The year 2012, in one sense, marks the 40th Anniversary of our Society, for it was in 1972 that John Lachs suggested to some of his colleagues interested in American Philosophy that they consider starting a new organization. The following year, this "American Philosophy" group held a symposium on "Possibilities for American Philosophy" at the Western Philosophy Association meeting. At that time the group's name was changed to "Society for the Advancement of American Philosophy," and in 1974 the first independent (...) annual meeting of the Society was held at Vanderbilt University.1The Society's name has stimulated contention for various reasons, but reflecting on forty years of this group, I want to say "we have come a .. (shrink)

: Many activities formerly not in the market are being "marketized," and women's labor is increasingly in the market. I consider the grounds on which to decide what should and what should not be "in" the market. I distinguish work that is paid from work done under "market norms," and argue that market values should not have priority in education, childcare, healthcare, and many other activities. I suggest that a feminist ethics of care is more promising than Kantian ethics or (...) utilitarianism for recommending social decisions concerning limits on markets. (shrink)

: Feminist epistemologists have found the atomistic view of knowers provided by classical epistemology woefully inadequate. An obvious alternative for feminists is Lynn Hankinson Nelson's suggestion that it is communities that know. However, I argue that Nelson's view is problematic for feminists, and I offer instead a conception of knowers as "individuals-in-communities." This conception is preferable, given the premises and goals of feminist epistemologists, because it emphasizes the relations between knowers and their communities and the relevance of these relations for (...) epistemic assessments. Furthermore, it provides a sense of epistemic agents as active reflective inquirers, capable of transforming and improving knowledge-seeking practices. (shrink)

Given the metaphysical and explanatory stalemate between Embedded and Extended cognition, different authors proposed moral arguments to overcome such a deadlock in favor of EXT. Farina and Lavazza attribute to EXT and EMB a substantive moral content, arguing in favor of the former by virtue of its progressiveness and inclusiveness. In this treatment, I criticize four of their moral arguments. In Sect. 2, I focus on the argument from legitimate interventions and on the argument from extended agency. Section 3 concerns (...) the argument from better protection and the argument from better treatment. Sections 4 and 5 are dedicated to counterarguments against each respectively. By distinguishing between EXT and the extended view, I argue that it is sufficient to use this second version for directly addressing and evaluating moral problems on normative grounds, independently of the causal or constitutive cognitive influence of the external resource on the agents’ minds. Moreover, I argue that the arguments and assumptions used by EXT theorists do not foster values of progressiveness and inclusiveness. To conclude, in Sect. 6, I show that the analysis of each argument converges on the conclusion that EXT does not have substantive moral content and implications per se, since they always depend on further assumptions. (shrink)

This study explores how religious women become legitimate actors in the public sphere and analyzes their agency—its meanings, capacities, and transformative aims. It presents a novel case study of Israeli Modern-Orthodox Agunah activists who engage in highly politicized collective feminist resistance as religious actors working for religious ends. Embedded in and activated by Orthodoxy, they advocate women’s rights to divorce, voicing a moral critique of tradition and its agents precisely because they are devoutly devoted to them. Such political agency is (...) innovatively conceptualized as “devoted resistance”: critique within relationship, enabled by cultural schema, and comprising both interpretive skills and “relational-autonomy” capacities. This study contends that understanding agency within religious grammars reveals its underlying logics, highlighting how structures shape the meanings and realization of women’s varied “agentive capacities.” It challenges current dichotomies like feminism/religion, resistance/submission, and autonomy/dependence. Overall, the author argues for a nuanced, culturally specific, capacity-based, relational approach to analyzing religious women’s agency. (shrink)

In this paper I present a critical analysis of the English law relating to the safeguarding of vulnerable adults, in particular how the law impacts on the sexual lives of adult women with mental disabilities. I consider the discourses of vulnerability that surround the different legal regimes and whether the emerging theoretical vulnerability literature can assist in developing more nuanced legal responses. I argue that the inherent jurisdiction and Care Act 2014 provide an opportunity to move away from the focus (...) on inherent features of vulnerability such as mental disability towards a more nuanced, situational and embodied account of what it means to safeguard ‘vulnerable adults’. This has the potential to be developed in England through the new legal framework of the Care Act and can be achieved through targeting interventions against the situational causes of vulnerability, for example the perpetrators of sexual violence. (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)

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)

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)

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)

Journal of Global Ethics, Volume 9, Issue 3, Page 263-275, December 2013.

