There can be little doubt, at least in the Western world, that autonomy is the ruling principle in contemporary bioethics. In spite of its ‘triumph’ however, the dominance of the utilitarian concept of autonomy is being increasingly questioned. In this paper, I explore the nature of autonomy, how it came to displace the Hippocratic tradition in medicine and how different concepts of autonomy have evolved. I argue that the reduction of autonomy to ‘the exercise of personal choice’ in medicine has (...) led to a ‘tyranny of autonomy’ which can be inimical to ethical medical practice rather than conducive to it. I take the case of Kerrie Wooltorton as an illustration of how misplaced adherence to respect for patient autonomy can lead to tragic consequences. An analysis of autonomy based on the work of Rachel Haliburton is described and applied to the role of autonomy in a recent bioethical debate — that arising from Savulescu's proposal that conscientious objection by health-care professionals should not be permit.. (shrink)

Pervasive feminism is a component located in emotionality—feminist emotion—and contains women's primary agency. Because affect and emotions are elusive, an interpretive conceptual tool is necessary and is key to making use of their potential for feminist politics aimed at women's empowerment and well-being and to build gender equality. This essay builds on contemporary feminist theory and affect theory and draws from multidisciplinary research. It presents a new theoretical framework anchored in hermeneutics and phenomenology to pin down the affective component of (...) women's multifaceted, intersectional emotional experiences of gender. A case study also illustrates how the theoretical premises around the concept of feminist emotion are compatible with and useful for feminist praxis. (shrink)

At first glance it might appear that experimental philosophers and feminist philosophers would make good allies. Nonetheless, experimental philosophy has received criticism from feminist fronts, both for its methodology and for some of its guiding assumptions. Adding to this critical literature, I raise questions concerning the ways in which “differences” in intuitions are employed in experimental philosophy. Specifically, I distinguish between two ways in which differences in intuitions might play a role in philosophical practice, one which puts an end to (...) philosophical conversation and the other which provides impetus for beginning one. Insofar as experimental philosophers are engaged in deploying “differences” in intuitions in the former rather than the latter sense, I argue that their approach is antithetical to feminist projects. Moreover, this is even the case when experimental philosophers deploy “differences” in intuitions along lines of gender. (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)

Philosophical anarchists have made their living criticizing theories of state legitimacy and the duty to obey the law. The most prominent theories of state legitimacy have been called into doubt by the anarchists' insistence that citizens' lack of consent to the state renders the whole justificatory enterprise futile. Autonomy requires consent, they argue, and justification must respect autonomy. In this essay, I want to call into question the weight of consent in protecting our capacity for autonomy. I argue that if (...) we care about all of the preconditions for autonomy, then we have good reasons to leave the state of nature. This leaves the philosophical anarchist with a dilemma. If she truly cares about autonomy, then she must welcome the state. But if she wants to deny the legitimacy of the state because of the value of consent, then she needs to downplay the moral significance of autonomy in people's lives. If autonomy matters, the state does too. If it doesn't, then consent doesn't. The philosophical anarchist can't have it both ways. (shrink)

Recent work on diachronic agency has challenged the predominantly structural or synchronic approach to agency that is characteristic of much of the literature in contemporary philosophical moral psychology. However, the embodied dimensions of diachronic agency continue to be neglected in the literature. This article draws on phenomenological perspectives on embodiment and narrative conceptions of the self to argue that diachronic agency and selfhood are anchored in embodiment. In doing so, the article also responds to Diana Meyers' recent work on corporeal (...) selfhood. (shrink)

Obesity is a public health problem influenced by behavioral patterns that span an ecological spectrum of individual-level factors, social network factors and environmental factors. Both individual and environmental approaches necessarily include significant influences from social networks, but how and under what conditions social networks influence behavior change is often not clearly mapped out either in the obesity literature or in many intervention designs. In this paper, we provide an analysis of recent empirical work in obesity research that explicates social network (...) influences on eating behaviors. We argue that a relational rather than individualistic view of personhood should help us better understand the content and context of social network relations that inform health behavior choices. We introduce the concept of ‘identity-constitutive affiliations’ as the glue that binds these social relationships together. Finally, we outline the implications for public health ethics in the development of effective interventions to address overweight and obesity, leveraging the content and context of social network ties to reinforce healthy (or alter unhealthy) eating. More complex treatment of positive and negative behaviors stemming from social network connections should lead to more comprehensive theoretical models of health behavior change and more effective public health interventions. (shrink)

Centre for Applied Philosophy and Public Ethics University of Melbourne, Parkville, 3010, Australia and.

