at the potential impact of an opt-out system for deceased donor organ donation in the UK, published in November 2008, is probably the most comprehensive and systematic inquiry to date into the issues and considerations which might affect the availability of deceased donor organs for clinical transplantation. By the end of a thorough and transparent process, a clear consensus was reached. The taskforce rejected the idea of an opt-out system. In this article (...) we acknowledge the life saving potential of organ transplants and seek to highlight the difficulties that arise when the issue of organ shortage competes with concerns over choice and authorisation in the context of deceased donor organ donation. (shrink)

This paper offers a critique of the “democratic state of education” proposed by Amy Gutmann in her influential book Democratic Education. In the democratic state of education, educational authority is shared among the state, parents and educational professionals; and educational objectives are geared toward equipping future citizens to participate in what Gutmann calls “conscious social reproduction”—the collective shaping of the future of society through democratic deliberation. Although I agree with some of Gutmann’s broad recommendations for civic education, I have misgivings (...) about the centrality that she gives to conscious social reproduction in her theory of education. I argue that in focusing so intently on the facilitation of conscious social reproduction, Gutmann’s theory makes insufficient room for the basic interests of individual children, and in particular, their prospective interest in autonomy. Gutmann’s considered position on sex education policy—specifically, her willingness to allow local communities to deny their children access to sex education—exemplifies the shortcomings of her theory. Ultimately, her democratic state of education fails to acknowledge the fundamental moral importance of individual flourishing, and the contribution that education can and should make to it. (shrink)

Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid (...) refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)

In this paper I look at various ways that interpersonal and social relations can be seen as required for autonomy. I then consider cases where those dynamics might play out or not in potentially paternalistic situations. In particular, I consider cases of especially vulnerable persons who are attempting to reconstruct a sense of practical identity required for their autonomy and need the potential paternalist’s aid in doing so. I then draw out the implications for standard liberal principles of paternalism, specifically (...) in clinical or therapeutic situations. The picture of potential paternalism that emerges here is much more of a dynamic, interpersonal scenario rather than a case of two separate individuals making decisions independent of each other. (shrink)

We continuously talk about autonomous technologies. But how can words qualifying technologies be the very same words chosen by Kant to define what is essentially human, i.e. being autonomous? The article focuses on a possible answer by reflecting upon both etymological and philosophical issues, as well as upon the case of autonomous vehicles. Most interestingly, on the one hand, we have the notion of “autonomy”, meaning that there is a “law” that is “self-given”, and, on the other hand, we have (...) the notion of “automation”, meaning that there is something “offhand” that is “self-given”. Yet, we are experiencing a kind of twofold shift: on the one hand, the shift from defining technologies in terms of automation to defining technologies in terms of autonomy and, on the other hand, the shift from defining humans in terms of autonomy to defining humans in terms of automation. From a philosophical perspective, the shift may mean that we are trying to escape precisely from what autonomy founds, i.e. individual responsibility of humans that, in the Western culture, have been defined for millennia as rational and moral decision-makers, even when their decisions have been the toughest. More precisely, the shift may mean that we are using technologies, and in particular emerging algorithmic technologies, as scapegoats that bear responsibility for us by making decisions for us. Moreover, if we consider the kind of emerging algorithmic technologies that increasingly surround us, starting from autonomous vehicles, then we may argue that we also seem to create a kind of technological divine that, by being always with us through its immanent omnipresence, omniscience, omnipotence and inscrutability, can always be our technological scapegoat freeing us from the most unbearable burden of individual responsibility resulting from individual autonomy. (shrink)

The development of cancer therapies is a long and arduous process. Because it can take several years for a cancer agent to pass clinical testing and be approved for use, terminal cancer patients rarely have the time to see these experimental therapies become widely available. For most terminal cancer patients the only opportunity they have to access an experimental drug that could potentially improve their prognosis is by joining a clinical trial. Unfortunately, several aspects of clinical trial methodology that are (...) set in place in order to optimise drug development for the benefit of future generations of cancer patients, pose significant limitations to current patient participation. Therefore, several terminal cancer patients believe that they should have the right to access experimental agents that have passed initial safety testing without having to participate in clinical trials. However, granting off-trial access to patients could be detrimental to the scientific process of drug development, and thus could pose significant risks to the health of future patients relying on sound research. Examining this matter through two divergent ethical lenses, rights-based ethics and communitarian ethics, may provide new insight into the issues surrounding the balance between the autonomous rights of current terminal cancer patients, and the needs of future patients and the values of society. (shrink)