Universalistic claims about the nature of justice are presumed to require larger commitments from a global perspective than partialist claims. This essay departs from standard partialist accounts by anchoring partialist claims in a different account of the nature of responsibility. In contrast to substantive responsibility, which is akin to an obligation and derived from principles, relational responsibilities grow out of relationships and their complex intertwining. While such accounts of responsibility are less clear cut, they will prove in the long run (...) to be more valuable in thinking about global ethics. I illustrate this point by considering the moral issue surrounding abandoned relationships. The approach offered here—partiality that rests upon relational responsibilities—makes the responsibilities owed by those in higher income countries towards lower income countries much richer and more complex than is usually presumed. (shrink)

This paper argues for a conception of autonomy that takes social oppression seriously without sapping autonomy of its valuable focus on individual self-direction. Building on recent work in relational accounts of autonomy, the paper argues that current conceptions of autonomy from liberal, feminist and critical theorists do not adequately account for the social features of belief formation. The paper then develops an alternative conception of relational autonomy that focuses on how autonomy contains both individualistic and social epistemic features. Rather than (...) consider autonomy to reside in an impenetrable inner citadel, a place immune from external influences, the paper argues that we must acknowledge the hermeneutic relationship between individual and social processes of belief adjudication. Taking such an argument seriously results in the need to alter our conception of autonomy and the schooling needed to foster its growth. (shrink)

Many commentators have contrasted the way that sociability is theorized in the writings of Mary Astell and Damaris Masham, emphasizing the extent to which Masham is more interested in embodied, worldly existence. I argue, by contrast, that Astell's own interest in imagining a constitutively relational individual emerges once we pay attention to her use of religious texts and tropes. To explore the relevance of Astell's Christianity, I emphasize both how Astell's Christianity shapes her view of the individual's relation to society (...) and how Masham's contrasting views can be analyzed through the lens of her charge that Astell is an “enthusiast.” In late seventeenth-century England, “enthusiasm” was a term of abuse that, commentators have recently argued, could function polemically to dismiss those deemed either excessively social or antisocial. By accusing Astell of enthusiasm, I claim, Masham seeks to marginalize the relational self that Astell imagines and to promote a more instrumental view of social ties. I suggest some aspects of Astell's thought that may have struck contemporaries as “enthusiastic” and contrast her vision of the self with Masham's more hedonistic subject. I conclude that, although each woman differently configures the relation between self and society, they share a desire to imagine autonomy within a relational framework. (shrink)

A standard view in ethics is that ethical issues concern a different range of human concerns than does politics. This essay goes beyond the long-standing dispute about the extent to which applied ethics needs a commitment to ethical theory. It argues that regardless of the outcome of that dispute, applied ethics, because it presumes something about the nature of authority, rests upon and is implicated in political theory. After internalist and externalist accounts of applied ethics are described, “mixed” approaches are (...) considered that contain inevitable political dimensions. A feminist alternative, Walker’s metaethic of responsibility, shows that authority is best understood as relational and that situations of unequal power are therefore often the places where applied ethics arises. Furthermore, in a democratic society, commitments to democracy should shape the account of authority, and, thus, the nature of applied ethics as well. (shrink)

