Philosophers’ intuitions about what constitutes autonomy are largely driven by the exemplars or paradigms that we recognize. There are indefinitely many exemplars, inasmuch as there are relatively private personae that serve as autonomy exemplars such as our parents, third grade teacher, or, for the megalomaniac, oneself. But among Western philosophers there are doubtless some exemplars that are widely shared and broadly influential. Philosophical exemplars include Socrates, Aristotle’s magnanimous man, Kant’s noumenal self that is perfectly attuned to the moral law, Mill’s (...) anti-authoritarian non-conformist, Marx’s manin-society, Nietzsche’s Zarathustra, and Sartre’s authentic youth who must decide whether to join the French resistance or stay at home for the sake of his mother. Exemplars from outside of philosophy include Antigone, Christ, Faust, Ibsen’s Enemy of the People, Winston Churchill, and even figures from popular culture such as the baseball player Ted Williams, the free spirited flower children of the 1960s, and practically any character that John Wayne ever played. (shrink)

Controversy swept the U.K. in January of 2000 over public disclosure of the fact that a Scottish surgeon named Robert Smith had amputated the limbs of two able-bodied individuals who reportedly suffered from a condition known as apotemnophilia. The patients, both of whom had sought and consented to the surgery, claimed they had desperately desired for years to live as amputees and had been unable, despite considerable efforts, to reconcile themselves psychologically to living with the bodies with which they were (...) born. Both surgeries were successful, and both patients, who had undergone psychiatric evaluation prior to the amputations, subsequently reported having no regrets. In the wake of a wave of sensationalistic stories in the media, the hospital at which the surgeries had been performed, the Falkirk and District Royal Infirmary, banned any future surgeries of the kind. Outraged local politicians promptly announced their intention to pass laws banning the procedure outright. One member of Scottish Parliament declared the surgery obscene and asserted that the whole thing is repugnant and legislation needs to be brought in now to outlaw this. (shrink)

The principle of autonomy presupposes Patient Decision Making Competence (PDMC). For a few decades a considerable amount of empirical research has been done into PDMC. In this contribution that research is explored. After a short exposition on four qualities involved in PDMC, different approaches to assess PDMC are distinguished, namely a negative and a positive one. In the negative approach the focus is on identifying psychopathologic conditions that impair sound decision making; the positive one attempts to assess whether a patient (...) actually has the required abilities and qualities. Characteristic of the latter approach is the use of (or development of) test-like instruments for PDMC assessment. Some of these tests are discussed and commented on. Although they may be useful in investigating aspects of PDMC, none of the described approaches and tests offers a reliable and valid method for PDMC assessment. In response to a potential misuse of tests, the concept of a supportive situation is briefly introduced in order to draw attention to the risk of prematurely deeming patients incompetent on the basis of low test scores, whereas their insufficient performance may be (partly) attributable to alack of situational support. Also, the need for and possibility of an emotionalist concept of PDMC are suggested, as an alternative to the more common rationalist one. In this regard,the legitimacy of competence being conceived as a presumption or fiction of law, deserves further investigation. (shrink)

In the course of that critical study he discusses the work of many of the most influential lawyers and philosophers of the era, including Isaiah Berlin, Richard ...

Respect, Pluralism, and Justice is a series of essays which sketches a broadly Kantian framework for moral deliberation, and then uses it to address important social and political issues. Hill shows how Kantian theory can be developed to deal with questions about cultural diversity, punishment, political violence, responsibility for the consequences of wrongdoing, and state coercion in a pluralistic society.