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

Religious associations sometimes seek to provide services and goods to the public using religious values that discriminate on grounds otherwise prohibited by law and public values. 'Group pluralists' support these efforts by highlighting the importance of shielding group authority from state overreach and protecting a robust associational life within democratic contexts. By contrast, 'liberal statists' insist on the state's final authority over societal groups and the need to protect individuals from arbitrary group power. This paper defends a third approach to (...) group authority called relational pluralism. Relational pluralism is skeptical that the state can resolve group conflicts fully and fairly and recognizes that too much state interference in group life weakens democratic relations. At the same time, it recognizes that groups can rarely act independently of other groups, including the regulatory state. Instead, groups rely on being empowered by other groups and often also by the state to carry out their projects. Group authority is nearly always 'relational' in that it depends on the cooperation of other groups. The paper sketches out a relational pluralist approach to understanding group authority and explains its democratic virtues. It shows how the approach can illuminate otherwise underappreciated features of conflicts about authority. (shrink)

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)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (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.

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient autonomy. These different manifestations of (...) autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

It has been suggested that there is a troubling antagonism between the potential goods afforded for parents in the parent–child relationship, and the goods of childhood. Indeed, the problem appears deep: on one way of framing it the problem is not merely that realisation of the goods of parenting for parents is incompatible with realisation of the goods of childhood for children; it is that realisation of the parental goods of parenting is dependent on precisely what it is that makes (...) childhood bad for children, namely their dependency and vulnerability.In this paper I consider this supposed ‘vulnerability paradox’, as I will refer to it. I argue for a re-assessment and revaluation of the vulnerability in the parent–child relationship by developing an account of the crucial role that vulnerability plays in underpinning and facilitating what is a core – but as yet unrecognised – good of that relationship for both parents and children: namely what I call the good of ‘mutual reflexive co-constitution’ that the relationship enables. (shrink)

In den westlichen Industrienationen gilt das Prinzip der informierten Einwilligung als das Zentralelement medizinischer Forschungsethik. In anderen, stärker die Relationalität als die Individualität von Personen betonenden Kulturen hingegen werden medizinische Entscheidungen traditionell eher durch die Gemeinschaft bzw. ihr Oberhaupt getroffen. Um verschiedenen kulturellen Normen gerecht zu werden, wird international tätigen Forschungsteams häufig empfohlen, den Community Consent und den Informed Consent einzuholen. Ausschlaggebend soll dabei letztlich der Informed Consent des Individuums sein. Es soll die Teilnahme auch dann verweigern können, wenn die (...) Gemeinschaft bzw. ihr Repräsentant dem Vorhaben zugestimmt hat. Der Beitrag diskutiert, ob eine solche Kopplung von Community Consent und Informed Consent tatsächlich geeignet ist, den Ansprüchen beider Prinzipien gerecht zu werden. Es wird argumentiert, dass die Kopplung von Community Consent und Informed Consent ethisch problematisch ist, wenn der Gemeinschaft hierbei ein Vetorecht eingeräumt wird, das geeignet ist, die Realisation konträrer individueller Interessen und damit das Selbstbestimmungsrecht der Betroffenen zu unterlaufen. Um zu gewährleisten, dass in interkulturellen Forschungszusammenhängen sowohl der individuellen als auch der relationalen Autonomie von Personen angemessener Raum gewährt wird, wäre es empfehlenswert, den Informed Consent ausdrücklich mit einer Community Consultation zu koppeln. Hier käme die Entscheidung gegen, aber auch für eine Studienteilnahme in letzter Instanz klar dem Individuum zu, während die Vorzüge einer Einbeziehung der Gemeinschaft in den Entscheidungsfindungsprozess anerkannt und genutzt werden könnten. (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)

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)

Der Beitrag analysiert Techniken öffentlicher Gesundheitskommunikation und skizziert im Ausblick Minimalbedingungen für ihre ethische Vertretbarkeit. Dazu wird erstens an einem aktuellen Beispiel veranschaulicht, wie mittels Text und Bild die Öffentlichkeit überzeugt werden soll, ein bestimmtes Gesundheitsverhalten an den Tag zu legen. Zweitens werden anhand der internationalen Ethik-Debatte fünf Grundtypen von Techniken in der Gesundheitskommunikation (Information, Argumentation, Persuasion, Manipulation und Zwang) rekonstruiert und entlang von Mittel, Zweck, Folgen für Adressaten sowie Implikationen für Autonomie aus ethischer Sicht unterschieden. Am besonders ambivalenten Beispiel (...) der Persuasion wird dann drittens diskutiert, welche ethischen Fallstricke es bei Gesundheitskommunikation zu bedenken gibt. Schließlich zeigen wir argumentativ auf, dass es in sensiblen bioethischen Themenfeldern wichtig ist, zwischen verschiedenen Techniken der Gesundheitskommunikation analytisch zu differenzieren. Ziel sollte die Ermöglichung einer fairen und transparenten Diskussion für breite Bevölkerungsgruppen sein. (shrink)

