A growing proportion of clinical research funded by pharmaceutical companies, high-income country research agencies, and not-for-profit funders is conducted in low- and middle-income settings. Disparities in wealth and access to healthcare between the populations where new interventions are often tested and those where many of them are ultimately marketed raise concerns about exploitation. This chapter examines several ethical requirements frequently advanced as mechanisms for protecting research subjects in underserved communities from exploitation and evaluates the effectiveness of those mechanisms as responses (...) to exploitation worries. It goes on to highlight where the conceptual frameworks relied upon by research ethicists must be improved if we are to fully understand the nature of the moral claims and obligations that arise in research conducted in underserved communities. (shrink)

Relational autonomy theorists attempt to accommodate social embeddedness within a conception of autonomy. These attempts are conceptually messy, at best, and category errors, at worst. Rejecting the liberal conception of autonomy due to feminist concerns is more helpfully answered by the neorepublican notion of freedom as nondomination. The conception of freedom as nondomination captures the values that motivate the relational turn in moral and political theory and does so in a conceptually neater way than attempting to accommodate those concerns in (...) our accounts of autonomy. (shrink)

It has been proposed that reoffending could be reduced by manipulating the neural underpinnings of offenders’ criminogenic mental features with what have been called neurocorrectives. The legitimacy of such use of neurotechnology – criminal neurorehabilitation, as the use is called – is usually seen to presuppose valid consent by the offenders subjected to it. According to a central criticism of nonconsensual criminal neurorehabilitation, nonconsensual use of neurocorrectives would express a degrading attitude towards offenders. In this article, I consider this criticism (...) of nonconsensual criminal neurorehabilitation. By using cases of autonomous persons who lead a subservient existence as an example, I propose that nonconsensual criminal neurorehabilitation need not express a more degrading attitude towards offenders than consensual criminal neurorehabilitation. The argument of this article does not show that nonconsensual criminal neurorehabilitation is morally or legally acceptable. Yet, in view of the argument, criticizing nonconsensual criminal neurorehabilitation for expressing a degrading attitude towards offenders is not compatible with simultaneously endorsing consensual criminal neurorehabilitation. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

Consider that an individual improves her capacities by neuroscientific means. It turns out that, besides altering her in the way(s) she intended, the enhancement also changes her personality in significant way(s) she did not foresee. Yet the person endorses her new self because the neuroenhancement she underwent changed her. Can the person’s approval of her new personality be autonomous? While questions of autonomy have already gathered a significant amount of attention in philosophical literature on human enhancement, the problem just described—henceforth (...) referred to as the question whether selfvalidating neuroenhancement can be autonomous—would not appear to have received due consideration. This article takes a step towards remedying the shortage. I start by explicating the main points of departure of its argument. In the subsequent sections of the article, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with autonomy. On the basis of the consideration, I propose that self-validating neuroenhancement can be autonomous. (shrink)

So‐called nudge policies utilize insights from behavioral science to achieve policy outcomes. Nudge policies try to improve people's decisions by changing the ways options are presented to them, rather than changing the options themselves or incentivizing or coercing people. Nudging has been met with great enthusiasm but also fierce criticism. This paper provides an overview of the debate on the ethics of nudging to date. After outlining arguments in favor of nudging, we first discuss different objections that all revolve around (...) the worry that nudging vitiates personal autonomy. We split up this worry into different dimensions of autonomy, such as freedom of choice, volitional autonomy, rational agency, and freedom as nondomination. We next discuss worries that nudging is manipulative, violates human dignity, and prevents more important structural reform. Throughout, we will present responses that proponents of nudging can muster. On the whole, we conclude that the objections fail to establish that the nudge program as a whole should be rejected. At the same time, they give us important guidance when moving towards an ethical assessment of nudges on a case‐by‐case basis. Towards the end, we provide some possible ways forward in debates around the ethics of nudging. (shrink)

Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’. In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be embedded (...) in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic. (shrink)