Background: Obtaining patients’ informed consent is an ethical and legal obligation in healthcare practice. Whilst the law provides prescriptive rules and guidelines, ethical theories of autonomy provide moral foundations. Models of practice of consent, have been developed in the bioethical literature to assist in understanding and integrating the ethical theory of autonomy and legal obligations into the clinical process of obtaining a patient’s informed consent to treatment.Aims: To review four models of consent and analyse the way each model incorporates the (...) ethical meaning of autonomy and how, as a consequence, they might change the actual communicative process of obtaining informed consent within clinical contexts.Methods: An iceberg framework of consent is used to conceptualise how ethical theories of autonomy are positioned and underpin the above surface, and visible clinical communication, including associated legal guidelines and ethical rules. Each model of consent is critically reviewed from the perspective of how it might shape the process of informed consent.Results and discussion: All four models would alter the process of obtaining consent. Two models provide structure and guidelines for the content and timing of obtaining patients’ consent. The two other models rely on an attitudinal shift in clinicians. They provide ideas for consent by focusing on underlying values, attitudes and meaning associated with the ethical meaning of autonomy.Conclusions: The paper concludes that models of practice that explicitly incorporate the underlying ethical meaning of autonomy as their basis, provide less prescriptive, but more theoretically rich guidance for healthcare communicative practices. (shrink)

Consider manipulation in which one agent, avoiding force, threat, or fraud mobilizes some non-concern motive of another so as to induce this other to behave or move differently than she would otherwise have behaved or moved, given her circumstances and her initial ranking of concerns. As an instance, imagine that I get us to miss the opening of a play that I have grudgingly agreed to attend by engaging your sublimated compulsive tendency to check the stove when we are halfway (...) to the theatre. Such motive manipulation is, I take it, widely regarded as morally worrisome. If it really is morally worrisome, then we should be able to explain adequately why it is so. But existing condemnations of manipulation come up short in this regard. In this paper, I develop and defend a more plausible account of the moral status of this phenomenon. (shrink)

Wealth and income are highly predictive of health and longevity. Egalitarians who maintain that this “socioeconomic-status gradient” in health is unjust are challenged by the fact that a significant component of it is owed to the higher prevalence of certain kinds of voluntary risk-taking among members of lower socioeconomic groups. Some egalitarians have argued that these apparently free personal choices are not genuinely free, and that those who make them should not be held morally responsible for the resulting harms to (...) their health. I argue to the contrary that such choices usually are fully free, and that those who make them are responsible for their consequences. This does not imply, however, that society cannot also be responsible for those consequences. It is responsible for them if they are statistically foreseeable and avoidable outcomes of unjust public institutions and policies. I show that many of the harms to health that contribute to the voluntary behavioral component of the SES health gradient satisfy that description. Society can therefore be morally responsible for those harms, even though the individuals who suffer them are also fully responsible for them. (shrink)

This paper investigates the idea of clinical autonomy. Whilst there is a considerable literature on moral autonomy there is very little on clinical autonomy except as a sociological phenomenon. Using the results of interviews with Community Psychiatric Nurses in England, the three main theories that they have about clinical autonomy are examined. It is argued that there are substantial problems with these theories and an alternative way of understanding clinical autonomy is proposed, the idea of contractual space.

Non-medical sex selection is premised on the notion that the sexes are not interchangeable. Studies of individuals who undergo sex selection for non-medical reasons, or who have a preference for a son or daughter, show that they assume their child will conform to the stereotypical roles and norms associated with their sex. However, the evidence currently available has not succeeded in showing that the gender traits and inclinations sought are caused by a “male brain” or a “female brain”. Therefore, as (...) far as we know, there is no biological reason why parents cannot have the kind of parenting experience they seek with a child of any sex. Yet gender essentialism, a set of unfounded assumptions about the sexes which pervade society and underpin sexism, prevents parents from realising this freedom. In other words, unfounded assumptions about gender constrain not only a child’s autonomy, but also the parent’s. To date, reproductive autonomy in relation to sex selection has predominantly been regarded merely as the freedom to choose the sex of one’s child. This paper points to at least two interpretations of reproductive autonomy and argues that sex selection, by being premised on gender essentialism and/or the social pressure on parents to ensure their children conform to gender norms, undermines reproductive autonomy on both accounts. (shrink)

Heated debates over healthcare policy in the United States point to the need for a legal framework that can sustain both moral diversity and peaceful cooperation. It is argued that the classical liberal Rule of Law, with its foundation in the ethical principle of permission, is such a framework. The paper shows to what extent the current healthcare policy landscape in the United States diverges from the rule of law and suggests how the current framework could be modified in order (...) to better approximate that ideal. Two objections are then answered. The first is that the rule of law cannot be realized due to the structure of legislatures. The second objection is that government should guarantee both liberty and all of the necessary conditions of autonomy. (shrink)

