In Giorgio Agamben’s eyes, Immanuel Kant’s work is the modern philosophical harbinger of the catastrophic ‘state of exception’. By focusing on the latter’s ‘author/subject corrective’, I make the connection between Agamben and Kant’s Critique of Pure Reason more apparent. In doing so, I show how Kant’s corrective instrumentalises autonomy in such a way that it compromises the validity it seeks to rationalise; it does so by separating the individual from actuality, by ostracising law from political challenge, and by conflating individual (...) and state interests. Taken together, these three undercurrents are defining features of Agamben’s ‘Homo Sacer’ series. (shrink)

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative (...) design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous. (shrink)

The idea of autonomy, presented as Kant’s main achievement in the Groundwork and the second Critique, is hardly present in the ethics of the “Doctrine of Virtue”. Against Pauline Kleingeld’s recent interpretation, I argue that this does not amount to a disappearance of the Principle of Autonomy, but to an important development of the notion of autonomy. I first show that Kant still advocated the Principle of Autonomy in the 1790s along with the thought of lawgiving through one’s maxims. I (...) then argue that the role of autonomy in Kant’s later ethics has a different focus than in the previous works, which requires to connect autonomy with autocracy. Conversely, in the “Doctrine of Virtue”, autocracy, which Kant had employed before as an independent notion, is construed as a new layer of autonomy. What Kant there calls subjective autonomy is thereby considered as reason’s self-government in the maxims of each rational agent. -/- . (shrink)

In this article I examine the phenomenon of international migration of medical graduates. The debate involving the ethical aspects of medical migration as well as the obstacles faced by doctors to practice unreservedly in their host countries are addressed. The situation of Australia in this context is also scrutinised. Finally, I propose a series of strategies aimed at minimising the unfavourable consequences of the international migration of doctors. This commentary favours a reform in the way institutions and society respond to (...) the process of medical migration and to the needs of migrant doctors. Continued research on this health care topic is required in order to identify the major factors that play a role in this process. (shrink)

As a rule, the Kantian capacity for self-control is interpreted as a kind of tool for compelling ourselves to act on the basis of the maxims we have adopted. To the extent that we merely acknowledge its role in following already-adopted maxims, however, we fail to capture the distinctive aspect of moral self-control identified by Kant. In this paper, I propose a fuller account of the Kantian capacity for moral self-control; I do so mainly by analyzing this capacity as our (...) ability to “abstract from” various sensible impressions. This analysis shows that Kant’s conception of moral self-control involves two intimately related levels, which are subject to different criteria. Whereas the first level is connected to our ability to adopt moral maxims and requires that we abstract from all sensible impressions, the second is associated with our ability to follow these maxims and does not necessarily require this radical abstraction. (shrink)

In the controversial Appendix to the Transcendental Dialectic, Kant claims to “complete the critical work of pure reason” [A670/b698] by providing a transcendental deduction of the ideas of pure reason. In order to analyse the role that this Appendix plays in the first Critique, this paper will read the Appendix alongside Kant’s comments in the B-Preface concerning the astronomy of Copernicus. Through an analysis of the nature of Kant and Copernicus’ respective use of presuppositions, and by looking at their respective (...) attempts to unify a science around a single systematic conception of the object of that science, this paper will offer a defence of the fundamental role that Kant’s transcendental deduction of the ideas of pure reason plays in the text. (shrink)

In this paper I consider the possibility that failing to fulfill the Kantian obligation to protect one’s rational nature might actually vitiate future instances of this obligation. I respond to this dilemma by defending a novel interpretation of Kant’s views on the relation between the value we have and the respect we are owed. I argue, contra the received view among Kant scholars, that the feature in virtue of which someone has unconditional and incomparable value is not the same feature (...) in virtue of which she is owed the respect that constrains how she may be treated. So, even though someone who fails to attempt to protect her rational nature fails to respect herself in the right way, and even though this moral failing does make her lose a certain kind of value, her obligations to respect herself do not go away. (shrink)

In the Groundwork of the Metaphysics of Morals and the Critique of Practical Reason, Kant claims that rational beings should want to have no inclinations. But in Religion within the Bounds of Bare Reason, he asserts that the inclinations are good in themselves. While many commentators hold that Kant simply wrote hyperbolically in the Groundwork and the second Critique, I argue Kant was sincere, and changed his mind about the worth of the inclinations between the second Critique and the Religion. (...) This is because he changed his mind about the source of immorality: whereas in the Groundwork and Critique of Practical Reason Kant took our inclinations to be tempters, starting in “Miscarriage of All Philosophical Trials in Theodicy” and concluding in the Religion, he posited a self-imposed propensity to evil as the source of immorality. Kant’s reason for changing his mind about the source of immorality was partly theological: if our inclinations were to blame for immorality, then God would also be to blame for creating us with them. The only way God could not be to blame is if our immorality were self-imposed. But Kant also concluded that looking for theoretical explanations of our immorality – whether theological or naturalistic – was itself problematic: such explanations ended up exonerating us for our immorality. Because they had this effect, I contend that Kant saw the offering of such exculpating theoretical explanations as itself motivated by immorality. This understanding of Kant makes sense of the approaches he takes in both “Miscarriage” and Religion. (shrink)

We outline an alternative to both scientific and liberal naturalism which attempts to reconcile Sellars’ apparently conflicting commitments to the scientific accountability of human nature and the autonomy of the space of reasons. Scientific naturalism holds that agency and associated concepts are a mechanical product of the realm of laws, while liberal naturalism contends that the autonomy of the space of reason requires that we leave nature behind. The third way we present follows in the footsteps of German Idealism, which (...) attempted to overcome the Kantian chasm between nature and agency, and is thus dubbed ‘post-Kantian.’ We point to an overlooked group of scholars in the naturalism debate who, along with recent work in biology and cognitive science, offer a path to overcome the reductive tendencies of empiricism while avoiding the dichotomy of logical spaces. We then bring together these different streams of research, by foregrounding and expanding on what they share: the idea of organisms as living agents and that of a continuity without identity between life and mind. We qualify this as a bottom-up transformative approach to rational agency, which grounds cognition in the intrinsically purposive nature of organisms, while emphasizing the distinction between biological agency and full-fledged mindedness. (shrink)

For years now, autonomy has been discussed as one of the central values in health care. Understood as self-realization, it is opposed to paternalism which is conceived as an intolerable occurrence of heteronomy. Although different concepts have been developed to nuance this opposition, when it comes to health care discourse, heteronomy is still the enemy of autonomy. In our article, we defend the thesis that autonomy is only achievable as heteronomy. We are not arguing for an expansion of the meaning (...) of autonomy, but are attempting to conduct an analysis which lays bare the ‘disrupting’ attendance of heteronomy within the principle of autonomy. Autonomy does not begin where heteronomy ends, but can only begin if heteronomy is already involved. To emphasize this, we prefer to elaborate a new concept: ‘oughtonomy’. This concept is inspired by Jacques Derrida’s distinction between ‘difference’ and ‘differance’. We will develop the concept of oughtonomy from a deconstructive reading of Kant’s idea of autonomy, inspired by philosophers such as Jacob Rogozinski, Jean-Luc Nancy and others. In addition to a first exploration of this concept, this article also discusses the possible consequences of oughtonomy for current debates concerning health care. Our quest for a new understanding of autonomy is motivated by the concern that, although the accent on autonomy as self-realization and independence has many advantages, we should also bear in mind the countless disadvantages. (shrink)