Critiques of the dehumanising aspects of contemporary medical practice have generated increasing interest in the ways in which health care can foster a holistic sense of wellbeing. We examine the relationship between two areas of this humanistic endeavour: narrative and dignity. This paper makes two simple arguments that are intuitive but have not yet been explored in detail: that narrative competence of carers is required for maintaining or recreating dignity, and that dignity promotion in health care practice is primarily narrative (...) in form. The multiple meanings that dignity has in a person’s life are what give the concept power and can only be captured by narrative. This has implications for health care practice where narrative work will be increasingly required to support patient dignity in under-resourced and over-subscribed health care systems. (shrink)

Drawing on Iris Marion Young’s essay, “House and Home: Feminist Variations on a Theme,” Weir argues for an alternative ideal of home that involves: (1) the risk of connection, and of sustaining relationship through conflict; (2) relational identities, constituted through both relations of power and relations of mutuality, love, and flourishing; (3) relational autonomy: freedom as the capacity to be in relationships one desires, and freedom as expansion of self in relationship; and (4) connection to past and future, through reinterpretive (...) preservation and transformative identification. (shrink)

Theorists of oppression commonly accept that unfair social power disparities result in a variety of harms. In particular, oppression is characterized by a loss of open-mindedness in the oppressors, and negative internalization in the oppressed. That is, while oppressors are often unable or unwilling to consider the points of view of the oppressed, the oppressed often come to internalize conditions of oppression by experiencing them as indicative of their own alleged shortcomings. Nevertheless, the psychological mechanisms behind these phenomena have remained (...) underexplored. This is unfortunate, since understanding the psychological processes behind these phenomena could help us understand how they could be reversed. In this work, I aim to fill this lacuna by extending debates on mechanisms of mindreading to show how close-mindedness and negative internalization come about. I synthesize empirical findings to show that while theorizing fosters emotional insulation by “reframing” affective cues from a third-person point of view, simulation fosters feelings of emotional vulnerability and psychological continuity. As a result, while theorizing allows oppressors to take a somewhat detached attitude during self and other interpretation, involuntary simulation fosters negative internalization on the part of the oppressed. (shrink)

This study concerns the sociotechnical bases of human autonomy. Drawing on recent literature on AI ethics, philosophical literature on dimensions of autonomy, and on independent philosophical scrutiny, we first propose a multi-dimensional model of human autonomy and then discuss how AI systems can support or hinder human autonomy. What emerges is a philosophically motivated picture of autonomy and of the normative requirements personal autonomy poses in the context of algorithmic systems. Ranging from consent to data collection and processing, to computational (...) tasks and interface design, to institutional and societal considerations, various aspects related to sociotechnical systems must be accounted for in order to get the full picture of potential effects of AI systems on human autonomy. It is clear how human agents can, for example, via coercion or manipulation, hinder each other’s autonomy, or how they can respect each other’s autonomy. AI systems can promote or hinder human autonomy, but can they literally respect or disrespect a person’s autonomy? We argue for a philosophical view according to which AI systems—while not moral agents or bearers of duties, and unable to literally respect or disrespect—are governed by so-called “ought-to-be norms.” This explains the normativity at stake with AI systems. The responsible people (designers, users, etc.) have duties and ought-to-do norms, which correspond to these ought-to-be norms. (shrink)

Travel for reproductive health care has become a widespread global phenomenon. Within the field, the decision to travel to seek third parties to assist with reproduction is widely assumed to be autonomous. However there has been scant research exploring the application of the principle of autonomy to the experience of the cross-border traveller. Seeking to contribute to the growing, but still small, body of sociological bioethics research, this paper maps the application of the ethical principle of autonomy to the lived (...) experience of infertile individuals who cross borders for reproductive care. It examines their choices as patient, consumer and traveller. It suggests that their experience evidences a contradictory autonomy, which offers them both choice and no choice in their final decision to travel. The paper argues that this lack of meaningful autonomy is enabled by a medicalised framework of infertility which prioritises technology as the cure to infertility. This both shapes expectations of infertile individuals and limits their options of family creation. Ultimately, the paper suggests that sociological bioethics research shows that the liberatory credentials of technology should be questioned, and identifies that this field demands greater scholarly attention. (shrink)

