An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A (...) widely shared assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range (...) of delusions, which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

This paper offers an analysis of the relation between political populism and mass media, and how this relation becomes problematic for democratic societies. It focuses on the fact that mass media, due to their purpose and infrastructure, can unintentionally reinforce populist messages. Research findings from communication science and political psychology are used to illustrate how, for example, a combination of mass media agenda setting and motivated reasoning can influence citizens’ political decisions and impair their political autonomy. This poses a (...) particular normative challenge for modern democracies: how to counter these populism-supporting effects within the constraints of democratic legitimacy? After showing how severely limited legal measures to curb populist media effects would be, the paper argues in favour of media competence education as a way of providing future citizens with an epistemic toolkit to navigate the media environment and strengthen their political autonomy. (shrink)

Despite growing understanding of the addictive qualities of the internet, and rising concerns about the effects of excessive internet use on personal wellbeing and mental health, the corresponding ethical debate is still in its infancy, and many of the relevant philosophical and conceptual frameworks are underdeveloped. Our goal in this chapter is to explore some of this evolving terrain. While there are unique ethical considerations that pertain to the formalisation of a disorder related to excessive internet use, our ethical concerns (...) (and indeed our mental health concerns) about whether certain technologies undermine wellbeing can and should be far broader than the debates about the appropriateness of particular diagnostic categories. In this chapter we introduce some of these wider debates with regards to persuasive digital technologies— particularly those which aim to maximise use, or even to encourage compulsive engagement—as well as the difficulty in articulating the harms involved in excessive internet use, especially where such use has not led to functional impairment. Following these conversations we briefly consider some more practical ethical implications, including regulation of certain design features, concerns about growing socioeconomic inequality in online services, and whether there should be a “right to disconnect.”. (shrink)

Adaptive preferences give rise to puzzles in ethics, political philosophy, decision theory, and the theory of action. Like our other preferences, adaptive preferences lead us to make choices, take action, and give consent. In 'False Consciousness for Liberals', recently published in The Philosophical Review, David Enoch (2020) proposes a criterion by which to identify when these choices, actions, and acts of consent are less than fully autonomous; that is, when they suffer from what Natalie Stoljar (2014) calls an 'autonomy (...) deficit'. According to Enoch, such actions are not protected in the usual way against interference by others; there is not the same prohibition against trying to prevent someone from acting in a particular way when that action is motivated by such adaptive preferences and is an attempt to satisfy them. In this note, I raise two concerns about Enoch's criterion. (shrink)

Much of the literature on impairment to self-governance focuses on cases in which a person either lacks the ability to protect herself from errant urges or cases in which a person lacks the capacity to initiate self-reflective agential processes. This has led to frameworks for thinking about self-governance designed with only the possibility of these sorts of impairments in mind. I challenge this orthodoxy using the case of melancholic depression to show that there is a third way that self-governance (...) can be undermined: an agent may fail to form the desire she most wants to act on. (shrink)