Scholars across disciplines recognize sport as an institution perpetuating sexism and bias against women in light of its masculine ideals. However, little philosophical research identifies how a masculine environment impacts women’s possibilities in sport. This paper shows that socially structured masculine ideals of athletic excellence impact recognition of women’s athletic achievements while contributing to contexts endangering respect and self-respect. Exploring athletic disrespect reveals connections to more broadly harmful sport practices that include physical and sexual violence. Thus, the practical concern is (...) that sport’s masculine ideals might undermine women’s pursuit of athletic excellence in more harmful ways than previously recognized. (shrink)

This chapter first introduces naturalistic approaches to ethics more generally and distinguishes methodological ethical naturalism (the focus of this chapter), from metaphysical ethical naturalism. The second part then discusses evolutionary ethics as a specific variant of methodological ethical naturalism. After introducing the concepts of evolutionary theory that are relevant for evolutionary ethics, I will sketch the history of evolutionary ethics, which offers an interesting lesson about why it became a controversial topic, and then focus on four central questions about ethics (...) that can be approached from within the framework of evolutionary ethics: 1. What should we do? 2. Why are we moral? 3. Are there moral facts? 4. Can we have justified moral beliefs and moral knowledge? (shrink)

Frailty has recently become a medical category with physical symptoms that define its diagnosis. This paper uses the resources of an ethics of care to analyze the relationship between frailty and fragility or vulnerability, the positives of frailty becoming a diagnostic category, and some problematic aspects of the same process.

This paper looks to phenomenology and enactive cognition in order to shed light on the self and sense of self of patients with locked-in syndrome. It critically discusses the concept of the minimal self, both in its phenomenological and ontological dimension. Ontologically speaking, the self is considered to be equal to a person’s sensorimotor embodiment. This bodily self also grounds the minimal sense of self as being a distinct experiential subject. The view from the minimal bodily self presupposes that sociality (...) comes after the self, or that in other words, the essence of self remains independent of our social interactions and relations. In this paper, I rely on the idea of enactive autonomy and Heidegger’s and Merleau-Ponty’s views of human existence as primordially social, to argue for the contrary. The self is fundamentally relational and this is also reflected at the level of the subjective experience of being a self. I indicate how a strong relational view of selfhood can serve as a preliminary heuristic to make sense of the situation of the patient with LIS and conclude with some practical implications concerning patient autonomy, our ethical responsibility toward the patient, and the possibilities for improving the life of patients with LIS. (shrink)

Hope has been neglected as a topic by philosophers interested in families, children, and children's autonomy. Hope may be confused with adjacent phenomena, such as optimism and wishful thinking. However, hope, when understood to involve goals, exploration of pathways to achieving those goals, and motivation to explore the pathways, is necessary for autonomy. It is also importantly related to children's resilience in response to challenges and stressors. In the course of explaining what I take autonomy to involve, why I think (...) children can have areas of local autonomy, and connections between hope, autonomy and resilience, I examine evidence that supports my claims about these connections. I then conclude with a brief discussion of implications of these connections for social policy, especially in the educational context, and for personal interactions with children. (shrink)

John Harris recently argues that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving the recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement, including moral education, that aim to make the enhancement recipients less likely to “fall” are detrimental to moral agency. In this paper, I present (...) a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harms our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, which subsequently undermine our moral agency. (shrink)

In this article I seek a more complete understanding of evil action. To this end, in the first half of the article I assess the conceptual strengths and weaknesses of the most compelling theories of evil action found in the contemporary philosophical literature. I conclude that the theories that fall under the category I call ‘‘Nuanced Harm Accounts’’ successfully identify the necessary and sufficient conditions of the concept. However, necessary and sufficient conditions are not coextensive with significant features, and Nuanced (...) Harm Accounts are incomplete even if they are correct. In order to supplement them, in the second half of the article I examine the normative relation that obtains between perpetrators and victims of evil and find them to be parties to a relation of asymmetrical power in which the vulnerability of the weaker party is exploited by the stronger party for its advantage, pleasure, or otherwise to achieve its aims. Moreover, the parties in the relation reciprocally enable each other’s role relative to one another. The strength of the more powerful party emerges out of the states of vulnerability of the victims, and the victims are vulnerable relative to the power(s) of the perpetrator. (shrink)