A few years ago, it was common for philosophers to begin inquiry into hope by noting that the subject has received little attention in the philosophical literature. But our ability to make this claim is quickly coming to an end; hope has been earning increasing recognition in the discipline, with philosophers exploring important questions related to the nature of hope, what makes hope rational, and how hope is connected to human wellbeing and agency. Despite this recent interest, however, there remains (...) very little discussion of the social and political dimensions of hope. My aim in this paper is to demonstrate the importance of a feminist perspective in bringing these dimensions into fuller view. I argue that feminist insights into the relational nature of the self, which call attention to where selves are socially situated in relation to others, enable a richer understanding of the nature and value of hope. (shrink)

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)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (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)

Non-Invasive Prenatal Testing is a technology which provides information about fetal genetic characteristics very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the (...) use of NIPT and emerging policy in the province of Ontario, Canada. Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. (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 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)

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)

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples for health care and the circumstances under which such a practice should be respected as compatible with (...) autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples’ joint decision-making, and the ethics of couples’ joint decision-making. We believe that the extent to which couples’ joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples’ joint decision-making about a woman’s own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman’s autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples’ joint decision-making should be viewed as consistent with the principle of respect for the woman’s autonomy. At the other end of the spectrum are decisions made by the man without the woman’s input, representing domination of one partner by the other. We recommend viewing the dynamics of couples’ joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples’ joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question. (shrink)

Fortunato and colleagues' target article extends both the ethical analysis and the clinical practice of nondisclosure by focusing on nocebo effects (Fortunato, Wasserman, and Menkes 2017). Instance...

Patient-centered care is now recognized as a clinical method and ideal model for patient – health professional relationships, and many definitions have influenced its evolution. Overall the patient-centered care literature has provided relatively little to define patient-centered care at the level of the patient-professional relationship. Additionally, patient-centered care lacks grounding in ethical theory. This thesis asserts that theoretical concepts from the ethics of care can provide a stronger conceptual basis for patient-centered care.This thesis begins with a critical interpretive review of (...) the patient-centered care literature, yielding 12 articles that previously introduced new theoretical and definitional work on patient-centered care and patient-centered communication. Six common themes and ideas were discovered, and include Engaging the Patient as a Whole Person, Recognizing and Responding to Emotions, Fostering a Therapeutic Alliance, Promoting an Exchange of Information, Sharing Decision Making, and Enabling Self-Management and Patient Navigation. These elements were then compared to key elements of the ethics of care. This thesis argues that feminists have good reason to consider care as a type of moral duty, and it describes how this duty functions. This thesis also argues that a duty to care is triggered when caregivers are presented with particular substantive forms of vulnerability. Specifically, this thesis argues that vulnerable subjects whose constitutive needs are at risk require particular moral obligations. The links between the ethics of care and patient-centered care are discussed, including how an ethics of care response ought to function in the health care context. Finally, the cases of J.J. and Makayla Sault, two aboriginal girls who refused chemotherapy in favour of traditional aboriginal healing practices, are analyzed. This thesis offers a short scoping review of the bioethics discourse surrounding these cases. A review of this discourse revealed several common themes, which included the peripheral importance of culture and history, the equating of best interests with survival, the supremacy of science-based medicine, and the impartial application of ethical principles. This thesis recommends that health care professionals apply an ethics of care approach to similar ethical dilemmas in the future, which involves shifting one's ethical focus to the central relationships of the case, understanding the unique perspective of the patient's narrative, and promoting a care-based rather than a justice-based approach to problem-solving. (shrink)

