Decision making in health care contexts is often deeply challenging for the patients, their close ones, and those who care for them. All of them have and perceive different forms of responsibilitie...

This is the most comprehensive book ever published on philosophical methodology. A team of thirty-eight of the world's leading philosophers present original essays on various aspects of how philosophy should be and is done. The first part is devoted to broad traditions and approaches to philosophical methodology. The entries in the second part address topics in philosophical methodology, such as intuitions, conceptual analysis, and transcendental arguments. The third part of the book is devoted to essays about the interconnections between philosophy (...) and neighbouring fields, including those of mathematics, psychology, literature and film, and neuroscience. (shrink)

Choice architecture is heralded as a policy approach that does not coercively reduce freedom of choice. Still we might worry that this approach fails to respect individual choice because it subversively manipulates individuals, thus contravening their personal autonomy. In this article I address two arguments to this effect. First, I deny that choice architecture is necessarily heteronomous. I explain the reasons we have for avoiding heteronomous policy-making and offer a set of four conditions for non-heteronomy. I then provide examples of (...) nudges that meet these conditions. I argue that these policies are capable of respecting and promoting personal autonomy, and show this claim to be true across contrasting conceptions of autonomy. Second, I deny that choice architecture is disrespectful because it is epistemically paternalistic. This critique appears to loom large even against non-heteronomous nudges. However, I argue that while some of these policies may exhibit epistemically paternalistic tendencies, these tendencies do not necessarily undermine personal autonomy. Thus, if we are to find such policies objectionable, we cannot do so on the grounds of respect for autonomy. (shrink)

In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also (...) have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann’s notion of “holding” persons’ identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this “holding” work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be “held” in place. (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)

This paper argues that it will be important for new genomic technologies to recognize the limits of traditional approaches to informed consent, so that other-regarding implications of genomic information can be properly contextualized and individual rights respected. Respect for individual autonomy will increasingly require dynamic consideration of the interrelated dimensions of individual and broader community interests, so that the interests of one do not undermine fundamental interests of the other. In this, protection of individual rights will be a complex interplay (...) between individual and community concerns. (shrink)

Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn to (...) a “social paradigm” of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled. (shrink)

RÉSUMÉ: Dans cet article, je m’intéresse à l’éthique de l’agentivité sexuelle courante. Il s’agit, plus particulièrement, des questions morales concernant quand, comment et pourquoi nous nous identifions à un type donné d’agent sexuel. Comme l’auto-identification met en jeux une combinaison complexe de processus individuels et sociaux, un cadre conceptuel qui rend justice à ces processus permettrait une analyse de l’éthique de l’auto-identification sexuelle. Je présente le concept de l’authenticité sexuelle comme étant utile dans les contextes où elle comporte deux aspects (...) principaux : l’adoption d’une identité sexuelle qui nous est propre et l’explication que nous en donnons à et avec d’autres personnes. (shrink)

Patientenverfügungen werden häufig als Ausdruck eines Bestrebens verstanden, ausschließlich selbst über die eigene Behandlung am Lebensende oder in anderen medizinisch kritischen Situationen entscheiden zu wollen. Kritische Stimmen wenden sich gegen eine Marginalisierung von Angehörigen oder ein verkürztes Verständnis von Autonomie, welches von der Relationalität als Grundgegebenheit menschlicher Existenz abstrahiert. Im vorliegenden Beitrag wird zunächst der rechtliche Rahmen beschrieben, der die Praxis bezüglich Patientenverfügungen und Stellvertretern in der Schweiz bestimmt. Zudem werden in der Schweiz verfügbare Patientenverfügungsformulare hinsichtlich der darin vorgesehenen Rolle (...) von Angehörigen bzw. nahe stehenden Personen analysiert. Abschließend soll gefragt werden, ob Patientenverfügungen, wie sie derzeit im Schweizer Kontext genutzt werden, wirklich als Instrumente rein individualistischer Selbstbestimmung verstanden werden können. (shrink)

