Agency and representation are viewed as preconditions for democratic action. The dominant understanding of agency and representation is defined in terms of certain capacities and abilities that are considered to constitute the basis of personhood. The article will put into question this understanding and the assumptions that underpin it and argue that it rests on a mistaken conception of human animality – one that reduces the self to an autonomous and disembodied rational mind. The article will also suggest that it (...) is problematic because it marginalizes more than human forms of life – as well as those of us who are differently human – and excludes their points of view from the political processes of world making. In contrast, I will put forward an understanding of agency and representation that is attuned to the relational dimensions of all life on earth. By paying attention to the semiotic propensities that all forms of life share – which entails considering nonlinguistic forms of communication – this article responds to the need for more radically democratic ways of listening, giving voice, and caring for the earth’s beings and the relations that form the conditions for life to flourish. (shrink)

In the age of artificial intelligence, the common interest in human autonomy is experiencing a revival. Autonomy has formerly and mostly been investigated from a theoretical scientific perspective, in which scholars from various disciplines have linked autonomy with the concepts of dignity, independence from others, morality, self-awareness, and unconventionality. In a series of three semi-qualitative, preregistered online studies, we investigated laypersons' understanding of autonomy with a bottom-up procedure to find out how far lay intuition is consistent with scientific theory. First, (...) in Study 1, participants provided us with at least three and up to 10 examples of autonomous behaviors, for a total of 807 meaningful examples. With the help of blinded research assistants, we sorted the obtained examples into categories, from which we generated 34 representative items for the following studies. Next, in Study 2, we asked a new sample of participants to rate the degree of autonomy reflected in each of these 34 items. Last, we presented the five highest-rated and the five lowest-rated items to the participants of Study 3, whom we asked to evaluate how strongly they represented the components of autonomy: dignity, independence from others, morality, self-awareness, and unconventionality. We identified that dignity, independence from others, morality, and self-awareness significantly distinguished between high- and low-autonomy items, implying that high autonomy items were rated higher on dignity, independence from others, morality, and self-awareness than low autonomy items, but unconventionality did not. Our findings contribute to both our understanding of autonomous behaviors and connecting lay intuition with scientific theory. (shrink)

For nearly two decades, ethicists have expressed concerns that the further development and use of memory modification technologies (MMTs)—techniques allowing to intentionally and selectively alter memories—may threaten the very foundations of who we are, our personal identity, and thus pose a threat to our well-being, or even undermine our “humaneness.” This paper examines the potential ramifications of memory-modifying interventions such as changing the valence of targeted memories and selective deactivation of a particular memory as these interventions appear to be at (...) the same time potentially both most promising clinically as well as menacing to identity. However, unlike previous works discussing the potential consequences of MMTs, this article analyzes them in the context of the narrative relational approach to personal identity and potential issues related to autonomy. I argue that such a perspective brings to light the ethical aspects and moral issues arising from the use of MMTs that have been hidden from previously adopted approaches. In particular, this perspective demonstrates how important the social context in which an individual lives is for the ethical evaluation of a given memory-modifying intervention. I conclude by suggesting that undertaking memory modifications without taking into account the social dimension of a person’s life creates the risk that she will not be able to meet one of the basic human needs—the autonomous construction and maintenance of personal identity. Based on this conclusion, I offer some reflections on the permissibility and advisability of MMTs and what these considerations suggest for the future. (shrink)

In this review essay, I critically evaluate the concept of autonomy and the role that it plays in the philosophy of sex and love in Patricia Marino’s book, Philosophy of Sex and Love: An Opinionated Introduction.