PT. A noção de “pessoa”, pensada a partir do legado antropológico e filosófico do ocidente, afirma-se como uma unidade corporal e espiritual que determina a sua singularidade no seio da comunidade. A “pessoa” assim perspectivada assume uma importância destacada na reflexão ética das aplicações científicas de artificialização da vida humana. Muito concretamente, a noção de “pessoa” deve contribuir para a fundamentação ética das terapêuticas de transplantação. A transplantação representa um dos mais notáveis avanços da medicina do século XX e com (...) um impacto incontornável na prestação de cuidados de saúde. Os transplantes são considerados o tratamento mais eficaz para patologias crónicas que afectam a funcionalidade de determinados órgãos vitais, restituindo ao doente uma melhoria na sua saúde e/ou qualidade de vida. O sucesso desta terapêutica é, no entanto, condicionado pela disponibilização de pessoas que queiram fazer dádiva de si, do seu próprio corpo, para o bem-estar de outrem. Deste modo, a doação, realizada após a morte da pessoa ou ainda em vida, enfrenta vários desafios técnicos, mas também, e principalmente, desafios éticos. A nossa dissertação centra-se na reflexão ética da doação de órgãos e tecidos para transplante e no impacto que a dádiva de uma parte específica do corpo pode comportar na noção de “pessoa”. Deste modo, ao mesmo tempo em que se procura promover a doação de órgãos para aumentar o número de transplantes, também se vão delineando estratégias para salvaguardar a integridade corporal do dador e a eminente dignidade que o constitui como pessoa. As estratégias consistem fundamentalmente num diálogo entre o princípio de autonomia, que determina a singularidade da pessoa, e o princípio de solidariedade, que é desencadeado pela relação com o outro. Estes princípios éticos, articulados e uma vez cumpridos, são os alicerces da doação voluntária e altruísta, e impedem a instrumentalização e exploração da pessoa dadora. -/- EN. The western anthropological and philosophical notion of ‘person’ emerges as a corporal and spiritual entity, which determines his singularity at the level of community. From this perspective, the notion of ‘person’ holds an important place in ethical considerations concerning the scientific applications of artificial manipulation of human life. More precisely, the notion of ‘person’ must contribute towards the ethical basis of transplant therapeutics. The transplantation of human organs and tissues is one of the most notable advances in twentieth century medicine, and, as such, has had an unquestionable impact on health care practice. Transplants are now seen as the best treatment for chronic diseases that impair the function of some vital organs, improving the patient health and/or quality of life. The success of organs transplantation depends entirely upon the altruism of people giving their bodies for the well-being of others. Organ donation, performed during life or after death, raises not only technical, but also mainly ethical challenges. This work focuses on the ethical considerations associated with human organs and tissue donation for transplantation and on the impact that a donation of an organ has on the notion of ‘person’. At the same time that one recognizes the need to increase the number of organs for transplanting, there is also the need to preserve the donor’s corporal integrity and his eminent dignity. Strategies to preserve the donor’s corporal integrity and dignity must take into consideration the dialogue between the principle of autonomy, which is characterized by the singular entity, and the principle of solidarity, born out of one’s relationship with those around you. These ethical principles, once engaged and fulfilled, are the bases of a voluntary and altruistic donation, and prevent the donor from becoming a mere instrument and being exploited as such. (shrink)

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred (...) to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and (...) human rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision on their behalf). (...) -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

We introduce Neuroartes as a biological humanism that concentrates on the development of social interventions. We review several connections between art and the human body, mainly the brain. We suggest art, painting in the present case, as a tool to work with the elderly with cognitive and/or motor impairment for the purpose of helping them with their subjectivity and autonomy.

It is largely unethical to sentence individuals who are addicted to drugs to prison. While substance use can be a crime, it must be treated differently from other crimes because addiction is a psychiatric disorder. Prisons are penal institutions. Legitimate goals of penal sanctions include retribution, deterrence, rehabilitation, and incapacitation.[i] Most of these goals do not speak to those with substance use disorder, and incarceration may be counterproductive given the wide availability of drugs and feeble rehabilitation efforts in prison. Further, (...) it may be the case that substance use disorder impairs an addict’s autonomy, calling into question his criminal culpability. Our understanding of substance use disorder has evolved and our prison sentencing practices must do the same. This paper will first provide background on substance use disorder as a psychiatric disorder. Then, the need to focus on rehabilitating rather than punishing those with substance use disorder who commit crimes will be explored. Finally, this paper will address whether an individual with substance use disorder can be considered culpable for any crime—regardless of severity—and whether that individual’s autonomy is impaired due to his addiction. I conclude that culpability should depend on whether the serious crime would have occurred in the absence of the drug addiction. In most cases, it is unethical to sentence an individual with substance use disorder to prison where other options such as home confinement are available. (shrink)

Charland's article suggests that we need to think more about whether decision-making capacity is impaired in severe addiction, working from the idea that drug dealers rely on this understanding of addiction to draw in their clients. Charland argues that it is possible to make a choice without being in control (to make decisions without having decision-making capacity). I argue in support of Charland's ideas by examining the reasons supporting a medical model of addiction and its importance. (For Charland's article and (...) the full set of commentaries, please see the Research Gate link). (shrink)

In this chapter, Fourie identifies and systematizes the impairments associated with having privilege and evaluates their implications for theories of relational equality and distributive justice. Having certain social privileges, for example, being a man in a patriarchal society, can also be damaging; in other words, there are “impairments of privilege.” Fourie delineates six kinds of impairments—epistemic, evaluative, emotional, health-related, affiliative, and moral. She then goes on to assess the implications of the impairments of privilege for two theories in political philosophy. (...) Relational egalitarianism, she argues, has the theoretical resources to identify and address the problems associated with these impairments, whereas distributive egalitarianism does not. Furthermore, she argues that assessing the impairments of privilege through relational egalitarianism helps to characterize a society of equals: we must address the causes of functional impairments, express respect for the worse off by not normalizing the experiences of the privileged, and minimize competitive positionality. (shrink)

I provide an updated version of The Impairment Argument against abortion and respond to numerous objections that can be (and have been) raised to it.

