Recent years have seen the emergence of a new brand of moral philosopher. Straddling the gap between academia on the one hand, and the world of law, medicine, and politics on the other, bioethicists have appeared, offering advice on ethical issues to a wider public than the philosophy classroom. Some bioethicists, like Peter Singer, have achieved wide notoriety in the public realm with provocative arguments that challenge widely held beliefs about the relative moral status of animals, human foetuses and newborn (...) babies. Other bioethicists practice their trade with greater protection from public scrutiny, confining their thoughts to committees in government circles, universities, charitable institutions, or hospitals. But what exactly is it that bioethicists have to offer in such contexts? What sort of expertise do bioethicists have that justifies their employment on these committees, or the time and space accorded to their views on television and the radio, or in newspapers and magazines? In spite of being an expanding group of professionals who attract large sums of private and public funding, bioethicists are sometimes met with suspicion or even hostility, both inside and outside academia. One common criticism is that the presence of bioethicists is unproductive in practical bioethical debate. In light of this criticism one might wonder why the relevant funding bodies have not spotted the hoax and withdrawn their funding. Certainly, if bioethicists.. (shrink)

Ethical guidelines commonly state that research subjects should have a right to withdraw consent to participate. According to the guidelines we have studied, this right applies also to research on biological samples. However, research conducted on human subjects themselves differs in important respects from research on biological samples. It is therefore not obvious that the same rights should be granted research participants in the two cases. This paper investigates arguments for and against granting a right to withdraw consent to research (...) on biobank samples. We conclude that (1) there are no explicit arguments for such a right in the guidelines we have studied, (2) the arguments against such a right are inconclusive, (3) considerations of autonomy, privacy, personal integrity, and trust in medical research provide sufficient reasons for granting a right to withdraw consent to research on biobank samples, (4) in certain cases, research participants should be allowed to waive this right. (shrink)

This paper deals with ethical issues of particular relevance to longitudinal research involving children. First some general problems concerning information and lack of understanding are discussed. Thereafter focus is shifted to issues concerning information and consent procedures in studies that include young children growing up to become autonomous persons while the project still runs. Some of the questions raised are: When is it right to include children in longitudinal studies? Is an approval from the child needed? How should information to (...) children be handled? A general point stressed is that autonomy considerations underline the importance of adjusting the information given to meet demands. A “presumption of competence” may be needed in research involving children, in order to pay their views sufficient attention. (shrink)

This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy (...) capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation—for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons. (shrink)

In this paper I shed light on the connection between respect, trust and patients’ satisfaction with their medical care. Using data collected in interviews with 49 women who had managed, or were in the process of managing, their risk of ovarian cancer using prophylactic surgery or ovarian screening, I examine their reported dissatisfaction with medical encounters. I argue that although many study participants appeared to mistrust their healthcare professionals’ (HCPs) motives or knowledge base, their dissatisfaction arose not from a lack (...) of trust, but from HCPs’ failure to treat them as persons or take their concerns seriously. I conclude by describing how respect, as evidenced by “being taken seriously”, is important for the development of trusting Patient–HCP relationships. (shrink)

This essay explores the two main objectives of Bishop’s book, which he analyzes in the context of the care for the dying: the medical metaphysics underlying medical science and biopolitics as governance of the human body. This essay discusses Bishop’s claims in view of newer developments in medicine, especially the turn to the construction of life, and confronts the concept of the patient’s sovereignty with an alternative model of vulnerable agency. In order to overcome the impasses of contemporary bioethics, the (...) essay argues that practical reason requires a two-fold ethics: first, it must develop a new hermeneutics of illness and disease, and second, in order to protect the individuals in the process of dying, moral claims concerning death must be based on the concept of human rights. (shrink)

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a (...) specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility. (shrink)

