In this article I explore partial ectogenesis through the lens of choice in childbirth, framing it as a mode of delivery. In doing so, I refocus discussion about partial ectogenesis, ensuring that this centers upon the autonomy and rights of the birthing person—as the procedure required to facilitate external gestation will be performed upon their body. By drawing a critical comparison between “delivery by partial ectogenesis” and request cesarean sections, I argue that delivery by partial ectogenesis ought to be available (...) on the basis of the pregnant person’s request alone. (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)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best (...) interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that harmful, (...) discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

Defends Kantian paternalism: Interference with an individual’s liberty for her own sake is justified absent her actual consent only to the extent that such interference stands a reasonable chance of preventing her from exercising her liberty irrationally in light of the rationally chosen ends that constitute her conception of the good. More specifically, interference with an individual’s liberty is permissible only if, by interfering, we stand a reasonable chance of preventing that agent from performing actions she chose due to distorted (...) reasoning and which would result in that agent’s rationally chosen ends not being as fully realized as they would have been had she so acted. -/- Applied to suicide intervention Kantian paternalism implies that such intervention is justified to the extent that it prevents a person from ending her life when, due to distorted reasoning, she engages in suicidal behavior that is at odds with her rationally chosen ends. (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.

Our decision-making is often subject to framing effects: alternative but equally informative descriptions of the same options elicit different choices. When a decision-maker is vulnerable to framing, she may consent under one description of the act, which suggests that she has waived her right, yet be disposed to dissent under an equally informative description of the act, which suggests that she has not waived her right. I argue that in such a case the decision-maker’s consent is simply irrelevant to the (...) permissibility of proceeding. I then consider two alternative views. According to the first, people susceptible to framing are able to give valid consent so long as they are sufficiently informed. This suggestion, I argue, maintains an overly narrow focus on mere quantity of information to the exclusion of other choice-affecting factors. A second response, which appeals to hypothetical consent, is likewise of little use in resolving the moral problem posed by framing effects. I conclude that if susceptibility to framing undermines the validity of consent, we may have good reason to reconsider whether consent has the rights-waiving function commonly attributed to it. (shrink)

Animal husbandry has been accused ofmaltreating animals, polluting the environment, and soon. These accusations were thought to be answered whenthe Dutch research program ``Sustainable TechnologicalDevelopment'' (STD) suggested a government-initiatedconversion from meat to novel protein foods (NPFs).STD reasoned that if consumers converted from meat toNPFs, non-sustainable animal husbandry would no longerbe needed. Whereas STD only worried about how toconstruct NPFs with a meat bite, this paper drawsattention to the presumed, but problematic, role forthe government in the execution of the STDsuggestions. Although (...) vegetarians take the credo ``YouAre What You Eat'' literally and accuse non-vegetariansof being beasts, a different interpretation is morepromising: eating meat has become a leading thread inmany lifestyles and narratives of self-identity. Sincethe freedom to follow your own lifestyle orconsumptive preferences is a core value incontemporary affluent societies, governmentintervention in the formation and satisfaction ofconsumer preferences for meat dishes is a precariousissue. Hence, NPFs might be interesting for a smallfraction of society, but we had better not expect toomuch from a government-initiated conversion from meatto NPFs as the answer to animal husbandry'sproblems. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

Most anti-paternalists claim that informed and competent self-regarding choices are protected by autonomy, while ill-informed or impaired self-regarding choices are not. Joel Feinberg, among many others, argues that we can in this way distinguish impermissible “hard” paternalism from permissible “soft” paternalism. I argue that this view confronts two related problems in its treatment of ill-informed decision-makers. First, it faces a dilemma when applied to decision-makers who are responsible for their ignorance: it either permits too much, or else too little, intervention (...) to satisfy its proponents. Second, the most promising rationales in favor of the view ignore the distinction between an agent’s voluntarily bringing about some state of affairs, on the one hand, and an agent’s voluntarily assuming a risk, on the other. I conclude that a decision-maker’s ignorance is irrelevant to the permissibility of intervention on her behalf. If it is permissible to intervene in a given ill-informed choice, it would be permissible to intervene in an otherwise similar but informed choice, at least provided that intervention would produce similar benefits in both cases. This shows that we should sometimes accept straightforwardly paternalistic rationales. (shrink)