This paper proposes a novel relational view of autonomy designed to overcome the inadequacies of procedural and substantive views of autonomy as they relate to physician-assisted suicide requests for individuals with diminished cognitive functioning. Traditional and other relational views of autonomy regard a patient as an “isolated monad,” ignore patients with limited personal autonomy, and overlook the contexts in which decisions like PAS are made. However, these weaknesses become the strengths of a synthesized relational view of autonomy, which enhances the (...) personal autonomy of those with limited personal autonomy so that their PAS requests can be granted. (shrink)

Drawing on contemporary agency theory and the phenomenological-existential tradition, this paper uses Mr. Stevens, the narrator-butler of Kazuo Ishiguro’s The Remains of the Day, to examine the interplay and potential tensions between different aspects (and thus different standards) of human agency. Highlighting the problem of mission creep described by John Martin Fischer, in which a notion expands beyond the original purpose, I use Stevens’s thoughts on dignity to outline three different ways actions can (or can fail to) trace back to (...) agents—autonomy as self-control, authenticity as sincerity, and authenticity as ownership. I then propose that the way Stevens embraces and acts consistently within his subservient professional role (autonomy as self-control) weakens his ability to take responsibility for his life in the sense required by authenticity as ownership. Because the self-responsibility of authenticity requires normative flexibility (the ability to revise and reshape one’s commitments and values), when normatively inflexible agents act in self-controlled ways according to their roles or welfare standards, they may limit their ability to take responsibility for their lives. In addition to illuminating debates about whether robust human agency is compatible with subservience, the normative flexibility involved in authenticity has implications for human agency more broadly. (shrink)

John Christman has argued that constitutively relational accounts of autonomy, as defended by some feminist theorists, are problematically perfectionist about the human good. I argue that autonomy is constitutively relational, but not in a way that implies perfectionism: autonomy depends on a dialogical disposition to hold oneself answerable to external, critical perspectives on one's action-guiding commitments. This type of relationality carries no substantive value commitments, yet it does answer to core feminist concerns about autonomy.

Much of the literature on practical authority concerns the authority of the state over its subjects—authority to which we are, as G. E. M. Anscombe says, subject “willy nilly”. Yet many of our “willy” (or voluntary) relationships also seem to involve the exercise of practical authority, and this species of authority is in some ways even more puzzling than authority willy nilly. In this paper I argue that voluntary authority relies on a form of voluntary obligation that is akin (in (...) some respects) to the kind of obligation one undertakes in making a promise. Voluntary authority depends, that is, on the possibility of taking on certain obligations more or less at will. It is generated through an interpersonal transaction that involves a directed act of deference, on one side, paired with appropriate uptake of that deference, on the other. Deference, in the relevant sense, should be understood as a normative power that is exercised when agents transfer deliberative discretion to others, undertaking directed obligations to treat others’ directives as content-independent and peremptory reasons. Voluntary authority, thus understood, is both grounded in and constrained by the equal moral authority or autonomy of the participants, since only autonomous agents have the standing to defer in a normatively significant way. (shrink)

Relational autonomy theorists attempt to accommodate social embeddedness within a conception of autonomy. These attempts are conceptually messy, at best, and category errors, at worst. Rejecting the liberal conception of autonomy due to feminist concerns is more helpfully answered by the neorepublican notion of freedom as nondomination. The conception of freedom as nondomination captures the values that motivate the relational turn in moral and political theory and does so in a conceptually neater way than attempting to accommodate those concerns in (...) our accounts of autonomy. (shrink)

ABSTRACTSerene Khader and Rosa Terlazzo have each recently proposed theories of adaptive preferences which purport to both respect persons’ agency and provide an effective political tool. While Khader and Terlazzo thus share a similar goal, they take fundamentally different paths in its pursuit: Khader offers a perfectionist account of APs and Terlazzo an autonomy-based theory. In this paper, I argue first that if it is to adequately respect persons’ agency, a theory of APs should in some way include autonomy considerations. (...) If it is to provide an effective political tool, however, our theory should not be entirely autonomy-based, but include a condition addressing a preference’s compatibility with basic flourishing. The suggestion is thus that it is worth considering the possibility of a ‘mixed,’ rather than exclusively perfectionist or exclusively autonomy-based, theory of APs. I outline two such theories. The first, I argue, does quite well with respect to the political efficacy aim of AP theoriz... (shrink)

This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. (...) This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (shrink)