Debates over how to conceptualize the nursing role were prominent in the nursing literature during the latter part of the twentieth century. There were, broadly, two schools of thought. Writers likeHenderson andOrem used the idea of a self‐care deficit to understand the nurse as doing for the patient what he or she could not do alone. Later writers found this paternalistic and emphasized the importance of the patient's free will. This essay uses the ideas of positive and negative freedom to (...) explore the differing conceptions of autonomy which are implicit in this debate. The notion of positive freedom has often been criticized as paternalistic, and the criticisms of self‐care in the nursing literature echo criticisms from political philosophy. Recent work on relational autonomy and on the relationship between autonomy and identity are used to address these objections. This essay argues for a more nuanced conception of the obligation to support autonomy that includes both positive (freedomto) and negative (freedomfrom) dimensions. This conception of autonomy provides a moral foundation for conceptualizing nursing in something like Henderson's terms: as involving the duty to expand the patient's capacities. The essay concludes by generalizing the lesson. Respect for autonomy on the part of any health care provider requires both respect for the patient's choices and a commitment to expand the patient's ability to actualize their choices. (shrink)

An examination of case law on forced marriage reveals that in addition to physical force, the role of emotional pressure is now taken into consideration. However, in both legal and policy discourse, the difference between arranged and forced marriage continues to be framed in binary terms and hinges on the concept of consent: the context in which consent is constructed largely remains unexplored. By examining the socio-cultural construction of personhood, especially womanhood, and the intersecting structural inequalities that constrain particular groups (...) of South Asian women in the UK, we argue that consent and coercion in relation to marriage can be better understood as two ends of a continuum, between which lie degrees of socio-cultural expectation, control, persuasion, pressure, threat and force. Women who face these constraints exercise their agency in complex and contradictory ways that are not always recognised by the existing exit-centred state initiatives designed to tackle this problem. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

ABSTRACT In this article we use theory and empirical evidence to synthesize a model for the analysis of autonomy in people with addictions. We review research on motivation and denial as accepted addiction constructs that need to be replaced with non-stigmatizing and autonomy-supportive language when seeking to ?treat? addicts. We present three main factors involved in relational autonomy in addiction (mentalizing, positive self-concept, and stigma), and illustrate our model by examining variations on these parameters in two case studies of heroin (...) addicts. We conclude that a growth perspective is needed to assess functioning in populations believed to be ?addicted? and make suggestions for assessment. (shrink)

I begin by discussing forms of cosmopolitanism that motivate challenges to distributive accounts of global justice. I then use Sen's version of the capabilities approach to show how distributive accounts fall short, why an overarching theory of justice is not needed, and that democracy understood as the exercise of public reasoning can do the work of identifying and addressing injustices. That said in favor of Sen, I argue that his account fails to attend to the kinds of injustices emerging from (...) relationships of power and the institutions and structures in which these relationships are embedded. To show this, I outline features of a feminist relational approach, which I then apply to Canada's attempt to address historic harms through the Indian Residential Schools Truth and Reconciliation Commission. While I agree with Sen that we do not need a theory of global justice that is universal, ideal, impartial, or abstracted from context, I aim to broaden the scope of justice beyond both distributive accounts and Sen's version of the capabilities approach. (shrink)

In this paper we defend the notion of narrative identity against Galen Strawson's recent critique. With reference to Elyn Saks's memoir of her schizophrenia, we question the coherence ofStrawsons conception of the Episodic self and show why the capacity for narrative integration is important for a flourishing life. We aho argue that Scú put pressure on narrative theories that specify unduly restncúve constraints on self-constituting narratives, and chrify the need to distinguish identity from autonomy.

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

The majority of current attention on the question of autonomy has focused on the internal reflection of the agent. The quality of an agent’s reflection on her potential action (or motivating desire or value) is taken to determine whether or not that action is autonomous. In this paper, I argue that there is something missing in most of these contemporary accounts of autonomy. By focusing overwhelmingly on the way in which the agent reflects, such accounts overlook the importance of what (...) the agent is reflecting upon. Whichever of these current formulations of autonomy we accept, reflection could be undertaken in full accordance with the conditions set, and yet the action fail to be autonomous. This will occur, I argue, if the agent is mistaken about the object of her reflection. More precisely, if she has a particular kind of false belief about the action she is contemplating undertaking, then no amount of reflection can render that action autonomous. This suggests the need for externalist conditions to be incorporated into an account of autonomy. (shrink)