Trust has generally been understood as an intentional mental phenomenon that one party has towards another party with respect to some object of value for the truster. In the landmark work of Annette Baier, this trust is described as a three-place predicate: A entrusts B with the care of C, such that B has discretionary powers in caring for C. In this paper we propose that, within the context of thick interpersonal relationships, trust manifests in a different way: as a (...) property of the relationship itself. We argue that this conceptualization has important implications for the debate over the ethics of interpersonal interventions. In particular, when trust is understood in this way, actions that would otherwise be deemed morally troubling may be permissible, or even morally desirable, on account of their role in strengthening trusting relationships. (shrink)

In the traditions of narrative ethics and casuistry, stories have a well-established role. Specifically, illness narratives provide insight into patients’ perspectives and histories. However, because they tend to see fiction as an aesthetic endeavour, practitioners in these traditions often do not realize that fictional stories are valuable moral sources of their own. In this paper I employ two arguments to show the mutual relationship between bioethics and fiction, specifically, science fiction. First, both discourses use imagination to set a scene and (...) determine a perspective. Second, bioethics and science fiction share the family resemblance of expressing moral beliefs. I then consider how understanding bioethics and science fiction as interrelated discourses can be the basis of a methodology for inquiry into relational autonomy in the context of biotechnologies and medicine. As an example of this methodology, I analyse Fay Weldon’s novel The Cloning of Joanna May (1989). (shrink)

In this paper, we defend two main claims. The first is a moderate claim: we have a negative duty to not use binary gender-specific pronouns he or she to refer to genderqueer individuals. We defend this with an argument by analogy. It was gravely wrong for Mark Latham to refer to Catherine McGregor, a transgender woman, using the pronoun he; we argue that such cases of misgendering are morally analogous to referring to Angel Haze, who identifies as genderqueer, as he (...) or she. The second is a radical claim: we have a negative duty to not use any gender-specific pronouns to refer to anyone, regardless of their gender identity. We offer three arguments in favor of this claim (which appeal to concerns about inegalitarianism and risk, invasions of privacy, and reinforcing essentialist ideologies). We also show why the radical claim is compatible with the moderate claim. Before concluding, we examine common concerns about incorporating either they or a neologism such as ze as a third-person singular gender-neutral pronoun. These concerns, we argue, do not provide sufficient reason to reject either the moderate or radical claim. (shrink)

In this dissertation I examine ethical issues that concern fertility preservation (FP) technologies for women from a feminist perspective. FP technologies involve the removal, cryopreservation and subsequent storage of reproductive materials for future use. The aim of these technologies is to preserve the option of future genetic reproduction. FP technologies have been developed in the cancer context because infertility is one of the long-term side-effects of many cancers or cancer therapies. Many FP technologies are still experimental, but some technologies are (...) becoming available to healthy women who wish to guard against age-related infertility. Although FP technologies are expanding women’s reproductive options and benefitting some women by satisfying their desires for genetically-related children, these technologies pose numerous physical, emotional and financial risks to women. I maintain that a feminist examination of choice is necessary for the ethical provision of FP technologies within patriarchal contexts. My analysis begins by demarcating two oppressive social biases from one another: namely pronatalism and biologism. I argue that each of these biases can unduly influence women’s reproductive choices about FP technologies. I then consider how these biases might be identified and challenged in the FP decision-making context. I outline an ethical process of informed choice that is equipped to protect patient autonomy when such autonomy is threatened by these biases. I then consider whether the choice to use FP should be available to both women within and without the cancer contexts. I argue that both disease-related FP and age-related FP can be morally permissible. Finally, I consider whether there should be an upper age limit on women’s access to their stored reproductive materials. I argue that age can be morally relevant to reproduction and thus age limits on access to assisted reproduction are morally permissible. I conclude by suggesting how feminist insights might inform policies on FP technologies and related assisted reproductive technologies. In sum, my dissertation shows that a feminist analysis of choices about FP is essential for ensuring the ethical provision of FP technologies. (shrink)