This article addresses the question of women's agency in traditionalist religion, through a study of self-narratives by women in the Orthodox Jewish community of Antwerp, Belgium. Women who study or work outside the boundaries of their community were interviewed about their experiences in negotiating gender ideologies by moving in and between the `secular' and `religious' spaces of higher education, work and home. Various subject positions emerged in terms of either rejecting, separating or reconciling dominant community norms regarding women's proper role (...) with personal trajectories of self-realization and individual autonomy. On the one hand, the results confirm the possibility of women's agency within religious-traditionalist settings and in that sense subscribe to some recent feminist theoretical challenges to secularism. However, it is argued that the younger generation faces more restrictions in negotiating religious and secular gender-role expectations in the Antwerp context. Their prospects depend on the dynamic between global fundamentalist tendencies and local liberal state policies of multicultural accommodation. (shrink)

Background Preconception Expanded Carrier Screening is a genetic test offered to a general population or to couples who have no known risk of recessive and X-linked genetic diseases and are interested in becoming parents. A test may screen for carrier status of several autosomal recessive diseases at one go. Such a program has been piloted in the Netherlands and may become a reality in more European countries in the future. The ethical rationale for such tests is that they enhance reproductive (...) autonomy. The dominant conception of autonomy is individual-based. However, at the clinic, people deciding on preconception ECS will be counselled together and are expected to make a joint decision, as a couple. The aim of the present study was to develop an understanding of autonomous decisions made by couples in the context of reproductive technologies in general and of preconception ECS in particular. Further, to shed light on what occurs in reproductive clinics and suggest concrete implications for healthcare professionals. Main text Based on the shift in emphasis from individual autonomy to relational autonomy, a notion of couple autonomy was suggested and some features of this concept were outlined. First, that both partners are individually autonomous and that the decision is reached through a communicative process. In this process each partner should feel free to express his or her concerns and preferences, so no one partner dominates the discussion. Further, there should be adequate time for the couple to negotiate possible differences and conclude that the decision is right for them. The final decision should be reached through consensus of both partners without coercion, manipulation or miscommunication. Through concrete examples, the suggested notion of couple autonomy was applied to diverse clinical situations. Conclusions A notion of couple autonomy can be fruitful for healthcare professionals by structuring their attention to and support of a couple who is required to make an autonomous joint decision concerning preconception ECS. A normative implication for healthcare staff is to allow the necessary time for decision-making and to promote a dialogue that can increase the power of the weaker part in a relationship. (shrink)

Feminists have argued that autonomous thought and decision-making are attained through respectful parenting and are blighted or destroyed when the parenting is disrespectful or abusive. However, it can be argued that young children are already capable of thinking and deciding things for themselves, so when sexist or abusive parenting leads to an adult incapable of such autonomy, the parenting or other social influences have destroyed what was originally there. It turns out, too, that the thinking and deciding sides of autonomy (...) are actually inseparable aspects of one and the same personal trait/virtue, and it can be shown that the other major human virtues—and human rationality as a whole—also have this dual aspect. We can go on to see that this duality is best interpreted in terms of the indissoluble complementarity of yin 陰 and yang 陽. (shrink)

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)

In international law, ‘humanitarian intervention’ refers to the use of military force by one nation or group of nations to stop genocide or other gross human rights violations in another sovereign nation. If humanitarian intervention is conceived as military in nature, it makes sense that only the most horrible, massive, and violent violations of human rights can justify intervention. Yet, that leaves many serious evils beyond the scope of legal intervention. In particular, violations of women's rights and freedoms often go (...) unchecked. To address this problem, I begin from two basic questions: When are violations of human rights sufficiently serious to require an international response of some sort? What should that response be? By re-orienting the aim and justification of international law to focus on individual autonomy rather than on peace between nations, I argue that women's rights violations other than genocide and mass rape can warrant intervention. Military intervention is often counter-productive to the aim of achieving autonomy, however. I suggest a range of responses to human rights violations that includes military intervention as one end of the spectrum, and combine this with a greater understanding of the scope of human rights violations that require international response. (shrink)