This article explores the notion of the dislocated self following deep brain stimulation (DBS) and concludes that when personal identity is understood in dynamic, narrative, and relational terms, the claim that DBS is a threat to personal identity is deeply problematic. While DBS may result in profound changes in behaviour, mood and cognition (characteristics closely linked to personality), it is not helpful to characterize DBS as threatening to personal identity insofar as this claim is either false, misdirected or trivially true. (...) The claim is false insofar as it misunderstands the dynamic nature of identity formation. The claim is misdirected at DBS insofar as the real threat to personal identity is the discriminatory attitudes of others towards persons with motor and other disabilities. The claim is trivially true insofar as any dramatic event or experience integrated into one’s identity-constituting narrative could then potentially be described as threatening. From the perspective of relational personal identity, when DBS dramatically disrupts the narrative flow, this disruption is best examined through the lens of agency. For illustrative purposes, the focus is on DBS for the treatment of Parkinson’s disease. (shrink)

Abstract This paper examines a convergence between Heidegger's reconceptualization of subjectivity and intersubjectivity and some recent work in feminist philosophy on relational autonomy. Both view the concept of autonomy to be misguided, given that our capacity to be self-directed is dependent upon our ability to enter into and sustain meaningful relationships. Both attempt to overturn the notion of a subject as an isolated, atomistic individual and to show that selfhood requires, and is based upon, one's relation to and dependence upon (...) others. The paper argues that Heidegger's notion of authentic Mitsein (being-with) rejects traditional notions of autonomy and subjectivity in favor of a relational model of selfhood. Ultimately, it provides a new point of entry into contemporary debates within feminist philosophy on Heidegger's thinking and defends Heidegger from certain feminist critiques. (shrink)

The Hypothesis of Extended Cognition (HEC)—that many cognitive processes are carried out by a hybrid coalition of neural, bodily and environmental factors—entails that the intentional states that are reasons for action might best be ascribed to wider entities of which individual persons are only parts. I look at different kinds of extended cognition and agency, exploring their consequences for concerns about the moral agency and personal responsibility of such extended entities. Can extended entities be moral agents and bear responsibility for (...) actions, in addition to or in place of the individuals typically held responsible? What does it mean to be autonomous when one’s cognition is influenced and supported by a milieu of environmental factors? To answer these questions, I explore strong parallels between HEC’s critique of individualism in cognition, and feminist critiques of individualist accounts of self, agency, and autonomy. This relational and social conception of autonomous agency, as scaffolded and supported (or undermined and impaired) by a milieu of social, relational, and normative factors, has important lessons for HEC. Drawing together these two visions of distributed and decentralized aspects of personhood highlights how cognition, action, and responsibility are inextricably linked. It also encourages a reconceptualization of all cognition and all concerns about responsibility for actions, not simply as sometimes extended around individuals, but as fundamentally communal, social, and normative, with individual cognition and individual moral responsibility being derivative special cases, not the paradigm examples. Individuals are merely one of many possible loci of cognition, action, and responsibility. (shrink)

. Morality is often dismissed as irrelevant in what is seen as the global anarchy of rival states each pursuing its national interest. When morality is invoked, it is usually the morality of justice with its associated moral conceptions of individual rights, equality, and universal law. In the area of moral theory, an alternative moral approach, the ethics of care, has been developed in recent years. It is beginning to influence how some see their global responsibilities.

The portrayal of novel neurotechnologies in Steven Spielberg’s Minority Report serves to inoculate viewers from important moral considerations that are displaced by the film’s somewhat singular emphasis on the question of how to reintroduce freedom of choice into an otherwise technology driven world. This sets up a crisis mentality and presents a false dilemma regarding the appropriate use, and regulation, of neurotechnologies. On the one hand, it seems that centralized power is required to both control and effectively implement such technologies (...) and, on the other hand, individual heroic resistance is required to protect citizens from the invasions of personal privacy and state control made possible through neurotechnologies. While Minority Report, as a dystopic vision of emergent neurotechnologies, engages surface ethical issues it risks cheapening them through its rather simplistic, dichotomous analysis. Most conspicuously absent from this approach is a sense of the social matrices that work to circumscribe or augment expressions of human freedom, privacy, control and power that are all implicated in our engagement with novel neurotechnologies. Were Minority Report unique in this respect it would have little interest, but we think this type of cheapening of ethical discourse about novel technologies is common. Because science fiction film informs the social imaginary in which ethical considerations and ultimately policy decisions take place, such cheapening risks subverting pervasive and tangible ethical issues by focusing on the sensationalistic and simplistic. (shrink)

Freedom of religious expression is to many a fundamental element of their identity. Yet the jurisprudence of the European Court of Human Rights on the Islamic headscarf issue does not refer to autonomy and identity rights of the individual women claimants. The case law focuses on Article 9 of the European Convention on Human Rights, which provides a legal human right to freedom of religious expression. The way that provision is interpreted is critically contrasted here with the right to personal (...) autonomy and identity now developed by that court in interpreting Article 8 which contains a right to respect one’s private life. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

A summary of the philosophical literature on trust.