Is it a stronger interference with people's freedom to withdraw options they currently have than to withhold similar options they do not have? Drawing on recent theorizing about sociopolitical freedom, this article identifies considerations that often make this the case for public policy. However, when applied to tobacco control, these considerations are shown to give us at best only very weak freedom-based reason to prioritize the status quo. This supports a popular argument for so-called “endgame” tobacco control measures: If we (...) believe that cigarettes would and should be withheld from entering markets in hypothetical scenarios in which they do not yet exist, then we also have reason to seek their abolition in situations, such as ours, in which cigarettes do exist—if necessary by banning their sale. The same considerations are then used to disarm objections that have recently been raised to using nudges in public policy. (shrink)

The book kicks off by remarking that the year 1972 must have been a very special year indeed. The Club of Rome published its report 'The Limits to Growth', the Ecologist published its 'Blueprint for Survival', and the United Nations held its first environmental conference in Stockholm. These three occasions were the first to use the notion of sustainable development with its current connotations. However, sustainable development only received its lasting status as a meta-objective for national and international environmental policy-making (...) with the publication of the WCED-report 'Our Common Future' in 1987. This report defined sustainable development as "development that meets the needs of the present generation without compromising the ability of future generations to meet their own needs". Subsequently, the debate on sustainable development reached a new climax with the United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro in 1992. This conference introduced the idea that sustainable development asks for adjustments of lifestyles and patterns of consumption, apart from adjustments in the sphere of production. UNCED emphasised the need for government intervention in non-sustainable lifestyles, and the second Dutch National Environmental Policy Plan (NEPP2) translated this emphasis to the Dutch context.UNCED and NEPP2 initiated an extensive public debate on government intervention in non-sustainable lifestyles, which was dominated by communicative and economic strategies. Unfortunately, these strategies hitherto failed to reconcile government intervention in non-sustainable lifestyles and respect for people's freedom to follow their own lifestyles. Therefore, this book's objective is to provide this very reconciliation by drawing an outline of a green third way for government intervention in non-sustainable lifestyles. This green third way presents itself as an alternative for the first (communicative) and second (economic) ways in the Dutch public debate. The book aims to articulate people's concerns about the deterioration of nature and the environment, materialised in the worldwide support for the notion of sustainable development, within a largely political liberal frame of reference.Chapter 2 maps the Dutch public debate on government intervention in non-sustainable lifestyles. This analysis shows that although communicative and economic strategies dominate the debate, these strategies are seriously flawed in their attempts to evade the principled question of whether government intervention in non-sustainable lifestyles implies an intolerable infringement of people's freedom to follow their own lifestyles, visions of the good life or consumptive preferences. Communicative and economic strategies are thus criticised on three accounts: 1) their failure to recognise the inextricable interconnectedness between attitudes and behaviour in people's lifestyles; 2) their evasion of the question of how government intervention in non-sustainable lifestyles could respect the individual freedom of choice; and 3) their unwillingness to investigate whether sustainable development could offer sound reasons to restrict this freedom of choice. Both strategies are, therefore, incapable of providing a meaningful interpretation of all key terms in the phrase 'government intervention in non-sustainable lifestyles'. It is not much of a surprise then that they cannot reconcile government intervention and respect for people's freedom to follow their own lifestyles. Therefore, the chapters 3,4 and 5 subsequently set out to remedy these three flaws of communicative and economic strategies. Luckily, lately a third strategy dawned in the Dutch public debate. This third strategy provides some of the materials to develop an outline of a green third way for government intervention in non-sustainable lifestyles.Chapter 3 argues, mainly inspired by Giddens's theory of structuration, his and Beck's accounts of reflexive modernisation and Douglas's grid-group analysis, for a narrative conceptualisation of the notions of lifestyle and self-identity. This conceptualisation 1) emphasises the inextricable interconnectedness of practices and narratives of self-identity in people's lifestyles, 2) stresses the duality of individual and society in the constitution of lifestyles, 3) changes the modernist distinction between citizen and consumer for the public-private hybrid of the citizen-consumer, and 4) maps the plurality of lifestyles in contemporary globalising, individualising and detraditionalising societies. The narrative conceptualisation of lifestyles implies that it is no longer possible to evade the question of whether government intervention in non-sustainable lifestyles necessarily entails an intolerable infringement of people's freedom to follow their own lifestyles. It will not do to emphasise some remaining freedom in either practices or narratives of self-identity, since these practices and narratives are inextricably interconnected in people's lifestyles.Chapter 4 argues, mainly informed by Berlin's and Rawls's political liberalism, Raz's liberal perfectionism and Habermas's notion of a deliberative democracy, that most government intervention in lifestyles is indeed an intolerable infringement of the individual freedom of choice. This liberal point of view 1) argues that respect for the individual freedom of choice implies that the government should