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and abortion, (...) and so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

From the outset, critical social theory has sought to diagnose people’s participation in their own oppression, by revealing the roots of irrational and self-undermining choices in the complex interplay between human nature, social structures, and cultural beliefs. As part of this project, Ideologiekritik has aimed to expose faulty conceptions of this interplay, so that the objectively pathological character of what people are “freely” choosing could come more clearly into view. The challenge, however, has always been to find a way of (...) doing this without arrogantly assuming special access to what is good for people. And this danger of paternalism is one to which social theorists have all too often fallen prey. In this brief essay, I focus on contemporary instances of clearly self-defeating behavior in contexts of complex choices. I begin by discussing a recent attempt to diagnose and solve these failures of choices, namely the public policy recommendations of behavioral economist Richard Thaler and reform-minded legal theorist Cass Sunstein. Their influential “libertarian paternalist” approach is particularly interesting, both in what it includes (attention to the socially constructed nature of choice situations and the roots of the problems in human nature) and in what it leaves out (an understanding of the social construction of human nature and an adequate appreciation of the value of autonomy). After discussing it, I consider a broadly perfectionist alternative, to the effect that the problem lies in a failure to adequately appreciate the importance of developing autonomy. I then turn to sketching the outlines of a new approach, based on the concept of “autonomy gaps,” which approaches overly demanding policies in relational and action-theoretical terms. In the final section, I show how this provides the basis for an analysis both in terms of a critique of ideology and of social pathology. (shrink)

There seems to be a deep tension between two aspects of aesthetic appreciation. On the one hand, we care about getting things right. On the other hand, we demand autonomy. We want appreciators to arrive at their aesthetic judgments through their own cognitive efforts, rather than deferring to experts. These two demands seem to be in tension; after all, if we want to get the right judgments, we should defer to the judgments of experts. The best explanation, I suggest, (...) is that aesthetic appreciation is something like a game. When we play a game, we try to win. But often, winning isn’t the point; playing is. Aesthetic appreciation involves the same flipped motivational structure: we aim at the goal of correctness, but having correct judgments isn’t the point. The point is the engaged process of interpreting, investigating, and exploring the aesthetic object. Deferring to aesthetic testimony, then, makes the same mistake as looking up the answer to a puzzle, rather than solving it for oneself. The shortcut defeats the whole point. This suggests a new account of aesthetic value: the engagement account. The primary value of the activity of aesthetic appreciation lies in the process of trying to generate correct judgments, and not in having correct judgments. -/- *There is an audio version available: look for the Soundcloud link, below.*. (shrink)

This article assesses how autonomy and machine learning impact the existential risk of nuclear war. It situates the problem of cyber security, which proceeds by stealth, within the larger context of nuclear deterrence, which is effective when it functions with transparency and credibility. Cyber vulnerabilities poses new weaknesses to the strategic stability provided by nuclear deterrence. This article offers best practices for the use of computer and information technologies integrated into nuclear weapons systems. Focusing on nuclear command and control, (...) avoiding autonomy and machine learning is recommended as one means to reduce the existential risk of unintended nuclear conflict. (shrink)

Autonomy, traditionally conceived, is the capacity to direct one’s actions in light of self-given principles or values. Character, traditionally conceived, is the set of unchosen, relatively rigid traits and proclivities that influence, constrain, or determine one’s actions. It’s natural to think that autonomy and character will be in tension with one another. In this paper, I argue that this is a mistake: while character influences and constrains choice, this poses no problem for autonomy. However, in particular cases (...) character can affect autonomy by generating a particular kind of influence upon choice. As a first approximation, character limits autonomy when it influences the agent’s choice in a way that were she aware of it, (1) she would disavow the influence, and (2) the influence could no longer operate in the same way. Put a bit differently, I argue that character undermines autonomy when it generates reflectively unstable perceptions of warrant. (shrink)