To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems that (...) when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question. (shrink)

Some philosophers object that Kant's respect cannot express mutual recognition because it is an attitude owed to persons in virtue of an abstract notion of autonomy and invite us to integrate the vocabulary of respect with other persons-concepts or to replace it with a social conception of recognition. This paper argues for a dialogical interpretation of respect as the key-mode of recognition of membership in the moral community. This interpretation highlights the relational and practical nature of respect, and accounts for (...) its governing role over other persons-regarding concepts. (shrink)

: The article first develops an account of autonomy, explaining individual autonomy by means of three normative components and then discussing two objections. The first objection claims that autonomy has to be thought of as essentially relational; this objection is refuted. The second objection, labeled the skeptical objection, claims that we simply do not live autonomously, nor could we ever. Reference is made to novels by Iris Murdoch to present a skeptical solution to this objection.

According to Marshall et al. (2024), some of the patients who refuse to stay in observation after being resuscitated following an opioid overdose are likely not making an autonomous choice. While I do not intend to dispute this claim, it merits discussion what is the concept of autonomy at play in making this assessment. I contend that the concept at work is more substantive than Marshall et al. acknowledge—and more substantive, too, than the form of autonomy usually thought to underpin (...) the moral justification of the requirement of informed consent . (shrink)

In this paper, following the taxonomy developed by Mackenzie, Rogers and Dodds of different sources and states of vulnerability, I claim that wild animals are inherently and situationally vulnerable. This is because they can experience suffering as a response to certain internal and external states and have a high exposure to, and a low capacity to cope with, harmful natural processes. From this it follows that we have a moral obligation to support and assist individuals who are occurrently vulnerable and (...) to reduce the risk of dispositional vulnerabilities becoming occurrent in the future, by endorsing some form of what I call ‘environmental enhancement’. Finally, I pay critical attention to how to prevent interventions aimed at ameliorating vulnerability from paradoxically generating pathogenic vulnerabilities. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in (...) alignment with one's values and goals). (shrink)

Over the last years, some of Spinoza studies have shifted to a consideration of the relational character of his ethics by focusing on the notion of autonomy. This concept is foreign to Spinoza's vocabulary. Therefore, I will attempt to explain what Spinozan relational autonomy is and its connection with the most important ethical concept in his philosophy: freedom. Following considerations about Spinozan freedom, I claim that it entails a relational character and that, for this reason, it is equal to relational (...) autonomy. We are free when our joint action is based on adequate ideas of what we have in common with others. (shrink)

The clinical relationship has been underexplored in dementia care. This is in part due to the way that the clinical relationship has been articulated and understood in bioethics. Robert Veatch’s social contract model is representative of a standard view of the clinical relationship in bioethics. But dementia presents formidable challenges to the standard clinical relationship, including ambiguity about when the clinical relationship begins, how it weathers changes in narrative identity of patients with dementia, and how the intimate involvement of family (...) fits alongside a paradigmatically dyadic relationship. Drawing on work in recent feminist theory, a critique is offered of the standard clinical relationship in bioethics as underwritten by an individualistic conception of autonomy. An alternative view of the clinical relationship in dementia, one that embraces a relational account of autonomy, is put forward. (shrink)

This article examines Re Imogen (No 6) (2020) 61 Fam LR 344, a decision of the Family Court of Australia, which held that an application to the Family Court is mandatory if a parent or a medical practitioner of a child or adolescent diagnosed with gender dysphoria disputes the diagnosis, the capacity to consent, or the proposed treatment. First, we explain the regulatory framework for the medical treatment of gender dysphoria in children and adolescents, including the development of the welfare (...) jurisdiction under Section 67ZC of the Family Law Act 1975 (Cth). We then provide an overview of the Re Imogen decision, and discuss the balancing exercise involved in determining a child’s best interests in the medical treatment context. We challenge the Family Court’s conclusion that, in relation to a dispute about diagnosis or treatment, a finding that the child or adolescent is Gillick competent to consent to treatment is not determinative, and the Family Court must determine the dispute. We argue that this conclusion represents an unjustified incursion into the right of Gillick competent transgender children and adolescents to make decisions about their own bodies and identities, and that the protective role of parents and the Family Court cannot justify interfering with their bodily autonomy in this context. Finally, we propose an alternative regulatory framework that removes the Family Court from the medical treatment process for gender dysphoria in circumstances of dispute between a parent and their Gillick competent child. (shrink)