This essay considers the impact of digital networks in organizations on worker autonomy. Worker autonomy, the control that workers have over their own work situation, is claimed in this essay to be a key determinant for the quality of work, as well as an important moral goal. Digital networks pose significant threats to worker autonomy as well as opportunities for its enhancement. In this essay, the notion of worker autonomy is analyzed and evaluated for its importance and moral relevance. It (...) is then considered how digital networks both threaten worker autonomy and offer opportunities for its enhancement. Three major opportunities (enhanced communicative powers, increased informedness, teleworking) and threats (electronic monitoring, task prestructuring, and dependency creation) are discussed and analyzed. Finally, the dynamics that determine the impact on worker autonomy of the introduction of a digital network in organizations are investigated. A particular model for analyzing these dynamics and their impacts, Bryan Pfaffenberger's model of a technological drama. It will be illustrated how this model illuminates these dynamics by analyzing them as a dialectic of strategies of technological regularization by design constituencies and technological adjustment by impact constituencies. It will also be assessed what role network design has in this process. (shrink)

This paper analyzes ethical aspects of the new paradigm of Ambient Intelligence, which is a combination of Ubiquitous Computing and Intelligent User Interfaces (IUI’s). After an introduction to the approach, two key ethical dimensions will be analyzed: freedom and privacy. It is argued that Ambient Intelligence, though often designed to enhance freedom and control, has the potential to limit freedom and autonomy as well. Ambient Intelligence also harbors great privacy risks, and these are explored as well.

Among bioethicists, and perhaps ethicists generally, the idea that we are obliged to respect autonomy is something of a shibboleth. Appeals to autonomy are commonly put to work to support legal and moral claims about the importance of consent, but they also feed a wider discourse in which the patient’s desires are granted a very high importance and medical paternalism is regarded as almost self-evidently indefensible.

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have (...) explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist. (shrink)

The right not to know is often defended on the basis of the principle of respect for personal autonomy. If I choose not to acquire personal information that impacts on my future prospects, such a choice should be respected, because I should be able to decide whether to access information about myself and how to use it. But, according to the incoherence objection to the right not to know in the context of genetic testing, the choice not to acquire genetic (...) information undermines the capacity for autonomous decision making. The claim is that it is incoherent to defend a choice that is inimical to autonomy by appealing to autonomy. In this paper, I suggest that the choice not to know in the context of genetic testing does not undermine self-authorship, which is a key aspect of autonomous decision making. In the light of this, the incoherence objection to the right not to know seems less compelling. (shrink)

Our knowledge of the human brain and the influence of pharmacological substances on human mental functioning is expanding. This creates new possibilities to enhance personality and character traits. Psychopharmacological enhancers, as well as other enhancement technologies, raise moral questions concerning the boundary between clinical therapy and enhancement, risks and safety, coercion and justice. Other moral questions include the meaning and value of identity and authenticity, the role of happiness for a good life, or the perceived threats to humanity. Identity and (...) authenticity are central in the debate on psychopharmacological enhancers. In this paper, I first describe the concerns at issue here as extensively propounded by Carl Elliott. Next, I address David DeGrazia’s theory, which holds that there are no fundamental identity-related and authenticity-related arguments against enhancement technologies. I argue, however, that DeGrazia’s line of reasoning does not succeed in settling these concerns. His conception of identity does not seem able to account for the importance we attach to personal identity in␣cases where personal identity is changed through enhancement technology. Moreover, his conception of authenticity does not explain the reason why we find inauthentic values objectionable. A broader approach to authenticity can make sense of concerns about changes in personal identity by means of enhancement technologies. (shrink)

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical (...) medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

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

There is significant research value in the secondary use of surplus human tissue which has been removed during clinical care and is stored in diagnostic archives. However, this value is limited without access to information about the person from whom the tissue was removed. As the research value of surplus tissue is often not realised until after the patient’s episode of care, it is often the case that no consent has been given for any surplus tissue to be used for (...) research purposes. The Human Tissue Act 2004 does permit research use of surplus tissue without consent, but the researcher must not be in possession of information which could identify the person from whom the tissue was removed. Due to the commonly applied ‘consent or anonymise’ approach, linking tissue and data is challenging and full anonymisation would likely render much research on surplus tissue ineffectual. This article suggests that in recognising the value in surplus tissue linked with information about the person, a ‘share and protect’ approach which considers safeguards other than anonymisation, where obtaining consent for research use would not be feasible, would better balance the public benefit of health research with the protection of individual rights and interests than a requirement for either consent or anonymisation. (shrink)