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient’s autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that our answer (...) to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing. (shrink)

This paper challenges the view that contentment leads to personal freedom and autonomy and argues for a relational and exercise concept of de facto freedom in the Zhuangzi 莊子. I first review influential interpretations of freedom in the Zhuangzi that equate freedom with contentment and nonfrustration, starting with Guo Xiang's 郭象 (d. 312 CE). By putting these interpretations in dialog with contemporary social philosophy (Christman, Meyers, Pettit, Elster, and Khader), I reflect on the two seminal problems of the psychologizing causal (...) and procedural approaches that allow the interpretation of freedom as contentment: the “happy slave” problem and the “sour grapes” problem. Proving this account of freedom inadequate, I argue for a different interpretation of freedom in the Zhuangzi that resembles a weakly substantive and constitutive account of freedom and autonomy in modern‐day social philosophy terms, such as Marina Oshana's. The theory of freedom that I analyze in the Zhuangzi, however, helps us correct the risk of material determinism of the constitutive account, offering a description of relational freedom and autonomy as constituted by socio‐material conditions but not determined by them. (shrink)

Two ways of understanding the notion of autonomy are outlined and discussed in this article, in order to clarify how and if informed consent requirements in biotechnological research are to be justified by the promotion of personal autonomy: A proceduralist conception linking autonomy with authenticity, and a substantivist conception linking autonomy with control. The importance of distinguishing autonomy from liberty is emphasised, which opens for a possible conflict between respecting the freedom and the autonomy of research participants. It is argued (...) that this has implications for how consent requirements based on different criteria of specificity and understanding should be viewed and justified. (shrink)

MacKay and Robinson (2016) claim that some legal procedures that regulate organ donations (VAC, opt-in, opt-out) bypass people's rational capacities and thus are “potentially morally worse than MAC”, which only employs a very mild form of coercion. We provide a critique of their argumentation and defend the opposite thesis: MAC is potentially morally worse than the three other options.

Comprender los dilemas éticos en torno a la subrogación de útero exige un conocimiento preciso de los conceptos de libertad y autonomía reproductiva. Una aproximación pertinente debe reconocer la naturaleza de la opresión sexual, sobre todo de cómo influye en la autonomía de las mujeres, en sus elecciones, en la identidad propia y en las relaciones interpersonales. El objetivo de este ensayo es defender la relevancia de las críticas del feminismo radical a las corrientes liberales progresistas, que a menudo prestan (...) mayor atención a los intereses de los denominados padres intencionales. Considerando lo que varias filósofas igualitaristas han expuesto desde una perspectiva socio-relacional de la autonomía para permitir la subrogación bajo ciertas condiciones -específicamente, sostienen que la regulación es compatible con la autonomía reproductiva de las mujeres si se sigue una modalidad altruista en un ambiente de protección y apoyo ante la revocación del consentimiento-, defiendo que las feministas radicales esclarecen apropiadamente cómo la opresión contra la mujer permanece en el ambiente cultural que aprueba los contratos de subrogación. La metodología macroscópica, basada en la metáfora del ave enjaulada de la filósofa norteamericana Marilyn Frye, es una herramienta provechosa para comprender por qué la subrogación no implica una mejoría para la autonomía reproductiva de las mujeres, incluso si permite que algunas madres gestantes obtengan un ingreso suficiente para sobrellevar la presión económica. (shrink)

This paper argues that human agency is not simply a function of intrinsic properties about the agent, but that agency instead depends on the ecology that the agent is in. In particular, the paper examines ways that disabilities affect agency and shows how, by paying deliberate attention to structuring the social environment around people with disabilities, we can mitigate some of the agential impact of those disabilities. The paper then argues that the impact of one’s social environment on agency isn’t (...) restricted only to those agents that have disabilities, but also characterizes all human agency. All of our agency is environmentally dependent. (shrink)

The Western focus on personal autonomy as the normative basis for securing persons’ consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor’s wish to donate after she (...) has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept. (shrink)

