Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty (...) in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes for which (...) a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

Feminist socially constitutive conceptions of autonomy make the presence of idealized social conditions necessary for autonomy. I argue that such conceptions cannot, when applied under nonideal conditions, play two key feminist theoretical roles for autonomy: the roles of anti-oppressive character ideal and paternalism-limiting concept. Instead, they prescribe action that reinforces oppression. Treated as character ideals, socially constitutive conceptions of autonomy ask agents living under nonideal ones to engage in self-harm or self-subordination. Moreover, conceptions of autonomy that make idealized social conditions (...) a requirement of autonomy yield the conclusion that oppressed agents are appropriate objects of paternalism. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper (...) is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

Many popular artificial intelligence (AI) ethics frameworks center the principle of autonomy as necessary in order to mitigate the harms that might result from the use of AI within society. These harms often disproportionately affect the most marginalized within society. In this paper, we argue that the principle of autonomy, as currently formalized in AI ethics, is itself flawed, as it expresses only a mainstream mainly liberal notion of autonomy as rational self-determination, derived from Western traditional philosophy. In particular, we (...) claim that the adherence to such principle, as currently formalized, does not only fail to address many ways in which people’s autonomy can be violated, but also to grasp a broader range of AI-empowered harms profoundly tied to the legacy of colonization, and which particularly affect the already marginalized and most vulnerable on a global scale. To counter such a phenomenon, we advocate for the need of a relational turn in AI ethics, starting from a relational rethinking of the AI ethics principle of autonomy that we propose by drawing on theories on relational autonomy developed both in moral philosophy and Ubuntu ethics. (shrink)

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation of situational vulnerability (...) and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (shrink)