Attempts to articulate the ways in which membership in socially subordinated social identities can impede one's autonomy have largely unfolded as part of the debate between different types of internalist theories in relation to the problem of internalized oppression. The different internalist positions, however, employ a damage model for understanding the role of social subordination in limiting autonomy. I argue that we need an externalist condition in order to capture the ways in which membership in a socially subordinated identity can (...) constrain one's autonomy, even if one is undamaged in one's autonomy competencies and self-reflexive attitudes. I argue that living among those practically empowered to harass, to engage in racial profiling, and to treat as expendable is incompatible with a freedom-condition required for unconstrained global self-determination. (shrink)

The feminist literature against the commodification of embryos in human embryo research includes an argument to the effect that embryos are “intimately connected” to persons, or morally inalienable from them. We explore why embryos might be inalienable to persons and why feminists might find this view appealing. But, ultimately, as feminists, we reject this view because it is inconsistent with full respect for women's reproductive autonomy and with a feminist conception of persons as relational, embodied beings. Overall, feminists should avoid (...) claims about embryos’ being inalienable to persons in arguments for or against the commodification of human embryos. (shrink)

Controversial and provocative, To Be Real is a blueprint for the creation of a new political force.

When women become perpetrators of suicide bombing, their agency – their ability to act upon and affect the world – is often denied. There are a number of reasons for this and one this thesis considers is that – as females – they are not expected to be violent. Accordingly, such women are judged to be coerced or incompetent, and so unable to rule themselves sufficiently as agents. Models of autonomy propose various frameworks for assessing whether acts or persons are (...) self-governing, and the relational approach in particular has garnered much support recently. However, some aspects of the relational account remain under-theorised, including how autonomy might be measured. In this thesis, I aim to bring these two elements together by examining whether an extension of the relational model may offer a way in which to estimate the autonomy of the bombers in a more nuanced fashion. I make two claims. First, that the relational conception of the agent and autonomy ‘fits’ the bombers. Second, that my spectrum view, which is rooted in the relational approach, maps the bomber’s autonomy approximately but in detail. As such, my spectrum view is a befitting notion of autonomy and allows a graded and comparative representation of the bomber’s autonomy. (shrink)

There is all over the world a sort of fever affecting all the research fields related, closely or somewhat loosely,with human health issues. Some of them – cloning, therapeutic cloning, stem cell therapy, human enhancement, etc. – arise fierce and controversial public debates. At the same time, a concern can be felt worldwide that tomorrow’s medicine might well become more and more « dual », the advanced health devices threatening to become the privilege of a small whealthy minority, or at (...) least excluding the vast majority of the poor and the low middle class. Furthermore, there are even greater disparities between wealthy and poor nations in access to health care and in the level of protection available to members of the latter’s population in a medical context. The theme of rationing health care has been ongoingly gaining in prevalence over the two to three last decades in the public debates, causing many to express worries about the ability of our health system to provide both efficiency and justice in health care. But, among all the new health care devices, are there not some which could be efficient both in terms of improvement of the management of patients’ health and of a just allocation of care ? Besides, not only emerge concerns linked with the development of new technologies in health care, but also in connection with the impact of social-political transformations onto the medical relationship : what are in this context the doctor-patient relationship in regard to autonomy and gender ? Should we be free to use or not to use these new technologies ? Might not the « quest for perfection » develop into a duty of perfection ? And, with the improvement of the therapeutic power to prolong human life, are we to think of assisted suicide as the future of death ? These are some of the issues that this conference wants to adress from an ethical perspective and with rigour. To enrich our discussions also medical and life science praticioners willing to reflect ethically on moral questions of health issues in their professional life and politicians faced with ethical decisions in the domain of health are welcome to participate. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen autonomy (...) and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing (...) on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

In this paper, I outline the cumulative network model of the self. This model articulates the self as relational, recognizing social relations as constitutive of the self. The theory arises out of concerns about the individualistic paradigms of two main frameworks in the analytic philosophical literature on personal identity, namely, the psychological and the animalist approaches to personhood and is explicitly inspired by feminist theories on relational autonomy and self. I argue that “relationality” is not only social, but that the (...) self is relational throughout, psychologically, physically, biologically, culturally, semantically, as well as socially. Hence, the self is a network of relations. The model also aims to recognize that temporality or historicity is constitutive of the self, that the self is a process, not a static three-dimensional thing. Hence, the self is a cumulative network. (shrink)