The received view in medical contexts is that informed consent is both necessary and sufficient for patient autonomy. This paper argues that informed consent is not sufficient for patient autonomy, at least when autonomy is understood as a "relational" concept. Relational conceptions of autonomy, which have become prominent in the contemporary literature, draw on themes in the thought of Charles Taylor. I first identify four themes in Taylor's work that together constitute a picture of human agency corresponding to the notion (...) of agency implicit in relational accounts of autonomy. Drawing on these themes, I sketch two arguments against the position that informed consent secures autonomy. The first is that informed consent is an "opportunity" concept whereas autonomy is an "exercise" concept; the second is that informed consent requires merely weak evaluation and not strong evaluation. On Taylor's analysis of agency, strong evaluation is required for agency and for autonomy. (shrink)

This article discusses the self-respect argument for basic liberties, which is that self-respect is an important good, best supported by basic liberties, and that this yields a reason for the traditional liberty principle. I concentrate on versions of it that contend that self-respect is best supported by basic liberties for reasons related to the recognition that such liberties convey. I first discuss the two standard approaches loosely associated with John Rawls and Axel Honneth. Here self-respect pertains to traits and conduct (...) (Rawls) or to one’s personhood (Honneth). It is argued that these approaches fail to show why self-respect is better supported by the liberty principle than certain alternatives worth taking seriously – unless (in the case of personhood self-respect) self-respect is construed in such a narrow way that it is not a condition for autonomy or welfare in any plausible sense. I then identify a self-attitude that I call “a sense of competence”, which at least shows that the liberty principle is more important to autonomy than what we might otherwise have reasons to believe. (shrink)

Feminist strong substantive autonomy (FSSA), as presented by Natalie Stoljar and Anita Superson, pronounces judgment on the autonomy status of certain women living under oppression. These women act on deformed desires, Superson explains, and as deformed desires cannot be the agent's own, the women are heteronomous. Stoljar argues that some women's choices violate the Feminist Intuition; by acting on false and oppressive values, these women render themselves heteronomous. I argue against Stoljar and Superson on epistemological grounds. I present six different (...) ways in which agents' choices can be related to deformed desires, with varying results for their autonomy statuses. I show that Stoljar and Superson are not able to distinguish properly among the differing autonomy statuses in these six cases, because doing so requires attention to agents' inner processes of decision-making, as those processes are enacted in the agents' social and temporal contexts. Stoljar and Superson judge others' autonomy statuses based on abstract generalizations rather than via empirical attention to agents' actual decision-making processes. Consequently, their judgments are not adequate to the lived self-direction of real persons. Assessing others' autonomy status requires consideration of agents' inner choice-making in sociotemporal context, which favors a procedural or weak substantive account of autonomy. (shrink)

The concept of responsibility for health is a significant feature of health discourse and public health policy, but application of the concept is poorly understood. This paper offers an analysis of the concept in two ways. Following an examination of the use of the word ‘responsibility’ in the nursing and wider health literature using three examples, the concept of ‘responsibility for health’ as fulfilling a social function is discussed with reference to policy documents from the UK. The philosophical literature on (...) moral responsibility is introduced, and in considering two versions, reactive attitudes and accountability, it is argued that in application both can be regarded, though with different emphasis, as being constituted in three parts: a responsible agent; having obligations ; and being susceptible to being held responsible if he fails to meet them. The three‐stage model is consistent with the examples of the word responsibility in use, but application to the social function model causes a number of problems for healthcare practice, especially for the reactive attitudes account. Apart from considerable problems in stating what exactly the obligations are and how they can be justified; and how blame might justly be apportioned and by whom, the very ideas of obligation and blame are in conflict within healthcare systems and professional nursing practice which have foundations deeply embedded in the notion of the supremacy of personal autonomy. It is concluded that current application of the concept of responsibility for health is conceptually incoherent, and if it is to retain its place in health policy and discourse, urgent remedy is required. (shrink)