There is much to learn from and admire in Danielle Wenner's "Nondomination and the Limits of Relational Autonomy." The core claim Wenner advances is that the very concerns that have motivated feminist relational autonomy theorists would be better pursued by foregoing their concern with autonomy and pursuing instead the political aim of promoting a neorepublican conception of freedom as nondomination. While leaving open the possibility that "autonomy speak may remain valuable in some contexts", Wenner nevertheless claims that "for the purposes (...) of understanding and combating relations of oppression and subjection, freedom as nondomination provides a more useful conceptual apparatus than the ideal of... (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)

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)

In this article I describe and defend an account of social freedom grounded in intersubjective recognition. I term this the ‘normative authorisation’ account. It holds that a person enjoys social freedom if she is recognised as a discursive equal able to engage in justificatory dialogue with other social agents about the appropriateness of her reasons for action. I contrast this with Axel Honneth’s theory of social freedom, which I term the ‘self-realisation’ account. According to this view, the affirmative recognition of (...) others is necessary for obtaining a positive relation-to-self and hence freedom. I identify several problems with this account, which challenge the connection Honneth draws between social recognition and freedom. I show how the normative authorisation account avoids these problems and captures some basic features of our everyday, normative interactions. Finally, I suggest that the account fits well with recent work on epistemic injustice. Specifically, it shows that securing the social conditions of freedom requires ensuring epistemically-just social relations. Thus, the normative authorisation account is an explanatorily powerful, inclusive theory of social freedom that fits well with wider accounts of justice and freedom. Thus, it represents the most promising way of understanding social freedom in terms of interpersonal recognition. (shrink)

Certain forms of practical deference seem to be incompatible with personal autonomy. I argue that such deference undermines autonomy not by compromising the governance of an authentic self, nor by constituting a failure to track objective reasons, but by constituting a particular social relation: one of interpersonal rule. I analyse this social relation and distinguish it from others, including ordinary relations of love and care. Finally, I argue that the particular form of interpersonal rule constituted by dispositions of practical deference (...) in itself entails a partial, though not total, disconnection from the good of a self-authored life. (shrink)

It has been alleged that compatibilists are committed to the view that agents act freely and responsibly even when subject to certain forms of radical manipulation. In this paper I identify and elucidate a form of compatibilist freedom, social autonomy, that is essential to understanding what is wrong with ordinary indoctrination and argue that it also holds the key to understanding what goes wrong in more fanciful manipulation cases.

In A Metaphysics for Freedom, Helen Steward proposes and defends a novel version of the libertarian account of free action. Amongst several objections that she considers to her view, one that looms particularly large is the Challenge from Chance: ‘the most powerful, widely-promulgated and important line of anti-libertarian reasoning’. This paper begins by arguing that Steward’s response to the Challenge is not fully convincing. It then goes on to explore a further possible libertarian line of defence against the Challenge, arguing (...) that it, too, ultimately fails. The conclusion is that the Challenge remains an important source of dialectical advantage for the compatibilist. (shrink)

The idea of coercion is one that has played, and continues to play, at least two importantly distinct moral-theoretic roles in our thinking. One, which has been the focus of a number of recent influential treatments, is a primarily deontic role in which claims of coercion serve to indicate relatively weighty prima facie wrongs and excuses. The other, by contrast, is a primarily axiological or eudaimonic role in which claims of coercion serve to pick out instances of some distinctive kind (...) of pro tanto human bad (such as unfreedom or interpersonal subjection). I argue that this turns out not to be a simple case of one idea put to two different uses, but rather a case of two subtly distinct ideas in need of separate philosophical treatment. Moreover, although often relatively neglected, the primarily eudaimonic idea of coercion is of enduring importance to both liberal-perfectionist and socialist political moralities, as well as to personal ethics. This paper aims to elucidate it and to examine its relationship to its better-theorised deontic cousin. In addition, the paper seeks to show how a better understanding of these aspects of the concept can enable us to resolve certain important and long-standing theoretical disagreements, such as the dispute over whether coercion is an ‘essentially moralised’ concept and the dispute over whether (genuine) offers can be coercive. (shrink)

I defend my pure social account of global autonomy from Steven Weimer's recent criticisms. In particular, I argue that it does not implicitly rely upon the very kind of nonsocial conception of autonomy that it hopes to replace.