The risk that direct-to-consumer advertising of prescription pharmaceuticals (DTCA) may increase inappropriate medicine use is well recognized. The U.S. Food and Drug Administration addresses this concern by subjecting DTCA content to strict scrutiny. Its strictures are, however, heavily focused on the explicit claims made in commercials, what we term their “propositional content.” Yet research in social psychology suggests advertising employs techniques to influence viewers via nonpropositional content, for example, images and music. We argue that one such technique, evaluative conditioning, is (...) operative in DTCA. We further argue that evaluative conditioning fosters unjustified beliefs about drug safety and efficacy, antagonising the autonomy of viewers’ choices about advertised medicines. We conclude that current guidelines are deficient in failing to account for evaluative conditioning, and that more research and debate are needed to determine the permissibility of this and other forms of nonpropositional persuasion. (shrink)

Climate policy decisions are decisions under uncertainty and are, therefore, based on a range of future climate scenarios, describing possible consequences of alternative policies. Accordingly, the methodology for setting up such a scenario range becomes pivotal in climate policy advice. The preferred methodology of the Intergovernmental Panel on Climate Change will be characterised as ,,modal verificationism"; it suffers from severe shortcomings which disqualify it for scientific policy advice. Modal falsificationism, as a more sound alternative, would radically alter the way the (...) climate scenario range is set up. Climate science's inability to find robust upper bounds for future temperature rise in line with modal falsificationism does not disprove that methodology, rather, this very fact prescribes even more drastic efforts to curb CO2 emissions than currently proposed. (shrink)

This paper begins with a critical part and concludes with a constructive part. First, with reference to a definition of liberalism and using immanent critique, I show deficiencies in the claims of four selfprofessed postliberals to have articulated non-liberal positions. Then, I argue that postliberal political theory consists in acknowledging that in political contexts some voluntary groups as such can be moral, not merely political, agents. Analysis of what moral autonomy is for persons as empirical (not noumenal) agents reveals that (...) that account can be transposed to some groups. A key common element among the four rejected positions is their emphasis on the normative authority of some practices as over against principles. My proposal congeals that normative emphasis on the social into group-moral authority. Recognition of some voluntary groups’ episodic moral authority over their members is non-liberal but not anti-liberal. (shrink)

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to (...) philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms. (shrink)

The rapid recent expansion of copyright law worldwide has sparked efforts to defend the ‘public domain’ of non-propertized information, often on the ground that an expansive public domain is a condition of a ‘free culture’. Yet questions remain about why the public domain is worth defending, what exactly a free culture is, and what role (if any) authors’ rights might play in relation to it. From the standard liberal perspective shared by many critics of copyright expansionism, the protection of individual (...) expression by means of marketable property rights in authors’ works serves as an engine of progress towards a fully competitive ‘marketplace of ideas’ – though only if balanced by an extensive public domain from which users may draw in the exercise of their own expressivity. This article shows that a significantly different, and arguably richer, conception of what a free culture is and how authors’ rights underpin it emerges from a direct engagement with the philosophy of Immanuel Kant. For Kant, progress towards a fully emancipated (i.e. a ‘mature’ or ‘enlightened’) culture can only be achieved through the critical intellectual activity that public communication demands: individual expressive freedom is only a condition, not constitutive, of this ‘freedom to make public use of one’s reason in all matters’. The main thesis defended in this article is that when Kant’s writings on publicity (critical public debate) are read in relation to his writings on the legal organization of publishing, a necessary connection emerges between authors’ rights – as distinct from copyrights – and what Jürgen Habermas and others have named the public sphere. I conclude that it is the public sphere, and not the public domain as such, that should serve as the key reference point in any evaluation of copyright law’s role in relation to the possibility of a free culture. (shrink)

State-sponsored breastfeeding promotion campaigns have become increasingly common in developed countries. In this article, by using the tools of liberal political theory, as well as public health and health promotion ethics, we argue that such campaigns are not justified. They ignore important costs for women, including undermining autonomy, fail to distribute burdens fairly, cannot be justified neutrally and fail a basic efficacy test. Moreover, our argument demonstrates that breastfeeding campaigns are a rare case that bridges the fields of public health (...) ethics and the ethics of health promotion campaigns. This demonstrates the need to consider the ethics of state promotion of both voluntary and coercive behavioural change that benefits third parties. (shrink)

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

The attention economy — the market where consumers’ attention is exchanged for goods and services — poses a variety of threats to individuals’ autonomy, which, at minimum, involves the ability to set and pursue ends for oneself. It has been argued that the threat wireless mobile devices pose to autonomy gives rise to a duty to oneself to be a digital minimalist, one whose interactions with digital technologies are intentional such that they do not conflict with their ends. In this (...) paper, we argue that there is a corresponding duty to others to be an attention ecologist, one who promotes digital minimalism in others. Although the moral reasons for being an attention ecologist are similar to those that motivate the duty to oneself, the arguments diverge in important ways. We explore the application of this duty in various domains where we have special obligations to promote autonomy in virtue of the different roles we play in the lives of others, such as parents and teachers. We also discuss the consequences of our arguments for employers, software developers, and policy makers. (shrink)

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