The concept of meaningful work has recently received increased attention in philosophy and other disciplines. However, the impact of the increasing robotization of the workplace on meaningful work has received very little attention so far. Doing work that is meaningful leads to higher job satisfaction and increased worker well-being, and some argue for a right to access to meaningful work. In this paper, we therefore address the impact of robotization on meaningful work. We do so by identifying five key aspects (...) of meaningful work: pursuing a purpose, social relationships, exercising skills and self-development, self-esteem and recognition, and autonomy. For each aspect, we analyze how the introduction of robots into the workplace may diminish or enhance the meaningfulness of work. We also identify a few ethical issues that emerge from our analysis. We conclude that robotization of the workplace can have both significant negative and positive effects on meaningful work. Our findings about ways in which robotization of the workplace can be a threat or opportunity for meaningful work can serve as the basis for ethical arguments for how to—and how not to—implement robots into workplaces. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

Individuals’ food choices are intimately connected to their self-images and world views. Some dietary choices adopted by consumers pose restrictions on their use of genetically modified food (GMF). It is quite generally agreed that some kind of labeling is necessary for respecting consumers’ autonomy of choice regarding GMF. In this paper, we ask whether the current practice of mandatory labeling of GMF products in the European Union is a sufficient administrative procedure for respecting consumers’ autonomy. Three issues concerning this question (...) are discussed. First, we argue that labeling needs to be accompanied by relevant and understandable information on genetic modification, genetically modified food, and the European practice of GMF labeling. Second, we claim that this type of informing makes it less likely that consumers start to avoid GMF products just because labels make them suspicious of the products. It is further noted that even though some consumers may react to labels this way, labels do not restrict their autonomy of choice. Third, a need for more precise labels indicating the source of the transferred gene is considered. It is found out that such labels are not morally necessary when also non-GMF products are available and no relevant differences (such as differences in price and healthiness) exist between them and GMF products. However, in some other cases more precise labels may be needed for respecting consumers’ autonomy of choice. (shrink)

The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly speaking compel (...) people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

This paper discusses Confucian notions of moral autonomy and moral agency that do not follow strict and ideal notions of autonomy that one can find in many Western theories of moral philosophy. In Kantian deontology, for example, one's autonomy, specifically one's rational will to follow universal moral rules, is a necessary condition of moral agency and moral responsibility. In Confucian moral philosophy, however, this type of strict moral autonomy is rarely observed. A Confucian moral agent is often depicted as a (...) partially heteronomous individual who often accepts and follows others' moral authority and considers external contingencies in her moral deliberations. Yet active moral agency is maintained in Confucian philosophy. In this paper, I will explain and analyze a partially heteronomous but active form of moral agency in Confucian moral philosophy. First, I will survey different notions of moral autonomy and explore philosophical theories of partial autonomy and heteronomy. Second, I will discuss, on the basis of interactive, responsive, and situated notions of the self, how Confucian moral agency can be explained without strict standards of autonomy. In Confucianism, morality or virtuosity reflects the relational, responsive, and situated nature of human being that resonates with other human beings and their environmental contingencies. Mencius, for example, acknowledges and discusses interactive or relational nature of moral action and the dependency of the moral self on external conditions of life without giving up active moral effort and full moral responsibility. Third, based on my analysis of moral autonomy and responsibility in early Confucian philosophy, I will argue that Confucian moral philosophy provides a unique way of understanding moral agency, not through self-enclosed independency but through relational and interactive interdependency of communal agency. (shrink)

So‐called nudge policies utilize insights from behavioral science to achieve policy outcomes. Nudge policies try to improve people's decisions by changing the ways options are presented to them, rather than changing the options themselves or incentivizing or coercing people. Nudging has been met with great enthusiasm but also fierce criticism. This paper provides an overview of the debate on the ethics of nudging to date. After outlining arguments in favor of nudging, we first discuss different objections that all revolve around (...) the worry that nudging vitiates personal autonomy. We split up this worry into different dimensions of autonomy, such as freedom of choice, volitional autonomy, rational agency, and freedom as nondomination. We next discuss worries that nudging is manipulative, violates human dignity, and prevents more important structural reform. Throughout, we will present responses that proponents of nudging can muster. On the whole, we conclude that the objections fail to establish that the nudge program as a whole should be rejected. At the same time, they give us important guidance when moving towards an ethical assessment of nudges on a case‐by‐case basis. Towards the end, we provide some possible ways forward in debates around the ethics of nudging. (shrink)

Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’. In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be embedded (...) in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic. (shrink)

This paper critically examines Alan Patten’s theory of neutrality of treatment. It argues that the theory assumes an inadequate conception of personal autonomy that undermines its plausibility. Because of this assumption the theory is unable to account for various configurations of power that work against personal autonomy. However, I suggest that the theory can resolve the problem by developing and reinterpreting its conception of autonomy and introducing an additional strategy for addressing the power misbalances that result from the market-based interactions (...) between individuals and their conceptions of the good. (shrink)

An ongoing debate between ‘procedural’ and ‘substantive’ theorists of personal autonomy addresses the following question: should agents have the final say on their own autonomy or should the objective circumstances in which agents live take prevalence when assessing their autonomy? Proceduralists favour the first strategy and substantive theorists restrict more explicitly the conditions under which autonomy is possible. I focus on forms of heteronomy which derive from oppressive circumstances and accept that substantive theorists are correct in contending that (i) forms (...) of oppression common in contemporary liberal societies (e.g. gender or racial oppression) tend to increase heteronomy; and (ii) the heteronomy which derives from social oppression tends to fly below the radar of procedural accounts. Still, I argue that a revised procedural strategy could limit these forms of heteronomy as long as it avoids the injunctions to ‘authenticity’ common in procedural models. I proceed by reconstructing John Christman’s model which, I argue, constitutes the most promising procedural account to assess autonomy under oppression. Christman’s theory, however, needs to be reinforced to ensure self-problematisation in light of a social perspective. I show that the latter is necessary to experience the forms of alienation which are markers of heteronomy according to Christman. (shrink)

While there is much literature on autonomy and the conditions for its attainment, there is less on how those conditions reflect on agents’ ordinary careers. Most people’s careers involve a great deal of subservient activity that would prevent the kind of control over agents’ actions that autonomy would seem to require. Yet, it would seem strange to deny autonomy to every agent who regularly follows orders at work—to do so would make autonomy a futile ideal. Most contemporary autonomy accounts provide (...) purely theoretical analysis without reference to any practical goal that autonomy could serve. These accounts are likely to resolve this issue in one direction: either almost entirely including or excluding subservient workers from autonomy. Either solution would fail to distinguish agents who sufficiently control their lives, in spite of limited subservience, according to their own standards, from agents for whom subservience precludes a fulfilling life. I suggest the solution lies in a return to goal-oriented autonomy accounts, which can use the goal to distinguish when subservience overwhelms autonomy from when subservience and autonomy can coexist. I present an account that anchors autonomy in the happiness that it provides for agents who sufficiently control their lives as determined by their more important prudential standards. On this account, agents in subservient careers can be autonomous if they determine how to make their careers consistent with their happiness. (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 like Henderson and Orem 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 (freedom to) and negative (freedom from) 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)

Laurence Ricard | : La notion d’autonomie personnelle joue un rôle central dans les théories politiques contemporaines et, plus spécifiquement, dans les théories de la justice. Or, dans le paradigme libéral dominant, elle est définie par une compréhension rationaliste de l’agent individuel. La présente étude défend la nécessité de redéfinir ce concept d’autonomie à la lumière des développements philosophiques et psychologiques qui ont complexifié notre compréhension de la subjectivité. L’emploi du concept d’autonomie relationnelle développé par certains auteurs féministes et par (...) certains théoriciens de la reconnaissance semble pour ce faire prometteur. Cet article cherche à montrer qu’une compréhension relationnelle de l’autonomie est nécessaire pour expliquer la motivation à la coopération sociale et pour redéfinir la justice et l’injustice de façon à ce qu’elles correspondent à l’expérience sociale vécue. | : The notion of personal autonomy plays a central role in contemporary political theories and especially in theories of justice. Generally speaking, the dominant liberal paradigm defines individual agency in a purely rationalistic manner. Against this tradition, the present study argues for the necessity of rethinking and redefining this rationalistic concept of autonomy in light of psychological and philosophical developments that have complicated our understanding of subjectivity. For this purpose, the concept of relational autonomy, developed by feminist authors and some theorists of recognition, is most promising. This article aims to show that a relational understanding of autonomy is necessary to explain motivations for social cooperation and to understand justice and injustice in a way that corresponds to lived social experience. (shrink)