Das belgische Parlament verabschiedete am 28. Mai 2002 das Euthanasiegesetz. Hierdurch wurden die verschiedenen Pflegeeinrichtungen mit einem neuen rechtlichen Rahmen konfrontiert. Das neue Gesetz lässt Euthanasie unter bestimmten Voraussetzungen zu. Dieser Beitrag möchte einige Orientierungspunkte für einen vertretbaren Umgang mit dem Euthanasiegesetz in katholischen Pflegeeinrichtungen liefern. Als Ausgangspunkt hierfür gilt der Grundsatz, dass alles Mögliche getan werden muss, um dem Sterbenden und seiner Umgebung den nötigen Beistand und die bestmögliche Betreuung zu geben und seinem Verlangen nach einem menschenwürdigen Lebensende entgegenzukommen. (...) Wird um Euthanasie gebeten, so entscheiden sich die katholischen Pflegeeinrichtungen Belgiens für die palliative Filterprozedur. Bevor hier die Konturen einer solchen Sorge für ein menschenwürdiges Lebensende umrissen werden, werden zunächst einige fundamentale Annahmen zum Menschsein und dem Wert der Autonomie inhaltlich beleuchtet. Der Autor stützt sich hierfür auf eine relationale Auffassung der Person, wie diese innerhalb der personalistischen Strömungen der Ethik entwickelt wird. (shrink)

(2013). Autonomy and the Normativity Question: Framing Considerations. International Journal of Philosophical Studies. ???aop.label???. doi: 10.1080/09672559.2012.727014.

Genetic information is becoming increasingly used in modern life, extending beyond medicine to familial history, forensics and more. Following this expansion of use, the effect of genetic information on people’s identity and ultimately people’s quality of life is being explored in a host of different disciplines. While a multidisciplinary approach is commendable and necessary, there is the potential for the multidisciplinarity to produce conceptual misconnection. That is, while experts in one field may understand their use of a term like ‘gene’, (...) ‘identity’ or ‘information’ for experts in another field, the same term may link to a distinctly different concept. These conceptual misconnections not only increase inefficiency in complex organisational practices, but can also have important ethical, legal and social consequences. This paper comes at the problem of conceptual misconnection by clarifying different uses of the terms ‘gene’, ‘identity’ and ‘information’. I start by looking at three different conceptions of the gene; the Instrumental, the Nominal and the Postgenomic Molecular. Secondly, a taxonomy of four different concepts of identity is presented; Numeric, Character, Group and Essentialised, and their use is clarified. A general concept of Information is introduced, and finally three distinct kinds of information are described. I then introduce Concept Creep as an ethical problem that arises from conceptual misconnections. The primary goal of this paper is to reduce the potential for conceptual misconnection when discussing genetic identity and genetic information. This is complimented by three secondary goals—1) to clarify what a conceptual misconnection is, 2) to explain why clarity of use is particularly important to discussions of genes, identity and information and 3) to show how concept creep between different uses of genetic identity and genetic information can have important ethical outcomes. (shrink)

This is a selective reading of Love's Labor: Essays on Women, Equality, and Dependency. My aim is twofold: to continue Love Labor's focus on dependency work and relations, adding certain distinctions and questions of my own; and to recognize the conjunction of three perspectives-theoretical, social/political, and personal-that strengthen this focus. I scant particulars of argument and ignore certain issues in the hope of providing a vivid outline of the rewards and demands of dependency as Eva Kittay envisions them.

