This is a substantially updated edition of the established guide to this key debate in modern political philosophy.

Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they (...) all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty’s philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors’ relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine. (shrink)

Autonomy as a personal ideal presupposes a conception of the self who owns and rules in a life that exemplifies the ideal. Philosophical discussion of autonomy continues to be injuenced by the thesis that the governing core of the self resides in our capacities for disengaged rational reflection, even when the thesis is not explicitly avowed. This conception of autonomy is shown to be inadequate because it alienates us from what matters in our lives. An alternative conception of autonomy is (...) presented that accords a substantial role to rejection and choice within an autonomous life without falling preq, to the charge of alienation. Some divergent implications of the two rival conceptions of autonomy for an understanding of liberal education are examined. Finally, the question of the value of autonomy from a social perspective is briefly discussed. (shrink)

Autonomy as a personal ideal presupposes a conception of the self who owns and rules in a life that exemplifies the ideal. Philosophical discussion of autonomy continues to be injuenced by the thesis that the governing core of the self resides in our capacities for disengaged rational reflection, even when the thesis is not explicitly avowed. This conception of autonomy is shown to be inadequate because it alienates us from what matters in our lives. An alternative conception of autonomy is (...) presented that accords a substantial role to rejection and choice within an autonomous life without falling preq, to the charge of alienation. Some divergent implications of the two rival conceptions of autonomy for an understanding of liberal education are examined. Finally, the question of the value of autonomy from a social perspective is briefly discussed. (shrink)

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we (...) consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

The Israeli Patient Rights Act attempts to accommodate personal autonomy within an avowedly paternalist communitarian state. Although Israel is still groping toward a solution, the legislation begins to show the different form a communitarian version of autonomy must take.

A communitarian approach to bioethics adds a core value to a field that is often more concerned with considerations of individual autonomy. Some interpretations of liberalism put the needs of the patient over those of the community; authoritarian communitarianism privileges the needs of society over those of the patient. Responsive communitarianism's main starting point is that we face two conflicting core values, autonomy and the common good, and that neither should be a priori privileged and that we have principles and (...) procedure that can be used to work out this conflict but not to eliminate it. Additionally, it favours changing behaviour mainly through the creation of norms and by drawing on informal social control rather than by coercion. (shrink)