This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background (...) of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)

Understanding the ethical concerns of paid and altruistic surrogacy requires a knowledge of reproductive freedom and procreative autonomy. An accurate approach must be sensitive enough of the nature of sexual oppression, specifically in its influence in women’s choices, self-identity and personal relationships. The aim of this essay is to stand up for the prominence of radical feminism in questioning reproductive liberalism, which overfocus the interests of the so-called intended parents. Having in mind what egalitarian philosophers have put forward from a (...) social-relational autonomy view to allow surrogacy contracts under certain circumstances —particularly, they suggest that legalization could be compatible with women’s reproductive autonomy following an altruistic fashion under protective measures and supportive to the surrogate’s revocation of consent—, I uphold that radical feminists properly make clear how oppression remains in the cultural environment that endorses surrogacy contracts. A macroscopic methodology, based on American philosopher’s Marilyn Frye metaphor of the caged bird, is a helpful tool to comprehend why surrogacy contracts do not enhance women’s reproductive autonomy, even if they enable some surrogate mothers to gain an income enough to endure tough economic pressure. (shrink)

Ageism within the context of care has attracted increasing attention in recent years. Similarly, autonomy has developed into a prominent concept within health care law and ethics. This paper explores the way that ageism, understood as a set of negative attitudes about old age or older people, may impact on an older person’s ability to make maximally autonomous decisions within health care. In particular, by appealing to feminist constructions of autonomy as relational, I will argue that the key to establishing (...) this link is the concept of self-relations such as self-trust, self-worth and self-esteem. This paper aims to demonstrate how these may be impacted by the internalisation of negative attitudes associated with old age and care. In light of this, any legal or policy response must be sensitive to and flexible enough to deal with the way in which ageism impacts autonomy. (shrink)

Many digital technologies, designed and controlled by intensive data-driven corporate platforms, have become ubiquitous for many of our daily activities. This has raised political and ethical concerns over how they might be threatening our personal autonomy. However, not much philosophical attention has been paid to the specific role that their hyper-designed (sensorimotor) interfaces play in this regard. In this paper, we aim to offer a novel framework that can ground personal autonomy on sensorimotor interaction and, from there, directly address how (...) technological design affects personal autonomy. To do this, we will draw from enactive sensorimotor approaches to cognition, focusing on the central notion of habits, understood as sensorimotor schemes that, in networked relations, give rise to sensorimotor agency. Starting from sensorimotor agency as a basis for more complex forms of personal autonomy, our approach gives us grounds to analyse our relationship with technology (in general) and to distinguish between autonomy-enhancing and autonomy-diminishing technologies. We argue that, by favouring/obstructing the enactment of certain (networks of) habits over others, technologies can directly act upon our personal autonomy, locally and globally. With this in mind, we then discuss how current digital technologies are often being designed to be autonomy-diminishing (as is the case of “dark patterns” in design), and sketch some ideas on how to build more autonomy-enhancing digital technologies. (shrink)