The pandemic caused by the SARS-CoV2 novel coronavirus is creating a global crisis. There is a global ambience of uncertainty and anxiety. In addition, nations have imposed strict and restrictive public health measures including lockdowns. In this heightened time of vulnerability, public cooperation to preventive measures depends on trust and confidence in the health system. Trust is the optimistic acceptance of the vulnerability in the belief that the health system has best intentions. On the other hand, confidence is assessed based (...) on previous experiences with the health system. Trust and confidence in the health system motivate people to accept the public health interventions and cooperate with them. Building trust and confidence therefore becomes an ethical imperative. This article analyses the COVID-19 pandemic in the south Indian state of Tamil Nadu and the state’s response to this pandemic. Further, it applies the Trust-Confidence-Cooperation framework of risk management to analyse the influence of public trust and confidence on the Tamil Nadu health system in the context of the preventive strategies adopted by the state. Finally, the article proposes a six-pronged strategy to build trust and confidence in health system functions to improve cooperation to pandemic containment measures. (shrink)

COVID-19 has turned many ethical principles and presuppositions upside down. More precisely, the principle of respect for autonomy has been shown to be ill suited to face the ethical challenges posed by the current health crisis. Individual wishes and choices have been subordinated to public interests. Patients have received trial therapies under extraordinary procedures of informed consent. The principle of respect for autonomy, at least in its mainstream interpretation, has been particularly questioned during this pandemic. Further reflection on the nature (...) and value of autonomy is urgently needed. Relational autonomy has been proposed as an alternative account of autonomy that can more adequately respond to contemporary ethical issues in general and to a pandemic such as the one we are currently facing in particular. As relational autonomy is an emerging notion in current bioethics, it requires further consideration and development to be properly operationalized. This paper aims to show how six different philosophical branches––namely, philosophy of nature, philosophical anthropology, existential phenomenology, discourse ethics, hermeneutics, and cultural anthropology––have incorporated the category of relation throughout the twentieth century. We first delve into primary philosophical sources and then apply their insights to the specific field of medical ethics. Learning from the historical developments of other philosophical fields may provide illumination that will enable bioethics to experience a successful “relational turn”, which has been partially initiated in contemporary bioethics but not yet achieved. (shrink)

There are instances where the provider of an intervention, such as surgery, has failed to obtain necessary informed consent from the recipient of the intervention. Perhaps the surgeon has failed to warn the patient that she may go into a coma, or even be killed, from the surgery. Sometimes, as a result of this intervention, the recipient cannot give informed consent to researchers for the release of their personal data precisely because of the intervention. If they are in a coma, (...) they cannot be reached. Sometimes, this personal data itself can prove that the provider of the intervention failed to obtain informed consent for the intervention. For example, a personal file may include a consent form that does not include warnings about the risk of falling into a coma from the surgery. Paradoxically, those who cannot give informed consent for the disclosure of their personal data on an intervention may have been especially ill-informed about the repercussions of the intervention. In such instances, should researchers ever use the data and disclose the data in their research? In an attempt to demonstrate when this dilemma may be relevant, and how it may be solved, I will present a real-world case of this dilemma in my own empirical research on refugees who agreed to repatriate to their countries of origin from Israel. I will consider what theories on consent, if any, can help us resolve this dilemma. (shrink)

Volume 19, Issue 6, June 2019, Page 62-64.

With the hope of somehow contributing to the ongoing discussion on the topic, this paper is loosely based on the debate that emerged from Rob Sparrow's article “Should human beings have sex? Sexual dimorphism and human enhancement”. Building on some of his arguments, my claim is that we should not refer to gender when discussing not-yet-born agents. More broadly still, my intention is to provide a further analysis of the intersection of the concepts of gender and autonomy. I will begin (...) by briefly highlighting Sparrow's article and critiques, with special emphasis on the poststructuralist attack. In doing so, I will consider the differences between structuralism and poststructuralism in relation to this debate. Subsequently, I will draw a parallel between Judith Butler's notion of the performativity of gender, sex and Ronald Dworkin's distinction between zoe and bios. The next move will then be to re-divert attention to the crucial role that health plays in the discussion, suggesting that one of the substantial differences between human enhancers and non-enhancers is the ranking that health has in their corresponding scale of values. Setting the bar for how an organism functions “normally” will be the last step necessary to create the basis for my main claim: building on Butler's description of the singular agent in relation to others, I will suggest Jürgen Habermas and Onora O'Neill as credible and valuable expansions of a position willing to reconcile individual and relational autonomy, supporting this final claim with the words of Immanuel Kant. If we aim to use genetic engineering and preimplantation genetic diagnosis to prevent unhealthy children from being born – as I shall state we should – we can use this notion of normality in a way that will be accepted also by those who are historically critical of such a way of conceptualising a human being, only if we understand the parallel need for society to shift to a more inclusive and shared definition of autonomy. (shrink)