This paper concerns the relationship between two questions. The first is a question about inner freedom: What is it to be rendered unfree, not by external obstacles, but by aspects of oneself? The second is a question about agency: What is it to fail at being a thing that genuinely acts, and instead to be a thing that is merely acted upon, passive in relation to its own behaviour? It is widely believed that answers to the first question must rest (...) on or be partly explained by answers to the second. Here I argue that this is a mistake: losses of inner freedom are not, after all, explicable in terms of failures of agency. To establish this conclusion, I consider three familiar lines of thought that appear to tie ideas about inner freedom to ideas about agency, each relating to a different conception of inner freedom: absence of inner constraint, self-government, and absence of determination by external forces. I argue that, in each case, any apparent conceptual reliance on a special conception of agency is merely illusory, the result being that we must allow clear water between our theories of inner freedom and our theories of agency. This conclusion is of significance for contemporary theories of agency and personal autonomy, as well as for ‘positive’ conceptions of political liberty. (shrink)

In this paper I engage with the notion that Covid-19 can be seen as the ‘great equalizer’, in virtue of the widespread sense of uncertainty it has caused and the fact that it has forced us to recognize our shared human fragility. Against the view that Covid-19 is the ‘great equalizer’, I argue that, on the contrary, the pandemic reflects existing vulnerabilities and, in many cases, exacerbates them. I do so by offering first a definition of both ontological and relational (...) vulnerability and discussing some important ethical and political dimensions of vulnerability in conditions of uncertainty. I then claim that understanding vulnerability in both ontological and relational terms allows us to see the differential impact of the pandemic on differently situated individuals. More specifically, I argue that vulnerability in conditions of uncertainty can threaten individuals’ sense of self, and thus their autonomy – both understood in relational terms. I consider what kind of response human vulnerability in times of crisis calls for. In particular, I maintain that a promising way to counteract uncertainty would be to adopt a solidaristic approach to public health, based on an understanding of solidarity as a relational concept. In other words, I argue that it is through solidarity that individuals’ vulnerabilities can be mitigated, and their autonomy promoted, even during the most uncertain times. I finally discuss two objections that could be raised against the solidaristic approach defended in my paper. First, the approach may fail to find the support of individuals who are unwilling to care for others when their own interests are under threat. Second, there might be those who deny that the virus constitutes a serious enough threat to warrant or justify the restrictions on individual freedoms imposed by governments in the name of solidarity. I conclude by arguing that while a commitment to solidarity can be easily undermined by scepticism towards political and other authorities, and by the failures of those authorities themselves, it is paramount that societies strive for it as the best means to preserve individuals’ health, autonomy, and well-being. (shrink)

In a series of reflections published in the wake of the Covid-19 crisis, Giorgio Agamben expresses a number of concerns related to the way the pandemic has altered the very fabric of our societies, potentially changing it forever. While maintaining a certain scepticism towards the threat represented by the virus itself, Agamben claims that the response to the contagion shows how easy it is for authorities to limit individual freedoms in the name of public health, and how readily they are (...) willing to put such limitations in place. At the same time, the pandemic shows how easy it is for individuals to accept this situation as the new normal, and how readily they are willing to give up their freedoms and relationships. In this paper I offer a brief overview of Agamben’s worries, focussing on two issues in particular: the loss of individual freedom of movement and association, and the moral and political implications of social distancing. I then approach these issues from a different angle, making use of relational theory to propose an alternative framework which relies on the notion of vulnerability. While agreeing with Agamben that there is reason to worry about the state seizing the opportunity to exercise unchecked power over its citizens, I argue that we should pay attention to the ways in which social distancing measures can be grounded in solidarity and respect for the autonomy of vulnerable individuals. (shrink)