One challenge in providing an adequate definition of physical disability is unifying the heterogeneous bodily conditions that count as disabilities. We examine recent proposals by Elizabeth Barnes (2016), and Dana Howard and Sean Aas (2018), and show how this debate has reached an impasse. Barnes’ account struggles to deliver principled unification of the category of disability, whilst Howard and Aas’ account risks inappropriately sidelining the body. We argue that this impasse can be broken using a novel concept: marginalised functioning. Marginalised (...) functioning concerns the relationship between a person’s bodily capacities and their social world: specifically, their ability to function in line with the default norms about how people can typically physically function that influence the structuring of social space. We argue that attending to marginalised functioning allows us to develop, not one, but three different models of disability, all of which—whilst having different strengths and weaknesses—unify the category of disability without sidelining the body. (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.

Since 2016, when the Facebook/Cambridge Analytica scandal began to emerge, public concern has grown around the threat of “online manipulation”. While these worries are familiar to privacy researchers, this paper aims to make them more salient to policymakers — first, by defining “online manipulation”, thus enabling identification of manipulative practices; and second, by drawing attention to the specific harms online manipulation threatens. We argue that online manipulation is the use of information technology to covertly influence another person’s decision-making, by targeting (...) and exploiting their decision-making vulnerabilities. Engaging in such practices can harm individuals by diminishing their economic interests, but its deeper, more insidious harm is its challenge to individual autonomy. We explore this autonomy harm, emphasising its implications for both individuals and society, and we briefly outline some strategies for combating online manipulation and strengthening autonomy in an increasingly digital world. (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)

Some have objected to human enhancement on the grounds that it violates the autonomy of the enhanced. These objections, however, overlook the interesting possibility that autonomy itself could be enhanced. How, exactly, to enhance autonomy is a difficult problem due to the numerous and diverse accounts of autonomy in the literature. Existing accounts of autonomy enhancement rely on narrow and controversial conceptions of autonomy. However, we identify one feature of autonomy common to many (...) mainstream accounts: reasoning ability. Autonomy can then be enhanced by improving people’s reasoning ability, in particular through cognitive enhancement; given how valuable autonomy is usually taken to be, this gives us extra reason to pursue such cognitive enhancements. Moreover, autonomy-based objections will be especially weak against such enhancements. As we will argue, those who are worried that enhancements will inhibit people’s autonomy should actually embrace those enhancements that will improve autonomy. (shrink)

Current AI policy recommendations differ on what the risks to human autonomy are. To systematically address risks to autonomy, we need to confront the complexity of the concept itself and adapt governance solutions accordingly.

'Autonomy' is originally a political notion. In this chapter, I argue that the political theory Kant defended while he was writing the _Groundwork_ sheds light on the difficulties that are commonly associated with his account of moral autonomy. I argue that Kant's account of the two-tiered structure of political legislation, in his _Feyerabend Lectures on Natural Law_, parallels his distinction between two levels of moral legislation, and that this helps to explain why Kant could regard the notion of (...) 'autonomy' as apt to express the principle of morality---at least in the mid 1780s. (shrink)

Recently, more attention has been paid to the nature and value of the intellectual virtue of epistemic autonomy. One underexplored issue concerns how epistemic autonomy is related to other intellectual virtues. Plausibly, epistemic autonomy is closely related to a number of intellectual virtues like curiosity, inquisitiveness, intellectual perseverance, and intellectual courage to name just a few. Here, however, I will examine the relation between epistemic autonomy and intellectual humility. I will argue that epistemic autonomy and (...) intellectual humility bear an interesting relationship to one another in that they are interconnected and mutually supporting intellectual virtues. In sections 2 and 3 I will provide a brief overview of the predominant accounts of intellectual humility (section 2) and epistemic autonomy (section 3) in the literature. With an understanding of these intellectual virtues in hand, we will examine their relationship of mutual support in section 4. Section 5 will explore a challenge to this relationship coming from the epistemology of disagreement, and section 6 concludes. (shrink)

I defend my pure social account of global autonomy from Steven Weimer's recent criticisms. In particular, I argue that it does not implicitly rely upon the very kind of nonsocial conception of autonomy that it hopes to replace.