This article traces the way autonomy has become a recognised value in health care in France. In a country that based its social fundamentals on the very idea of solidarity for many years, autonomy has long been considered a foreign ‘Anglo-American principle’. Taking the example of the end-of-life debate, the article shows, however, how the use of the French term ‘accompagnement’ allowed autonomy to be redefined and to be associated with the concept of solidarity. Exploring the arguments used over the (...) past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that took place in public and legal discourses on end-of-life care. The analysis demonstrates how the scope of autonomy has been limited by other social values, such as the protection of the dying person, in order to become an accepted social value in its own right. The example of the French end-of-life debate shows that depending on how the concept of autonomy is adapted and applied in a specific context, it can be compatible with the idea of solidarity. Such compatibility has been challenged previously in the international bioethics debate. By demonstrating the possibility of combining autonomy and solidarity, this article makes an important contribution to the international bioethics debate and to the dialogue between countries that are often perceived as significantly different. (shrink)

Data-intensive science comes with increased risks concerning quality and reliability of data, and while trust in science has traditionally been framed as a matter of scientists being expected to adhere to certain technical and moral norms for behaviour, emerging discourses of open science present openness and transparency as substitutes for established trust mechanisms. By ensuring access to all available information, quality becomes a matter of informed judgement by the users, and trust no longer seems necessary. This strategy does not, however, (...) take into consideration the networks of professionals already enabling data-intensive science by providing high-quality data. In the life sciences, biological data- and knowledge bases managed by expert biocurators have become crucial for data-intensive research. In this paper, I will use the case of biocurators to argue that openness and transparency will not diminish the need for trust in data-intensive science. On the contrary, data-intensive science requires a reconfiguration of existing trust mechanisms in order to include those who take care of and manage scientific data after its production. (shrink)

BackgroundInternationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of (...) the issues involved in such a change in process.MethodsThis study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed.Results3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated.ConclusionsThe review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated. (shrink)

The United States, like other countries facing rising health care costs, is pursuing a commitment to interoperable electronic health records. Electronic records, it is thought, have the potential to reduce the risks of error, improve care coordination, monitor care quality, enable patients to participate more fully in care management, and provide the data needed for research and surveillance. Interoperable electronic health records on a national scale — the ideal of a national health information network — seem likely to magnify these (...) advantages. Thus, the recent economic stimulus package contains considerable funding for the development of “health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner.”. (shrink)

Nocebo effects occur when an adverse effect on the patient arises from the patient's own negative expectations. In accordance with informed consent, providers often disclose information that results in unintended adverse outcomes for the patient. While this may adhere to the principle of autonomy, it violates the doctrine of “primum non nocere,” given that side-effect disclosure may cause those side effects. In this article we build off previous work, particularly by Wells and Kaptchuk and by Cohen :3–11.[Taylor & Francis Online], (...) [Web of Science ®] [Google Scholar]), to suggest ethical guidelines that permit nondisclosure in the case when a nocebo effect is likely to occur on of the basis of nonmaleficence. We accept that that autonomy vis-à-vis informed consent must be forestalled, but salvage much of its role by elaborating a practical clinical approach to postencounter follow-up. In doing so, we reconcile a clinically practicable process of determining conditions of disclosure with long-standing ethical commitments to patients. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

The philosophy of trust is a relatively small subfield. Nonetheless, it contains within it many important insights. Our contention in this paper is that careful study of this subfield can b...