This article challenges a key tacit assumption underpinning legal and ethical instruments in health care, namely, that people are ideally bounded, independent, and often also strategically rational individuals. Such an understanding of personhood has been criticized within feminist and other critical scholarship as being unfit to capture the deeply relational nature of human beings. In the field of medicine, however, it also causes tangible problems. I propose that a solidarity-based perspective entails a relational approach and as such helps to formulate (...) new solutions to complex ethical and regulatory questions, ranging from caring for people at the end of their lives to improving policies for organ donation and better governance of health data. It also underscores the importance of universal health care. Although a solidarity-based perspective does not require health to be seen as an individually enforceable right, it does influence our understanding of individual rights: it draws attention to how their meaning is shaped by shared social practices. I conclude by arguing that, in light of current pressures for medicine to become more personalized, using a relational understanding of personhood to shape policies and practices is a much needed endeavor. (shrink)

Informed consent is medico-legal orthodoxy and the principal means by which research encounters with the body are regulated in the UK. However, biomedical advancements increasingly frustrate the degree to which informed consent can be practiced, whilst introducing ambiguity into its legal significance. What is more, feminist theory fundamentally disrupts the ideologically liberal foundations of informed consent, exposing it as a potentially inadequate mode of bioethical regulation. This paper explores these critiques by reference to a case study—embryo donation to health research, (...) following fertility treatment, as regulated by the HFEA 1990—and contends that informed consent cannot adequately respond to the material realities of this research encounter. Thereafter, by drawing on feminist theories of vulnerability, this paper proffers an alternative bioethical approach, which calls for structural reform in recognition of the fundamentally bilateral constitution of self and society and a renewed appreciation for the affective/dispositional tenor of lived experience. (shrink)

Das ethische Prinzip des Respekts vor der Autonomie des Patienten/Probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

This article offers an alternative approach to multicultural theories, called ‘caring multiculturalism’. It argues that, despite good intentions, multicultural theory reproduces rhetoric that constructs groups as substantive entities, which leaves little room to accommodate changing power relations. Caring multiculturalism, drawing on caring ethics, feminist critiques of multiculturalism and discursive social psychology, advocates instead the contextualisation of groups’ claims to diversity and of governments’ practices of multiculturalism. As a framework rooted in discursive psychology, caring multiculturalism sees individual and collective identities as (...) relational, negotiated and political, and therefore non-totalising and changeable. As a feminist approach to multiculturalism, it analyses and attempts to change gendered power asymmetries embedded in intra- and intergroup relations by advocating an attentive and responsive approach to the needs and claims of minority groups and of the individuals within them. The article outlines the main tenets of caring multiculturalism with illustrations from multicultural practices in three European municipalities. (shrink)

Fair skin is often regarded as a beauty ideal in many parts of the world. Genetic selection for non-disease traits may allow reproducers to select fair skin for the purposes of beauty, and may be justified under various procreative principles. In this paper I assess the ethics of genetic selection for fair skin as a beauty feature. In particular, I explore the discriminatory aspects and demands of such selection. Using race and colour hierarchies that many would find objectionable, I argue (...) that selection for beauty that is underpinned by such hierarchies is not a trivial selection. Given this, I claim that we should not make such selections. (shrink)

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)

This article argues that immoralists do not fully enjoy autonomous agency because they are not capable of engaging in the proper form of practical reflection, which requires relating to others as having equal standing. An adequate diagnosis of the immoralist’s failure of agential authority requires a relational account of reflexivity and autonomy. This account has the distinctive merit of identifying the cost of disregarding moral obligations and of showing how immoralists may become susceptible to practical reason. The compelling quality of (...) reason should not be represented as the capacity to force them to abide by morality on pain of incoherence. Rather, its authority (and objectivity) is shown when it presents them with the prospect of a transition that makes sense for them to undertake. (shrink)