More and more researchers argue that online technologies manipulate human users and, therefore, undermine their autonomy. We call this the MAL view on online technology because it argues from Manipulation to Autonomy-Loss. MAL enjoys public visibility and will shape the academic discussion to come. This view of online technology, however, fails conceptually. MAL presupposes that manipulation equals autonomy loss, and that autonomy is the absence of manipulation. That is mistaken. In short, an individual can be manipulated (...) while being fully personally autonomous. Internet policy researchers should be aware of this point to avoid looking in the wrong place in future research on manipulative and harmful online technology. (shrink)

Adaptive preference formation is the unconscious altering of our preferences in light of the options we have available. Jon Elster has argued that this is bad because it undermines our autonomy. I agree, but think that Elster's explanation of why is lacking. So, I draw on a richer account of autonomy to give the following answer. Preferences formed through adaptation are characterized by covert influence (that is, explanations of which an agent herself is necessarily unaware), and covert influence (...) undermines our autonomy because it undermines the extent to which an agent's preferences are ones that she has decided upon for herself. This answer fills the lacuna in Elster's argument. It also allows us to draw a principled distinction between adaptive preference formation and the closely related phenomenon of character planning. (shrink)

The philosophical significance of attitudinal autonomy—viz., the autonomy of attitudes such as beliefs—is widely discussed in the literature on moral responsibility and free will. Within this literature, a key debate centres around the following question: is the kind of attitudinal autonomy that’s relevant to moral responsibility at a given time determined entirely by a subject’s present mental structure at that time? Internalists say ‘yes’, externalists say ’no’. In this essay, I motivate a kind of distinctly epistemic attitudinal (...) autonomy, attitudinal autonomy that is relevant to knowledge. I argue that regardless of whether we are externalists or internalists about the kind of attitudinal autonomy that is relevant for moral responsibility, we should be externalists about the kind of autonomy that a belief must have to qualify as knowledge. (shrink)

Sometimes neuroscientists discover distinct realizations for a single psychological property. In considering such cases, some philosophers have maintained that scientists will abandon the single multiply realized psychological property in favor of one or more uniquely realized psychological properties. In this paper, we build on the Dimensioned theory of realization and a companion theory of multiple realization to argue that this is not the case. Whether scientists postulate unique realizations or multiple realizations is not determined by the neuroscience alone, but by (...) the psychological theory under examination. Thus, one might say that, in the splitting or non-splitting of properties, psychology enjoys a kind of autonomy from neuroscience. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

In the debates regarding the ethics of human enhancement, proponents have found it difficult to refute the concern, voiced by certain bioconservatives, that cognitive enhancement violates the autonomy of the enhanced. However, G. Owen Schaefer, Guy Kahane and Julian Savulescu have attempted not only to avoid autonomy-based bioconservative objections, but to argue that cognition-enhancing biomedical interventions can actually enhance autonomy. In response, this paper has two aims: firstly, to explore the limits of their argument; secondly, and more (...) importantly, to develop a more complete understanding of autonomy and its relation to cognitive enhancement. By drawing a distinction between the capacity for autonomy and the exercise and achievement of autonomy and by exploring the possible effects of cognitive enhancement on both competence and authenticity conditions for autonomy, the paper identifies and explains which dimensions of autonomy can and cannot, in principle, be enhanced via direct cognitive interventions. This allows us to draw conclusions regarding the limits of cognitive enhancement as a means for enhancing autonomy. (shrink)

I present an account of epistemic autonomy as a distinctively wide-ranging epistemic virtue, one that helps us to understand a range of phenomena that might otherwise seem quite disparate – from the appropriate selection of epistemic methods, stances and topics of inquiry, to the harms of epistemic oppression, gaslighting and related phenomena. The account draws on four elements commonly incorporated into accounts of personal autonomy: (i) self-governance, (ii) authenticity, (iii) self-creation and (iv) independence. I further argue that for (...) a distinctively epistemic virtue of autonomy; the above elements must ultimately reliably lead to valuable epistemic goods (for the agent herself and others). I then turn to the domains or ways in which epistemic autonomy so understood, can be made manifest. I suggest that epistemic autonomy is a virtue that allows us to appropriately choose (i) subject matters and areas of inquiry, (ii) methods, sources, and processes of belief formation, (iii) epistemic goals and (iv) epistemic stances or frameworks. So understood, epistemic autonomy has a role to play in shaping most every aspect of our epistemic lives. (shrink)