My aim in this dissertation is to analyze Black oppression and White domination. I attempt to show how social systems unjustly diminish Black Americans’ opportunities to form and pursue their conceptions of good lives and unjustly strengthen White Americans’ opportunities for the same. I believe that the accounts of Black oppression and White domination I offer are more adept at identifying the expansive and varied wrongs of Black oppression in America, analyzing the relationship between theorizing oppression and addressing oppression through (...) social and political change in America, and demonstrating the ways that Whites benefit from and are incentivized to maintain oppressive systems in America, than the accounts put forward by other theorists. In Chapter 1, I begin by discussing why I frame my project in terms of oppressive “wrongs” rather than “harms”. I worry the term ‘harm’ may be taken to imply that one has experienced subjective suffering or a measurable loss, whereas I am concerned with instantiations of oppressive systems even when they don’t cause the person subject to the oppressive system to experience a measurable loss or subjective suffering. In an effort to describe how I identify wrongs, I then argue that in virtue of the deep importance of freely pursuing one’s chosen life plan, any barriers one faces in pursuing his or her life plan must be justifiable. Barriers one experiences in virtue of his or her race are typically not justifiable. On this basis, I argue for my principle of racial injustice, which states that individuals are prima facie wronged by socially constructed barriers to their abilities to form and seek their conception of a good life if those barriers exist in virtue of their race. The “prima facie” nature of the wrongness is significant, I argue, because correcting the injustices of Black oppression will require that Whites face some barriers to pursuing our life plans that we do not currently face; it is not the case, then, that every race-based barrier is truly wrongful. I then discuss my understanding of race, arguing that race’s mutability across contexts and how one’s race is intimately tied to systems of subordination and domination support my view that race is socially constructed. I end with a brief history of White domination and Black subordination in the U.S. In Chapter 2, I outline general experiences of racism as espoused by Black writers and the statistical data that support these accounts. I then take a deep look at mass incarceration, including a history of the system, its disproportional impact on Black Americans, and the many resulting injustices inflicted largely on incarcerated Black Americans, their families, and their communities. I specifically highlight the recognition-wrongs inflicted on Black Americans through mass incarceration, where recognition-wrongs are acts that function primarily as a mode of dehumanizing individuals. Recognition-wrongs include verbal degradation through things like slurs, but also epistemic injustices, a concept developed by Miranda Fricker and others to identify injustices that wrong individuals in virtue of their status as knowers and communicators of knowledge. I then discuss kinship-wrongs, a concept I develop to identify wrongs that impact people’s ability to form and maintain relationships. I highlight and conceptualize these wrongs in an attempt to draw attention to their significance in racial subordination. In Chapter 3, I develop an account of oppression that is particularly responsive to race-based wrongs. I begin by showing why the influential accounts authored by Iris Marion Young and Ann Cudd are unsatisfactory for capturing Black oppression. I attempt to develop an account that is sensitive to the experiences of subordination detailed by Black Americans, equipped to address the material harms of oppression, and also able to make sense of the recognition- and kinship-wrongs raised in Chapter 2. I ultimately determine that a member of a c-group is subject to an oppressive wrong when, in virtue of his or her or their membership in that c-group, he or she or they suffer wrongs that are systematically perpetrated through social, political, or legal norms, conventions, or practices. A c-group is any collection of persons who share some set of constraints, incentives, penalties, and the like. I end the chapter by carefully describing my commitments to each clause of the definition of oppression, beginning by analyzing c-groups, describing systematically perpetrated wrongs, explaining what it means to be wronged in virtue of one’s c-group membership, and showing that my account of oppression is sensitive to both material and recognition-wrongs. In Chapter 4, I argue that we ought to understand oppression in the framework of a capabilities approach. I begin by explaining the concept of capabilities, which are real opportunities to function in particular ways. I then argue that securing capabilities is a better aim for justice than ensuring that people function in certain valuable ways because a focus on capabilities protects people’s opportunities to pursue the kinds of lives they want to live, respecting their interest in freely determining their life goals, while a focus on protecting valuable functionings inappropriately prescribes life goals to them. I show how capabilities can be utilized as part of a theory of justice, and argue that my utilization of capabilities, combined with the other moral commitments I defend throughout the dissertation, comprises a rectificatory theory of racial justice aimed at eliminating Black oppression. I argue that through the framework of capabilities, I can analyze both the material and recognition-wrongs of oppression, avoid the kinds of bad idealizations that often skew our understanding of oppressive systems and their impact, and make judgments about modern day society without developing an account of perfect justice. I next show that to avoid inflicting further recognition-wrongs, it is essential that oppressed peoples are the primary arbiters of which capabilities and oppressive systems should be prioritized in policy and advocacy. I conclude Chapter 4 with a brief sketch of how we can turn the priorities of the oppressed into public policy, moving from the prioritization process, to policy development, to implementing policies, and finally to monitoring and revising them. My final chapter, Chapter 5, shows how my account can also be used to analyze the norms of White domination that coincide with Black oppression. I begin by discussing “correlative capabilities,” which are those capabilities that are strengthened for Whites in virtue of the fact that Whites are not subject to oppression as Black Americans are. My discussion of correlative capabilities maps closely onto the advantages typically described as White privilege. I then turn to more insidious advantages Whites gain from Black oppression. I argue that oppressive norms advantage Whites by creating a social structure that empowers us with the capabilities to dominate racial narratives and ignore our racialized identities. The capability to dominate racial narratives consists in Whites’ abilities to pontificate on racialized events without justification for our views and still have our perspectives treated as mainstream, worthy of debate, and often as nearly definitive. I demonstrate this capability in action by examining Colin Kaepernick’s protest in the NFL, the coverage it received, and his resulting treatment. I then discuss Whites’ capability to ignore our racialized identities, showing how we establish Whiteness as a central, unconditioned perspective. Whites see ourselves as “simply people,” while seeing non-Whites as raced. This leads to Whites promoting color-blind conceptions of justice, which move us farther from true justice by ignoring social norms’ impact on policy development and implementation. I then show how Whites may go one step further and argue that we are victimized by “reverse racism” when efforts are made to eliminate oppressive systems. Finally, I end Chapter 5 with a discussion of how Whites are also disadvantaged by Black oppression, particularly in our capabilities to perform our jobs well, live morally, and establish and maintain relationships. I then conclude the dissertation by discussing how we might teach race-sensitive virtues in an effort to change White-favorable social norms. (shrink)

According to relational views of autonomy, some social relations or forms of dependence are necessary for autonomous agency. Recent relational theorists have primarily focused on autonomy of action or practical autonomy, and the result has been a shift away from individualistic conceptions of autonomy in the practical realm. Despite these trends, individualistic conceptions are still the default when it comes to autonomy of belief or intellectual autonomy. In this paper, I argue for a relational account of intellectual autonomy. Specifically, I (...) claim that intellectual autonomy requires a sense of one’s standing as an equal member of the epistemic community. (shrink)

Existentialist philosophy offers an understanding of how trying to eliminate ambiguities that inevitably mark the human condition only seemingly leads to freedom. This existentialist outlook can also serve to shed light on how democratic politics may similarly show tendencies which aim at overcoming immanent tensions. Such tendencies in democratic politics can be clarified using Sartre’s notion of ignorance – and truth as its counterpart. His concept of ignorance goes beyond merely facts or knowledge and refers to a mode of being. (...) It expresses a subject’s desire to avoid, rather than confront, resistances stemming from the world. Based on a distinction of different forms in which this orientation can manifest itself, this article shows how democratic politics, too, can be threatened by ignorance as a way of doing politics. This ignorance comes in different guises which all express a desire to eliminate tensions that democratic politics cannot overcome without undermining itself. (shrink)