In this paper I explore the politics of trust in the clinical testing of pharmaceuticals in the US. Specifically, I analyze trust in terms of its institutional manifestations in the pharmaceutical clinical trials industry. In the process of testing new drugs, pharmaceutical companies must (1) protect their proprietary information from the clinicians who conduct their studies, and (2) find a way to ensure human subjects’ compliance to study protocols. Concern with these two critical issues leads drug companies to approach clinicians (...) and research subjects with an attitude of mistrust and the desire to exert control over their activities. This orientation results in an institutionalization of mistrust that structures the relationships and activities required for the clinical development of new pharmaceutical products. (shrink)

Increasingly, bioethicists defend informed consent as a safeguard for trust in caretakers and medical institutions. This paper discusses an ‘ideal type’ of that move. What I call the trust-promotion argument for informed consent states:1. Social trust, especially trust in caretakers and medical institutions, is necessary so that, for example, people seek medical advice, comply with it, and participate in medical research.2. Therefore, it is usually wrong to jeopardise that trust.3. Coercion, deception, manipulation and other violations of standard informed consent requirements (...) seriously jeopardise that trust.4. Thus, standard informed consent requirements are justified.This article describes the initial promise of this argument, then identifies challenges to it. As I show, the value of trust fails to account for some commonsense intuitions about informed consent. We should revise the argument, commonsense morality, or both. (shrink)

We begin with our reasons for seeking to bring Kant to bear on contemporary information and computing ethics (ICE). We highlight what each contributor to this special issue draws from Kant and then applies to contemporary matters in ICE. We conclude with a summary of what these chapters individually and collectively tell us about Kant’s continuing relevance to these contemporary matters – specifically, with regard to the issues of building trust online and regulating the Internet; how far discourse contributing to (...) deliberative democracy online may include storytelling and appeals to the emotions; and whether or not search engine algorithms should be made public. We further highlight how certain chapters – especially as they incorporate more recent philosophical traditions such as phenomenology and cognitive psychology – develop a Kantian approach (or at least one that is both inspired by while simultaneously transforming Kant) to ethical issues in ICE, including the ethical implications of the on-going blurring of the border between the real and the virtual; designing software in light of distributed ethical responsibility; and trust-building in e-Science collaborations. (shrink)

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, (...) the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities. (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)

This is the second in a series of five papers on the role, remit and function of research ethics committees which are intended to provide for REC members a broad understanding of the most important issues in research ethics and governance. This paper examines the role of ethics committees in assessing the science of the research it reviews. While ethics committees are not specifically constituted to review the science of a project, they must nevertheless assess the social benefits of research (...) and, in this context, have an important role in checking that the science has been properly peer-reviewed. (shrink)

The authors interpret the data to mean that patients think that their physicians should make relevant decisions in Learning Health System based trials, and label that as being of 'utmost importance'. However, the patients themselves (in the excerpts provided) emphasize that trust in physicians is instrumental for obtaining protection of patient's bests interests (which seems to be of utmost importance for patients). Furthermore, the perceived bias regarding outcome certainty deserves more discussion. Namely, the decision to defer to physician's opinion is (...) linked to perceived certainty of best clinical outcomes and instrumental for protection of best interest, while it lacks appreciation of the level of uncertainty that exists in clinical decision-making. Finally, a discussion on what are the implications of patient perspectives for individual, vs. relational autonomy is something the authors don't pursue, but instead use "physician-patient autonomy" throughout the paper. (shrink)

In this article, we seek to contribute to the debate on the requirement of disclosure in the context of informed consent for research. We defend the subjective standard of disclosure and describe ways to implement this standard in research practice. We claim that the researcher should make an effort to find out what kinds of information are likely to be relevant for those consenting to research. This invites researchers to take empirical survey information seriously, attempt to understand the cultural context, (...) talk to patients to be better able to understand what can be potentially different concerns and interests prevalent in the target population. The subjective standard of disclosure should be seen as a moral ideal that perhaps can never be perfectly implemented but still can and should be used as a normative ideal guiding research practice. In the light of these discussions, we call for more empirical research on what considerations are likely to be perceived as relevant by potential research participants recruited from different socio-economic and cultural groups. (shrink)