One of the ethical issues that has been raised recently regarding emerging neurotherapies is that people will be coerced explicitly or implicitly in the workplace or in schools to take cognitive enhancing drugs. This article builds on this discussion by showing how the law may pressure people to adopt emerging neurotherapies. It focuses on a range of private law doctrines that, unlike the criminal law, do not come up very often in neuroethical discussions. Three doctrines—the doctrine of mitigation, the standard (...) of care in negligence, and child custody determinations in family law—are addressed to show how the law may pressure people to consent to treatment by offering a choice between accepting medical treatment and suffering a legal disadvantage. The doctrines considered in this article apply indirect pressure to submit to treatment, unlike court-ordered medical treatment, which applies direct pressure and is not addressed here. The outcome of this discussion is to show that there is a greater range of social pressures that may encourage the uptake of novel neurotherapies than one might initially think. Once treatments that were developed and offered with therapeutic benefits in mind become available, their existence gives rise to unintended legal consequences. This certainly does not mean we should cease developing new therapies that may be of tremendous benefit to patients, but it does raise some questions for physicians and for legal policy-makers. How should physicians, who are required by medical ethical principles to obtain valid consent to treatment, react to a patient’s reluctant consent that is driven by legal pressure? From the legal policy perspective, are our legal doctrines satisfactory or should they be changed because, for example, they unduly promote the collective interest over individual freedom to reject medical treatment or because they channel us toward economically efficient treatments to the detriment of more costly but potentially superior approaches of dealing with behavioural problems? (shrink)

Around the world the wealthy can get their lives extended while the poorget little basic medical help. Over the same years that the field ofbioethics has prospered and expanded, this disparity has increased.Reasons for the failure of bioethics to successfully address thishealth/wealth issue include its identification with the cognitiveand social authority of medicine; its gatekeeping behavior;its funding sources; its questionable use of ``principlism'' andits emphasis on crises and dilemmas to the neglect of ``housekeeping''issues. The work of most women in bioethics (...) rarely addresses thehealth/wealth issue; if it does, their work may be ignored, aswere the recommendations of Canadian feminists working under governmentgrants. To achieve equity in health care, the structure of both medicineand bioethics needs to be changed. Yet, since bioethicists generallyhave accepted the status quo, this seems unlikely to happen. (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)

The vagueness or imprecision of ‘the normal’ allows it to be exploited for various purposes and political ends. It is conspicuous in both medicine and athletics; I am going to try to say something about the normal in each of these areas. In medicine the idea of the normal is often deployed in understanding what constitutes disease and hence, as some see it, in determining the role of physicians, in determining what is or ought to be covered by insurance, and (...) in underwriting certain views on social justice. In athletics the use of performance enhancing substances raises different sorts of questions about the normal, especially when it comes to deciding what constitutes an enhancement and which enhancements, if any, are acceptable. (shrink)

Public health involves the use of power to change institutions and redistribute resources and deliberately to shape individual thought and behavior. This requires normative legitimation and demands ethical critique. This article explores concepts that are vital to public health ethics, but have been relatively neglected. These are membership, solidarity and the concept of place. The article argues that the practice of public health should recognize the equal rights of membership in communities of health justice. Public health should also rely on (...) a sense of obligation and mutual aid in a world of shared vulnerability and reciprocal recognition. Finally, public health achieves its goals not merely—and perhaps not most fundamentally—through information and altering the logical ratiocination of individuals or groups, but rather through the reformation of sense and sensibility. (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)

‘Undermatched’ is the name education researchers have given to the surprisingly large number of students who attend post-secondary institutions which are less selective than their academic credentials would permit, or who simply fail to even apply for college when they are qualified to do so. At first, this might seem like an obviously bad trend, especially as rates of undermatching are much higher among students from low-income backgrounds. This article argues, however, that individual cases of undermatching are sometimes morally acceptable (...) when the choice is made autonomously. Some readers will have trouble calling this situation just, as it is one in which a disadvantaged person has decided on a course of action which will likely perpetuate this disadvantage. To address this, the article considers alternate ways in which we might distinguish between autonomous and non-autonomous choices in undermatching cases. The article concludes with some indications about how this analysis should affect future theory and policy intended to protect against unjust undermatching. (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...