An important part of what it means for agents to be situated in the everyday world of human affairs includes their engagement with economic practices. In this paper, we employ the concept of cognitive institutions in order to provide an enactive and interactive interpretation of market and economic reasoning. We challenge traditional views that understand markets in terms of market structures or as processors of distributed information. The alternative conception builds upon the notion of the market as a “scaffolding institution.” (...) Introducing the concept of market as a “socially extended” cognitive institution we go beyond the notion of scaffolding to provide an enactive view of economic reasoning that understands the market participant in terms of social interactive processes and relational autonomy. Markets are more than inert devices for information processing; they can be viewed as “highly scaffolded,” where strong constraints and incentives predictably direct agents’ behavior. Building on this idea we argue that markets emerge from (a) the economic interaction of both supply and demand sides, in continual and mutual interplay, and (b) more basic social interactions. Consumer behavior in the marketplace is complex, not only contributing to determine the market price, but also extending the consumer’s cognitive processes to reliably attain a correct evaluation of the good. Moreover, this economic reasoning is socially situated and not something done in isolation from other consumers. From a socially situated, interactive point of view buying or not buying a good is something that enacts the market. This shifts the status of markets from external institutions that merely causally affect participants’ cognitive processes to social institutions that constitutively extend these cognitive processes. On this view the constraints imposed by social interactions, as well as the possibilities enabled by such interactions, are such that economic reasoning is never just an individual process carried out by an autonomous individual, classically understood. In this regard, understanding the concept of relational autonomy allows us to see how economic reasoning is always embodied, embedded in, and scaffolded by intersubjective interactions, and how such interactions make the market what it is. (shrink)

According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this paper argues that (...) standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy. (shrink)

Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women’s health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and (...) plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women’s needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers. (shrink)

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to (...) serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation. (shrink)

In his article, Bester (2018) criticizes the so-called “harm consensus” movement among a growing number of bioethicists and practitioners. He argues that the harm principle is unable to replace the...

Deep brain stimulation (DBS) is an effective treatment for the debilitating motor symptoms of Parkinson’s disease and other neurological disorders. However, clinicians and commentators have noted that DBS recipients have not necessarily experienced the improvements in quality of life that would be expected, due in large part to what have been described as the ‘psychosocial’ impacts of DBS. The premise of this paper is that, in order to realise the full potential of DBS and similar interventions, clinical services need to (...) be arranged in such a way that these psychosocial dimensions are recognised and managed. Our starting point is that the psychosocial effects of DBS ‘in the field’ present us with analytically-useful disruptions: they disturb and foreground deeply held assumptions relating to the individual, health and its treatment, and which in a crude form manifest as the myth of technological solutionism within health care. Drawing on scholarship in medical sociology and science and technology studies (STS), we argue that DBS brings to the fore the relational dimensions of personhood, and demonstrates the emotional and social turmoil that can result if the relational dimensions of personhood are ignored by clinical services. In light of this, we argue that DBS should be implemented within a regime of care. Drawing on ethnographic research of a paediatric DBS clinical service, we provide an example of a regime of care, and conclude by reflecting on what other DBS services might learn from this paediatric service. (shrink)

This article considers procedural justice in the law, with specific reference to the adjudicative context of governmental officials applying legal standards to particular cases. We critically survey the three main accounts of procedural justice in the literature: utilitarian, outcome‐based, and dignitarian. Utilitarian and outcome‐based theories share the instrumental view that the only purpose of procedures is to lead to accurate legal outcomes. However, the former are willing to trade off the benefits of accuracy against its costs, whereas the latter hold (...) that procedural rights are necessary to guard against the injustice caused when individuals' legal rights are mistakenly denied. Dignitarian theories maintain that process matters apart from outcomes, because procedures should show respect for individuals' dignity in the Kantian sense of rational agency. We present a new perspective, drawing on relational theory. Relational theory holds that we are social creatures whose self‐identities and sense of self‐respect are bound up with the quality of our relationships with other individuals, groups, and institutions. Our relational account is informed by empirical research in social psychology which has found that people's evaluation of procedures is substantially influenced by relational concerns. (shrink)