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of autonomy, and argue that (...) a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Biobanks are increasingly being linked together into global networks in order to maximise their capacity to identify causes of and treatments for disease. While there is great optimism about the potential of these biobank networks to contribute to personalised and data-driven medicine, there are also ethical concerns about, among other things, risks to personal privacy and exploitation of vulnerable populations. Concepts drawn from theories of globalisation can assist with the characterisation of the ethical implications of biobank networking across borders, which (...) can, in turn, inform more ethically sophisticated responses. Using the China Kadoorie Biobank as a case study, we show how distinguishing between the subnational, transnational, supranational and extranational spheres of operation and influence can help researchers, institutions and regulators to understand and manage the ethical issues raised by the globalisation of biobanking. (shrink)

Für die Argumentation von Moralphilosophen, die die Legalisierung der aktiven Sterbehilfe befürworten, spielt das Autonomieprinzip eine wichtige Rolle. Ihrer Auffassung nach verlangt der Respekt vor der Autonomie, die Entscheidung eines schwer kranken Menschen gegen die Fortsetzung des Lebens vorbehaltlos anzuerkennen. Dagegen haben verschiedene Theoretiker auf Gefahren hingewiesen, die die rechtliche Zulassung der Tötung auf Verlangen für die individuelle Autonomie mit sich bringt. Sobald der Kranke über die Möglichkeit der aktiven Sterbehilfe verfüge, falle ihm die Verantwortung für die Inanspruchnahme von Pflegeleistungen (...) zu. In der Folge könne u. a. von Seiten der Familie die Forderung an ihn gestellt werden, den vom Gesetzgeber eröffneten Ausweg zu nutzen und sie von der Last seiner Pflege zu befreien. Die Bedenken erscheinen insofern berechtigt, als Formen sozialen Zwangs vorstellbar sind, die eine freie Entscheidung des Patienten verhindern. Allerdings vermag weder das Verbot noch die Zulassung der aktiven Sterbehilfe eine autonome Entscheidung aller Individuen zu gewährleisten. Die Abwägung der Risiken, mit denen beide Optionen behaftet sind, spricht im Ergebnis für die Legalisierung der Tötung auf Verlangen. (shrink)

Codes of ethics currently offer no guidance to scientists acting in capacity of expert. Yet communicating their expertise is one of the most important activities of scientists. Here I argue that expert communication has a specifically ethical dimension, and that experts must face a fundamental trade-off between "actionability" and "transparency" when communicating. Some recommendations for expert communication are suggested.

In the trust-health relationship, how trusting other people in society may promote good health is a topic often examined. However, the other direction of influence – how health may affect trust – has not been well explored. In order to investigate this possible effect, we employed Bayesian Mindsponge Framework (BMF) analytics to go deeper into the information processing mechanisms underlying the expressions of trust. Conducting Bayesian analysis on a dataset of 1237 residents from Cali, Colombia, we found that general health (...) status is positively associated with generalized trust, but recent experiences of illnesses/injuries have a negative moderating effect. Personalized trust is largely unchanged across different general health conditions, but the trust level becomes higher with recent experiences of illnesses/injuries. Psychophysiological mechanisms of increasing information filtering intensity toward unfamiliar sources during a vulnerable state of health is a plausible explanation of found patterns in generalized trust. Because established personal relationships are reinforced information channels, personalized trust is not affected as much. Rather, the results suggest that people may rely even more on loved ones when they are in bad health conditions. This exploratory study shows that the trust-health relationship can be examined from a different angle that may provide new insights. (shrink)

Trust is a topic of longstanding philosophical interest. It is indispensable to every kind of coordinated human activity, from sport to scientific research. Even more, trust is necessary for the successful dissemination of knowledge, and by extension, for nearly any form of practical deliberation and planning. Without trust, we could achieve few of our goals and would know very little. Despite trust’s fundamental importance in human life, there is substantial philosophical disagreement about what trust is, and further, how trusting is (...) normatively constrained and best theorized about in relation to other things we value. This entry is divided into three sections, which explore key (and sometimes interconnected) ethical and epistemological themes in the philosophy of trust: (1) The Nature of Trust; (2) The Normativity of Trust, and (3) The Value of Trust. (shrink)