This qualitative study analysed the agency of eight non-abusing mothers in the Turkish Cypriot Community after disclosure that their child had been sexually abused by someone outside the family. The aim was to discover how, after disclosure, such mothers act to protect their children in the contexts of their family and community. The data were gathered via semi-structured in-depth interviews and analysed using Interpretative Phenomenological Analysis. In the nuclear family context, maternal agency emerged in the form of motherhood skills, including (...) emotionally supporting the abused child, double-checking the child’s safety or limiting the child’s mobility, and controlling the actions of adult sons. In the community context, maternal agency was manifested in efforts to prevent men in the extended family or the abuser’s family from concealing the abuse and to obtain informal support from others such as birth or extended family members. The women were usually successful in hiding their reactions or making decisions in their children’s best interest despite frequently having to cope with the reality of living in a restrictive and patriarchal culture. The results emphasise the need for working with the general public and professionals to change the culture of silence and to improve the social support network for sexually abused children and non-abusing family members, especially mothers. (shrink)

Our values change. What we value, want, desire, prefer, and how much; for nearly everyone, these will be different at different times in their life. These changes can be gradual or abrupt; they can be long-lasting or short-lived; and they can be induced by forces outside yourself or they can come from within or they can have no specific catalyst at all. Such preference change raises a number of questions for our theorising about rational choice, and these have been discussed (...) at length. In §2 and §3, I’ll outline two of these questions along with some of the putative solutions that have been proposed. But preference change also raises questions for our theorising about autonomy, and these have hardly been considered at all. In §4, I’ll outline three problems for personal autonomy; and in §5, I’ll outline one problem for political autonomy. In §6, I conclude. (shrink)

The central claim of this article is that narrative agency, which I will define as a subject’s capacity to make sense of herself as an ‘I’ over time and in relation to other ‘I’s, is a precondition for identity formation. I engage with two critiques of this claim: first, that narrative agency is limited by, rather than primary to, subordinating gender norms and, second, that a view of narrative agency as primary is committed to too ambitious a conception of the (...) communicability of narratives. I argue that the narrative model survives these two criticisms by emphasising its irreducibility, its inherent relationality and its generative potential. I then suggest some of the ways in which a concept of narrative agency might help feminist critical theory to posit mutual recognition and respect as productive criteria for progressive self and social transformation. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative (...) care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

According to a traditional account, moral cognition is an achievement gained over time by sharing a practice under the guidance and the example of the wise, in analogy with craft and apprenticeship. This model captures an important feature of practical reason, that is, its incompleteness, and highlights our dependence on others in obtaining moral knowledge, coherently with the socially extended mind agenda and recent findings in empirical psychology. However, insofar as it accords to exemplars’ decisive authority to determine the standard (...) of correctness for moral cognition, the model does not offer protection against arbitrariness and discrimination. The article argues that to understand the socially distributed nature of practical knowledge, we have to discard the notion of exemplars and reconceive of others as having equal normative standing. This claim allows us to revisit the conception of autonomy as key to distributed practical knowledge. While autonomy does not amount to selfsufficiency and self-reliance, it does demand independence of judgement and stands in contrast to servility, submission, and other sorts of defective ways of relying on others. The requirement of equal standing provides the basis for distinguishing between proper and improper reliance on others. Keywords: autonomy, Aristotle, exemplarism, extended mind, constructivism, practical knowledge, equal standing. (shrink)

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, (...) knowledge, and capacity, and reducing hazard. (shrink)

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

'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)

Philosophy and Literature is an internationally renowned refereed journal founded by Denis Dutton at the University of Canterbury, Christchurch. It is now published by the Johns Hopkins University Press. Since its inception in 1976, Philosophy and Literature has been concerned with the relation between literary and philosophical studies, publishing articles on the philosophical interpretation of literature as well as the literary treatment of philosophy. Philosophy and Literature has sometimes been regarded as iconoclastic, in the sense that it repudiates academic pretensions, (...) insidious jargon and institutional vogue. Dutton, who remains the editor, still writes a regular column. A distinctive feature of Philosophy and Literature was the annual Bad Writing Contest, held from 1995–98, which sought to identify (and publish) the ‘most stylistically lamentable passages’ of academic prose, often to great amusement. (shrink)