In a recent paper, Schaefer et al. proposed to enhance autonomy via improving reasoning abilities through cognitive enhancement [1]. While initially their idea additionally seems to elegantly avoid objections against genetic enhancements based on the value of autonomy, we want to draw attention to several problems their approach poses. First, we will show that it is not at all clear that safe and meaningful methods to genetically or pharmaceutically enhance cognition will be feasible any time soon. Second, we want to (...) provide a deeper discussion of the role of cognition and reasoning abilities in philosophical concepts of autonomy, as discussed in the mentioned paper. In doing so, we wish to demonstrate that using reasoning abilities as the common denominator in different accounts of autonomy in the context of enhancement does not do justice to the highly complex interrelations between cognition, reasoning abilities and autonomy. Neither should this way of arguing be accepted as a basis to call for practical outcomes, such as funding research into e. g. genetic cognitive enhancements, if the examined concepts of autonomy are taken seriously. (shrink)

El enfoque de las capacidades ha estado principalmente asociado al liberalismo, ya que sus figuras fundacionales, Sen y Nussbaum, se han declarado explícitamente parte de esa corriente de pensamiento. Sin embargo, puede afirmarse que algunas de las características de dicho enfoque podrían encontrar su mejor formulación, proyección y desarrollo fuera del liberalismo. A partir de sus conceptos constitutivos de reconocimiento, intersubjetividad y alta sensibilidad a la vulnerabilidad, la justicia social crítica se presenta como un espacio normativo más apropiado para el (...) desarrollo y la proyección del enfoque de las capacidades. Esta tesis es ilustrada a través de dos importantes discusiones normativas, la primera de ellas es la que tiene por tema a la métrica de justicia y la segunda es la que hace a la forma de entender la democracia, la ciudadanía y la razón pública. A partir de la interpretación de estos conceptos es que se justifica que la justicia social crítica es un mejor marco normativo para el enfoque de las capacidades que el liberalismo. (shrink)

This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that—even with (...) respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy and substantive-relational autonomy. While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation. (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)

The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy depends upon such responsiveness to (...) reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

Given the ubiquity and centrality of social and relational influences to the human experience, our conception of self-governance must adequately account for these external influences. The inclusion of socio-historical, externalist considerations into more traditional internalist accounts of autonomy has been an important feature of the debate over personal autonomy in recent years. But the relevant socio-temporal dynamics of autonomy are not only historical in nature. There are also important, and under-examined, future-oriented questions about how we retain autonomy while incorporating new (...) values into the existing set that guides our interaction with the world. In this paper, we examine these questions from two complementary perspectives: philosophy and neuroscience. After contextualizing the philosophical debate, we show the importance to theories of autonomous agency of the capacity to appropriately adapt our values and beliefs, in light of relevant experiences and evidence, to changing circumstances. We present a plausible philosophical account of this process, which we claim is generally applicable to theories about the nature of autonomy, both internalist and externalist alike. We then evaluate this account by providing a model for how the incorporation of values might occur in the brain; one that is inspired by recent theoretical and empirical advances in our understanding of the neural processes by which our beliefs are updated by new information. Finally, we synthesize these two perspectives and discuss how the neurobiology might inform the philosophical discussion. (shrink)

Advances in psychology and neuroscience have elucidated the social aspects of human agency, leading to a broad shift in our thinking about fundamental concepts such as autonomy and responsibility. Here, we address a critical aspect of this inquiry by investigating how people consider the socio-relational nature of their own agency, particularly the influence of others on their perceived control over their decisions and actions. Specifically, in a series of studies using contrastive vignettes, we examine public attitudes about when external influences (...) on everyday decisions are perceived as " undue " – that is, as undermining the control conditions for these decisions to be considered autonomous – vs. when they are perceived as appropriate and even supportive of autonomous decision-making. We found that the influence of preauthorized agents – individuals and institutions with whom we share a worldview – was judged to be less undue than non-preauthorized agents, even after controlling for the familiarity of the agent. These effects persisted irrespective of the extent to which respondents identified as communitarian or individualistic, and were consistent across two distinct scenarios. We also found that external influences that were rational were perceived as less undue than those that were arational. Our study opens new avenues of inquiry into the " folk conception " of autonomy, and we discuss the implications of our findings for the ethics of public policies designed to influence decisions and for information sharing in social networks. (shrink)