Straipsnyje analizuojamos bioetikoje vyraujančio pagarbos asmens autonomijai principo prielaidos. Remiantis antropologų L. Dumont’o ir C. Geertzo darbais parodoma, kaip pagarbos asmens autonomijai principas yra susijęs su vakarietiška, krikščioniška, individualistine asmens samprata bei iš to plaukiančiu racionalumo reikšmės įtvirtinimu informuoto sutikimo koncepte. Taip pat ginama idėja, kad būtina atsižvelgti į rūpesčio etikos, pabrėžiančios emocijų svarbą moralėje ir paremtos reliacinio asmens prielaida, pasiūlytas įžvalgas. Straipsnyje parodoma, kaip rūpesčio etikoje pasiūlyti normatyviniai rūpesčio idealai gali būti pritaikomi bioetiniame kontekste – konceptualizuojant rūpestį medicinos sferoje (...) galima pritaikyti Bourdieu pasiūlytą habitus konceptą ir išryškinti ne tik tarpasmeninių santykių svarbą moraliniam vystymuisi, bet ir įvairias sociokultūrines bei istorines įtakas, lemiančias tam tikrus mūsų elgsenos modelius. (shrink)

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous (...) action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1). (shrink)

Our life with art is suffused with trust. We don’t just trust one another’s aesthetic testimony; we trust one another’s aesthetic actions. Audiences trust artists to have made it worth their while; artists trust audiences to put in the effort. Without trust, audiences would have little reason to put in the effort to understand difficult and unfamiliar art. I offer a theory of aesthetic trust, which highlights the importance of trust in aesthetic sincerity. We trust in another’s aesthetic sincerity when (...) we rely on them to fulfill their commitments to act for aesthetic reasons — rather than for, say, financial, social, or political reasons. We feel most thoroughly betrayed by an artist, not when they make bad art, but when they sell out. This teaches us something about the nature of trust in general. According to many standard theories, trust involves thinking the trusted to be cooperative or good-natured. But trust in aesthetic sincerity is different. We trust artists to be true to their own aesthetic sensibility, which might involve selfishly ignoring their audience’s needs. Why do we care so much about an artist’s sincerity, rather than merely trusting them to make good art? We emphasize sincerity when wish to encourage originality, rather than to demand success along predictable lines. And we ask for sincerity when our goal is to discover a shared sensibility. In moral life, we often try to force convergence through coordinated effort. But in aesthetic life, we often hope for the lovely discovery that our sensibilities were similar all along. And for that we need to ask for sincerity, rather than overt coordination. (shrink)

This dissertation is a philosophical contribution to the theories on trust and on risk communication. The importance of trust in risk communication has been argued for and empirically studied since the 80s. However, there is little agreement on the notion of trust and the precise function of trust. This thesis sets out to study both aspects from a philosophical point of view. The dissertation consists of five essays and an introduction. Essay I is a comment on risk perception theory and (...) the psychometric model in particular. The essay argues that sometimes individuals take risks simply because they are in a vulnerable position and have no other choice. Four factors are identified as crucial in risks from vulnerability: poor outset conditions, lack of reasonable options, hope and liability to disinformation. Essay II addresses the democratic approach to risk communication and the ideal of risk communication as a dialogue between more or less equal stakeholders. The essay develops a typology of different risk communication practices and influence distributions and concludes that the form of risk communication most commonly referred to in the literature is of the most imbalanced kind where all three types of influence falls to the same party. Essay III argues that trust can be understood as comfortable defocusing. Trust as comfortable defocusing means that when a person trusts, he or she is comfortable with letting certain things be in the hands or in the control of the trusted other. Departing from this idea a definition of trust is proposed consisting of three elements: the truster’s comfortable defocusing from the trusted person’s part of caring for X, based on a belief about the trusted person’s care for X, concerning something of concern to the truster. Essay IV explores the concept of trustworthiness and under which conditions trust can be betrayed in a morally justified way. It is argued that two aspects are essential for every reasonable notion of trustworthiness: reliability in terms of commitment to trust and predictability in terms of compliance with norms. In order to be untrustworthy in a morally justified way two major conditions need to be fulfilled: first, what is expected from the trustee needs to be either immoral or part of an ongoing immoral or unjust relationship between truster and trustee and, secondly, the trustee must not be in a position to explicitly reject trust. Essay V examines two of the most employed distinctions within the trust literature, that of trust/confidence and of trust/reliance. These distinctions are evaluated against a set of five criteria. It is argued that both these distinctions are employed to cover several distinguishing properties, thus adding to conceptual confusion. (shrink)