Critics of persuasive advertising argue that it undermines the autonomy of consumers by manipulating their desires in morally problematic ways. My aim is this paper is to refine that argument by employing a conception of autonomy that is not at odds with certain forms of manipulation. I argue that the charge of manipulation is not sufficient for condemning persuasive advertising. On my view, manipulation of an agent’s desires through advertising is justifiable in cases where the agent accepts the (...) process through which the desires were developed. I show how the standard manipulation objection proves too much as it would also condemn cases of that kind. I argue that this distinction is especially important when we consider the implications of “new media.” In addition to increasing vulnerability to manipulation, new media have considerable impacts on well-being. By siding with the traditional autonomy argument, we would be compelled to take an implausible stand against all forms of manipulation through advertising, but I suggest that only a proper subset of those cases are morally problematic. This conclusion opens up a space for persuasive advertising that is permissible while nevertheless condemning cases that violate consumers’ autonomy. (shrink)

Could it be that if a fetus is not a person abortion is still immoral? One affirmative answer comes in the form of ‘The Impairment Argument’, which utilizes ‘The Impairment Principle’ to argue that abortion is immoral even if fetuses lack personhood. I argue ‘The Impairment Argument’ fails. It is not adequately defended from objections, and abortion is, in fact, a counterexample to the impairment principle. Furthermore, it explains neither what the wrong-making features of abortion are (...) nor what features of fetuses ground their supposed moral significance. By presupposing the fetus lacks personhood and providing no alternate account of the basis of fetuses’ moral significance, there is nothing to constitute abortion’s wrongness. Attempts to modify it fail for the same reasons. Thus, the impairment argument fails to show abortion is immoral. (shrink)

A number of bioethicists have been critical of the power of the family to “veto” a patient’s decision to posthumously donate her organs within opt-in systems of organ procurement. One major objection directed at the family veto is that when families veto the decision of their deceased family member, they do something wrong by violating or failing to respect the autonomy of that deceased family member. The goal of this paper is to make progress on answering this objection. I (...) do this in two stages. First, I argue that the most plausible interpretation of what happens when a person registers as an organ donor in an opt-in system is that she gives her consent to the state to posthumously remove her organs for transplantation purposes. Call this the Authorization Account. Second, given the Authorization Account, I argue by analogy that when families veto an individual’s decision to donate and the individual’s organs are not in the end removed, neither the doctors nor the family violate the individual’s autonomy in any morally objectionable sense. Call this the Nonremoval Thesis. I argue that since the Nonremoval Thesis is true, we do not violate or fail to respect the autonomy of registered donors when we fail to remove their organs because their family has objected. (shrink)

Respect for autonomy and beneficence are frequently regarded as the two essential principles of medical ethics, and the potential for these two principles to come into conflict is often emphasised as a fundamental problem. On the one hand, we have the value of beneficence, the driving force of medicine, which demands that medical professionals act to protect or promote the wellbeing of patients or research subjects. On the other, we have a principle of respect for autonomy, which demands (...) that we respect the self-regarding decisions of individuals. As well as routinely coming into opposition with the demands of beneficence in medicine, the principle of respect for autonomy in medical ethics is often seen as providing protection against beneficial coercion (i.e. paternalism) in medicine. However, these two values are not as straightforwardly opposed as they may appear on the surface. In fact, the way that we understand autonomy can lead us to implicitly sanction a great deal of paternalistic action, or can smuggle in paternalistic elements under the guise of respect for autonomy. -/- This paper is dedicated to outlining three ways in which the principle of respect for autonomy, depending on how we understand the concept of autonomy, can sanction or smuggle in paternalistic elements. As the specific relationship between respect for autonomy and beneficence will depend on how we conceive of autonomy, I begin by outlining two dominant conceptions of autonomy, both of which have great influence in medical ethics. I then turn to the three ways in which how we understand or employ autonomy can increase or support paternalism: firstly, when we equate respect for autonomy with respect for persons; secondly, when our judgements about what qualifies as an autonomous action contain intersubjective elements; and thirdly, when we expect autonomy to play an instrumental role, that is, when we expect people, when they are acting autonomously, to act in a way that promotes or protects their own wellbeing. I then provide a proposal for how we might work to avoid this. I will suggest that it may be impossible to fully separate paternalistic elements out from judgements about autonomy. Instead, we are better off looking at why we are motivated to use judgements about autonomy as a means of restricting the actions of patients or research subjects. I will argue that this is a result of discomfort about speaking directly about our beneficent motivations in medical ethics. Perhaps we can reduce the incentive to smuggle in these beneficent motivations under the guise of autonomy by talking directly about beneficent motivations in medicine. This will also force us to recognise paternalistic motivations in medicine when they appear, and to justify paternalism where it occurs. (shrink)