Deliberative democracy’s approach with its emphasis on a multidimensional conception of freedom is very well suited to offer a sophisticated and critical account of freedom of speech in the democratic public sphere. Nevertheless, it has rarely engaged other competing free speech theories in order to offer a valuable social critique of other ways of thinking about freedom of expression. This article tries to fill this gap by critically engaging Robert Post’s theory of freedom of speech based on democratic self-government. On (...) Post’s account, the key to effective democratic self-government is political autonomy, which he reduces to negative liberty and formal equality. I argue that this reduction creates serious problems. A purely procedural account of democracy makes it difficult to politicize new issues in the public sphere and also makes a dominant discourse resistant to contestation. Further, given his theory, Post does not have enough normative resources to offer an account of public justification, which would expand effective political liberty. (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)

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)

The vast majority of gamete donations worldwide are made anonymously, and in some countries, including Spain, France, and Denmark, the anonymity of donors is explicitly protected by law. Nonetheless, a growing number of countries have called into question the morality of such practices and are enacting laws allowing children access to identifying information about their gamete donor. A significant reason for the growing legislative support for nonanonymous gamete donations is the belief that donor‐conceived children have a fundamental moral right to (...) know their genetic origins and that the right should be legally protected. A variety of factors, such as the increasing number of children born by means of gamete donation, advances in genetic science and technology that make it easy to discover the identity of a person's genetic parents, and the widespread belief that genetic information is important for protecting people's health, have made this alleged right quite salient, even leading some to challenge the ethical appropriateness of gamete donation practices altogether. Often, however, this right is assumed rather than explicitly justified. The purpose of this paper is to call into question the ethical justifications that are often thought to ground a right to know one's genetic origins.Proponents of a right to know this information usually argue that such a right protects at least three vital interests: the interest of donor‐conceived people in having strong family relationships, their health interests, and their interest in forming a healthy identity. These different interests might be protected by different aspects of the right to know one's genetic origins: knowing one's mode of conception, accessing medically relevant information, and accessing identifying information about one's genetic parents. I will discuss each of these interests and explore whether and how they might be set back by an individual's lack of access to information about his or her genetic parentage. I will also evaluate whether donor anonymity policies are, as many of their opponents argue, morally impermissible because they fail to protect these important interests. (shrink)

There is understandable concern about policies or practices that impose one person's will on another. These seem to disrespect autonomy. But such concerns suppose that there is something there to r...

In recent years, informed consent has been suggested as a way to deal with risks posed by engineered nanomaterials. We argue that while we can learn from experiences with informed consent in treatment and research contexts, we should be aware that informed consent traditionally pertains to certain features of the relationships between doctors and patients and researchers and research participants, rather than those between producers and consumers and employers and employees, which are more prominent in the case of engineered nanomaterials. (...) To better understand these differences, we identify three major relational factors that influence whether valid informed consent is obtainable, namely dependency, personal proximity, and existence of shared interests. We show that each type of relationship offers different opportunities for reflection and therefore poses distinct challenges for obtaining valid informed consent. Our analysis offers a systematic understanding of the possibilities for attaining informed consent in the context of nanomaterial risks and makes clear that measures or regulations to improve the obtainment of informed consent should be attuned to the specific interpersonal relations to which it is supposed to apply. (shrink)

This article looks at how and why addiction should be understood as a ‘sociorelational’ disorder, and what this implies on a policy level in terms of the treatment and prevention of addiction. In light of scientific research, we argue that the neurobiological changes that underlie addiction are heavily influenced by sociorelational processes. We thereby advocate for a conceptual approach in which autonomy in addiction is a sociorelational concept, and social environments are considered autonomy undermining or autonomy promoting. We then discuss (...) the various implications this should have on policies. (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)

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)

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)

Accounts of adaptive preferences are of two kinds: well-being accounts fully theorized for their own sake and political accounts theorized to facilitate the political project of reducing oppression and marginalization. Given their practical role, the latter are often less fully theorized, and are therefore less robust to theoretical criticism. In this paper, I first draw on well-being accounts to identify the well-theorized elements that political accounts should want to adopt in order to strengthen their project and avoid common criticisms. Second, (...) I appeal to the political project to show the shortcomings of the well-being accounts on which I draw. (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)

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

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)

With its implicit vilification of materiality, the notion of objectification has failed to produce a coherent and effective ethical analysis of heterosexual sex work. The concept of derivatization, grounded in an Irigarayan model of embodied intersubjectivity, is more effective. However, queer sex work poses new and different ethical challenges. This paper argues that although queer sex work can entail both objectification and derivatization, the former is not ethically objectionable, and the latter, although the cause for some justified ethical concern, must (...) be analyzed within the context of structural sexual injustice. (shrink)

Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social environment inhibits their (...) ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (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)

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)

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)

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)