Mainstream conceptions of autonomy have been surreptitiously gender-specific and masculinist. Feminist philosophers have reclaimed autonomy as a feminist value, while retaining its core ideal as self-government, by reconceptualizing it as “relational autonomy.” This article examines whether feminist theories of relational autonomy can adequately illuminate the agency of Islamist women who defend their nonliberal religious values and practices and assiduously attempt to enact them in their daily lives. I focus on two notable feminist theories of relational autonomy advanced by Marina Oshana (...) and Andrea Westlund and apply them to the case of Women's Mosque Movement participants in Egypt. I argue that feminist conceptions of relational autonomy, centered around the ideal of self-government, cannot elucidate the agency of Women's Mosque Movement participants whose normative ideal involves perfecting their moral capacity. (shrink)

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing. Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights—the right not to know, and the child’s (...) right to an open future—frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs. (shrink)

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes. Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others brings them closer to the research but also brings the research closer (...) to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and ‘thorny’ work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, “How could it be otherwise?” ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of ‘keeping open’ the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to ‘open up’ engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: engagement and knowledge exchange; analysis of mindmap contributions; development of a conceptual schema ; and feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it. (shrink)

Research is a global enterprise requiring participation of both genders for generalizable knowledge; advancement of science and evidence based medical treatment. Participation of women in research is necessary to reduce the current bias that most empirical evidence is obtained from studies with men to inform health care and related policy interventions. Various factors are assumed to limit autonomy amongst the Yoruba women of western Nigeria. This paper seeks to explore the experience and understanding of autonomy by the Yoruba women in (...) relation to research participation. Focus is on factors that affect women's autonomous decision making in research participation. An exploratory qualitative approach comprising four focus group discussions, 42 in-depth interviews and 14 key informant interviews was used. The study permits a significant amount of triangulation, as opinions of husbands and religious leaders are also explored. Interviews and discussions were audiotaped and transcribed verbatim. Content analysis was employed for data analysis. Findings show that concepts of autonomy varied amongst the Yoruba women. Patriarchy, religion and culture are conceived to have negative impact on the autonomy of women in respect to research participation. Among the important findings are: 1) male dominance is strongly emphasized by religious leaders who should teach equality, 2) while men feel that by making decisions for women, they are protecting them, the women on the other hand see this protection as a way of limiting their autonomy. We recommend further studies to develop culturally appropriate and workable recruitment methods to increase women's participation in research. (shrink)

This essay develops a framework for understanding what I call the ethics of reflexivity, that is, the norms that govern attitudes and actions with respect to one’s own worth. I distinguish five central aspects of the reflexive commitment to living in accordance with one’s personal ideals: the extent to which and manner in which one regards oneself from an evaluative point of view, the extent to which one cares about receiving the respect of others, the degree to which one interprets (...) one’s personal ideals in an individualistic or collective manner, the degree to which one’s commitment to living in accordance with one’s personal ideals is rigid or flexible, and the worthiness of one’s personal ideals. This framework, I argue, illuminates the nature and moral significance of virtuous and vicious forms of the character trait of pride. (shrink)

I examine the standard view of dignity in Western literature and Metz’s African community view of dignity as a capacity for communal harmonious living. I argue that moral dignity is not just having a capacity for harmonious communal living, but the moral use of such capacity for the promotion of love, friendship, positive identity and active solidarity, which involves normatively prescriptive and evaluative elements. Thus, a plausible African communal conception of moral dignity, which is founded on a moral conception of (...) personhood and community, involves a combination of capacity and agency that is conceptually tied to communal responsibility and respect for self and others. This indicates that human capacities do not have an inherent moral worth. Capacities are instrumentally good and their worth depends on how they are used to promote the moral good of communal well-being, on which individual well-being or dignity depends. This view captures the various use-senses of dignity, addresses many of the problems with many of the analyses of dignity in the literature, and also indicates its relevance. (shrink)

In this paper I ask what implicit attitudes tell us about our freedom. I analyze the relation between the literature on implicit attitudes and an important subcategory of theories of free will—self-disclosure accounts. If one is committed to such a theory, I suggest one may have to move to a more social conceptualization of the capacity for freedom. I will work out this argument in five sections. In the first section, I discuss the specific theories of free will that are (...) central to this paper. In the second section, I will show that implicit-bias research raises questions about people’s capacities to exercise free will. In the third section, I will consider how an individual may overcome these failures and argue that the individual ability for self-regulation is significantly limited. One could stop here and conclude that free will is a limited capacity. But I argue that this conclusion would be too hastily drawn. I will instead continue to ask what would be required for free will. By discussing how failures of free will are due to social structures and may be therefore repaired by changing social structures in section 4, I will arrive at an alternative conclusion about the capacity for free will in section 5. (shrink)

ver since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, (...) a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria. (shrink)