take a neutral and anti-perfectionist stance, 2) holds it that directive, communicative and economic, strategies for government intervention would only be justified if certain choices harmed others, caused injustice, or were obviously irrational, 3) accepts, in the second instance, that the political liberal argument is not neutral and anti-perfectionist at all, but believes that this perfectionist turn only strengthens the need to respect the individual freedom of choice, and 4) advocates extensive public deliberation on the objectives and instruments of environmental policy-making. The political liberal emphasis on the need to respect the individual freedom of choice implies that directive strategies for government intervention in non-sustainable lifestyles generally do not show enough respect for people's freedom to follow their own lifestyles, unless it is obvious that certain lifestyles harm others or cause injustice.Chapter 5 argues, mainly on the basis of Rawls's savings principle, Wissenburg's restraint principle, Passmore's chains of love, and De-Shalit's transgenerational communities, for a double interpretation of sustainable development as a principle of intergenerational justice and a future-oriented green ideal. This double interpretation 1) embraces the restraint principle and the argument that no individual can claim an unconditional right to destroy environmental goods as a baseline that could justify directive strategies for government intervention in non-sustainable lifestyles, 2) suggests that people's concerns about the deterioration of nature and the environment articulate future-oriented narratives of self-identity that could fuel non-directive strategies to develop further responsibilities towards nearby future generations, 3) prefers to draw a list of primary environmental goods instead of quantifying some environmental utilisation space as a practical guideline for day-to-day environmental policy-making, and 4) concludes that the uncertainty of scientific knowledge about the unintended environmental repercussions of consumptive choices casts serious doubt about attempts to justify directive strategies for government intervention in non-sustainable lifestyles beyond the requirement of sustaining the baseline of the restraint principle and the list of primary environmental goods. Sustainable development, thus, provides sound arguments to restrict people's freedom to follow their own lifestyles, when these lifestyles transgressed the baseline of the restraint principle and the list of primary environmental goods. However, the individual freedom of choice should not be restricted for any further environmental considerations. Non-directive strategies are thus to stimulate the development of such further responsibilities towards nearby future generations. The challenge for a green third way of government intervention in non-sustainable lifestyles becomes to search for adjustments of social and material conditions that could tempt people to develop sustainable lifestyles.Chapter 6, finally, returns from these rather unearthly reflections to the more mundane issues in the public debate on government intervention in non-sustainable lifestyles by presenting an outline of a green third way. This green third way offers an alternative to the overly directive communicative and economic strategies for government intervention in non-sustainable lifestyles, and broadens the prevailing political landscape with a strategy that promises superiority in addressing the intricacies of environmental policy-making in liberal-democratic societies. Although this green third way leaves ample room to use communicative and economic instruments to secure the environmental baseline of the restraint principle and the list of primary environmental goods, these instruments are framed in a quite different perspective or set of premises now. A short discussion of the Schönau Energy Initiatives serves to illustrate the kernel of an alternative strategy. This green third way offers a non-directive strategy for government intervention in non-sustainable lifestyles in which the government hopes to stimulate the development of sustainable lifestyles by adjusting the social and material conditions that surround people in following their lifestyles. The green third way, thus, reconciles government intervention in non-sustainable lifestyles and respect for people's freedom to follow their own lifestyles to a satisfactory degree. It accepts that the requirement to secure the environmental baseline of the restraint principle and the list of primary environmental goods justifies the use of directive strategies for government intervention in non-sustainable lifestyles in a limited set of conditions. However, it also emphasises that non-directive strategies should do the majority of the job. In this non-directive strategy the government should provide the social and material conditions in which a plurality of sustainable lifestyles could flourish. (shrink)

What constraints should be imposed on individual liberty for the sake of protecting our collective security? A helpful approach to answering this question is offered by a theory that grounds political obligation and authority in a moral requirement of fair contribution to mutually beneficial cooperative schemes. This approach encourages us to split the opening question into two—a question of correctness and a question of legitimacy—and generates a detailed set of answers to both subsidiary questions, with a nuanced and plausible set (...) of implications. The plausibility of its treatment of the issues surrounding liberty and security, I argue, helps to confer credibility on the fairness-based theory that carries these implications. (shrink)

Background The principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of (...) any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures. Objective To conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies. Methods We conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed. Results Our search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients’ autonomous decision-making through cultural, social, religious, or intersectional pathways. Conclusion Two main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients’ inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention. (shrink)