Experimental design is one aspect of a scientific method. A well-designed, properly conducted experiment aims to control variables in order to isolate and manipulate causal effects and thereby maximize internal validity, support causal inferences, and guarantee reliable results. Traditionally employed in the natural sciences, experimental design has become an important part of research in the social and behavioral sciences. Experimental methods are also endorsed as the most reliable guides to policy effectiveness. Through a discussion of some of the central concepts (...) associated with experimental design, including controlled variation and randomization, this chapter will provide a summary of key ethical issues that tend to arise in experimental contexts. In addition, by exploring assumptions about the nature of causation and by analyzing features of causal relationships, systems, and inferences in social contexts, this chapter will summarize the ways in which experimental design can undermine the integrity of not only social and behavioral research but policies implemented on the basis of such research. (shrink)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

This paper explores the claim that someone can reasonably consider themselves to be under a duty to respect the autonomy of a person who does not have the capacities normally associated with substantial self-governance.

Distributive egalitarians believe that distributive justice is to be explained by the idea of distributive equality (DE) and that DE is of intrinsic value. The socio-relational critique argues that distributive egalitarianism does not account for the “true” value of equality, which rather lies in the idea of “equality as a substantive social value” (ESV). This paper examines the socio-relational critique and argues that it fails because – contrary to what the critique presupposes –, first, ESV is not conceptually distinct from (...) DE, and second, the idea of ESV cannot serve as a “foundation” or “root” of distributive egalitarianism. (shrink)

Through the vehicle of Nicolas Sarkozy’s so-called “Dakar Address” we will analyse the West’s persisting lack of insight into the need for a Western decolonization. We will try to identify the dangers that come from this refusal, such as the abidance in colonial patterns, the enduring self-understanding as superior com-pared to Africa, and the persisting unwillingness to accept the colonial guilt. Decolonization has to be understood as a two-fold business. Decolonization is over-coming endured and perpetrated violence. It is not only (...) important that the colonial oppressed regain strength, it is equally important that the perpetrator of colonial violence understand their excess of violence and work on effecting its return impossible. We explain how Western thinking remains dangerous and untrustwor-thy if it refuses its own decolonization. Finally, we will draw attention to a fundamental pattern of Western thought that clashes with the fundamental values of the West: contempt. In a final step we suggest how this contempt can be overcome through desuperiorisation and the establishment of elative ethics. (shrink)

Does the fact that humans are vulnerable, needy and dependent beings play an important role in Kantian ethics? It is sometimes claimed that it cannot and does not. I argue that it can and does. I distinguish between broad (all persons are vulnerable) and narrow (only some persons are vulnerable) senses of vulnerability, and explain the role of vulnerability in both senses in Kantian ethics. The basis of this argument is to show that the core normative focus of Kantian ethics (...) is on the dignity that human beings have in virtue of their capacity for rational agency. This implies that the empirical conditions under which human beings can acquire, sustain, exercise, and develop their rational capacities are of core moral importance in Kantian ethics. This explains why human vulnerabilities, including the vulnerability of human bodies, are important in Kantian ethics, since rational capacities in human agents (and the bodies those rational capacities depend upon) are highly vulnerable in all persons (vulnerability in the broad sense) and especially vulnerable in some sub-groups of persons (vulnerability in the narrow sense). (shrink)

Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all (...) human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. (shrink)