The further development of public health ethics will be assisted by a more direct engagement with political theory. In this way, the moral vocabulary of the liberal tradition should be supplemented—but not supplanted—by different conceptual and normative resources available from other traditions of political and social thought. This article discusses four lines of further development that the normative conceptual discourse of public health ethics might take. The relational turn. The implications for public health ethics of the new ‘ecological’ or ‘relational’ (...) interpretation that is emerging for concepts such as agency, self-identity, autonomy, liberty and justice. Governing the health commons. The framework of collective action problems is giving way to notions of democratic governance and management of common resources. The concept of membership. Membership is specified by the notions of equal respect and parity of voice and agency. The concept of mutuality. Mutuality is specified by the notions of interdependent concern and care. (shrink)

Most accounts of immigration ethics implicitly rely upon neoclassical migration theory, which understands migration as the result of poverty and unemployment in sending countries. This paper argues that neoclassical migration theory assumes an account of the human person as solely an autonomous rational agent which then leads to ethics of migration which overemphasize freedom and self-determination. This tendency to assume that migration works as neoclassical migration theory describes is shared by political philosophers, such as Joseph Carens, Michael Walzer, and David (...) Miller. This paper argues that all three philosophers incorrectly frame migration as a contest between the freedom of the migrant and the communal self-determination of the political community. Migration systems theory is presented as a theory that draws upon a relationally embedded understanding of autonomy in order to begin to develop a migration systems ethics. This paper concludes by arguing that the central ethical category for an ethics of migration is not freedom or self-determination, but justice-in-relation. (shrink)

The study of remembering is both compelling and challenging, in part, because of the multiplicity and the complexity of influences on memory. Whatever their interests, memory researchers are always aware of the many different factors that can drive the processes they care about. A search for the phrase ‘influences on memory’ confirms this daunting and exhilarating array of influences, of many different kinds, operating at many different timescales, and presumably often interacting in ways that we can’t yet imagine, let alone (...) model. There are hormonal and neuromodulatory, genetic and pharmacological, developmental and age-related influences; there are influences of arousal, stress, gender, mood, emotion, sleep and personality; there are unconscious, schematic or semantic influences, and there are influences of context, situation, task and environment. There are many aspects of ‘media influence on memory’ (Loftus and Banaji, 1989; Strange and Garry, 2007), and, of course, there are both ‘social influences on memory’ (Echterhoff and Hirst, 2009) and ‘cultural influences on memory’ (Gutchess and Indeck, 2009). Notoriously, there are numerous ‘suggestive influences’ on memory (Loftus, 2003): influences of misinformation (Seifert, 2002; Wright and Loftus, 1998), or of ‘memory conformity’ (Gabbert et al., 2006) and ‘memory contagion’ (Roediger et al., 2002). People who know each other well, such as intimate couples, ‘may be well practised in yielding to each other’s influence and incorporating their partner’s information into their own memories of the past’ (French et al., 2008: 264). (shrink)

Literature on the ethics of researching refugees, both as participants and partners, presents strong arguments for why anonymity is the safer option in the event of questionable consent. However, blanket anonymity, without asking refugee interviewees if they wish to be anonymous, may cause more harm than good in certain contexts. One such context which this article will explore is the context of Israel, where a working Refugee Status Determination (RSD) system has yet to be established. This case study highlights that, (...) even in extreme circumstances where identity exposure can create risks, there may be a case for allowing identity exposure and perhaps an obligation on the part of the researcher to publish a name if this is the strong wish of the interviewee. This article builds on literature addressing confidentiality of identities (Duvell et al., 2010; Giordano et al., 2007; Kelly, 2009; Lahman et al., 2011; Lee, 1993; Mackenzie et al., 2007; Pittaway et al., 2010) and literature addressing informed consent (Hugman et al., 2011; Mackenzie et al., 2007; Pittaway et al., 2010; Zion et al., 2010). Primary sources demonstrating the use of waiving anonymity were collected between 2007 and 2012. Data were collected from refugee and activist civil society publications, television and newspaper media reports, participatory observation in the Israeli Knesset, and in-depth interviews with refugees and asylum seekers from South Sudan, Sudan, DR Congo, Liberia and Eritrea living in Tel Aviv, Jerusalem and Eilat. (shrink)