According to Marshall et al. (2024), some of the patients who refuse to stay in observation after being resuscitated following an opioid overdose are likely not making an autonomous choice. While I do not intend to dispute this claim, it merits discussion what is the concept of autonomy at play in making this assessment. I contend that the concept at work is more substantive than Marshall et al. acknowledge—and more substantive, too, than the form of autonomy usually thought (...) to underpin the moral justification of the requirement of informed consent . (shrink)

A widely held picture in political science emphasizes the cognitive shortcomings of us citizens. We’re ignorant. We don’t know much about politics. We’re irrational. We bend the evidence to show our side in the best possible light. And we’re malleable. We let political elites determine our political opinions. This paper is about why these shortcomings matter to democratic values. Some think that democracy’s value consists entirely in its connection to equality. But the import of these shortcomings, I argue, cannot be (...) explained in purely egalitarian terms. To explain it, we must instead think of democracy’s value partly in terms of collective autonomy. Our ignorance and irrationality undermine the epistemic conditions for realizing this kind of autonomy. They stop us knowing the outcomes of our political choices. Our irrationality and malleability undermine the independence conditions for realizing such autonomy. They mean our political choices are subject to problematic kinds of interpersonal influence. Thus, at root, the import of the widely held picture is that, if accurate, it closes off this critical aspect of democracy’s value. (shrink)

Our values change. What we value, want, desire, prefer, and how much; for nearly everyone, these will be different at different times in their life. These changes can be gradual or abrupt; they can be long-lasting or short-lived; and they can be induced by forces outside yourself or they can come from within or they can have no specific catalyst at all. Such preference change raises a number of questions for our theorising about rational choice, and these have been discussed (...) at length. In §2 and §3, I’ll outline two of these questions along with some of the putative solutions that have been proposed. But preference change also raises questions for our theorising about autonomy, and these have hardly been considered at all. In §4, I’ll outline three problems for personal autonomy; and in §5, I’ll outline one problem for political autonomy. In §6, I conclude. (shrink)

Wszalek offers a detailed examination of the challenges involved in assisting people with language and communication impairments in the comprehension of legal language and concepts (LLC). If we settle for a minimum threshold of LLC comprehension, we are likely to observe that some people will not meet this threshold due to personal choices, such as not having practiced reading sufficiently or having avoided intellectually stimulating social interactions.

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the (...) class='Hi'>autonomy paradox, to which the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

Accounts of aesthetic valuing emphasize two constraints on the formation of aesthetic belief. We must form our own aesthetic beliefs by engaging with aesthetic value first-hand (the acquaintance principle) and by using our own capacities (the autonomy principle). But why? C. Thi Nguyen’s proposal is that aesthetic valuing has an inverted structure. We often care about inquiry and engagement for the sake of having true beliefs, but in aesthetic engagement this is flipped: we care about arriving at good aesthetic (...) beliefs for the sake of the values that arise in the process of doing so. The engagement is the point, so we must use our own capacities in first-hand encounters. Here I challenge Nguyen’s account. I argue that it misconstrues the value of aesthetic belief; it conflicts with restrictions on aesthetic testimony; and it has trouble harnessing engagement-value for a theory of aesthetic value. A better approach emphasizes the social character of aesthetic valuing. On this view, aesthetic valuing is a social practice structured around the collaborative exercise and improvement of certain special capacities. The autonomy and acquaintance principles tell us to engage these capacities in forming our aesthetic beliefs. Understood aright, and contrary to consensus, these rules are identical. (shrink)

In this paper we will demonstrate that a computational system can meet the criteria for autonomy laid down by classical enactivism. The two criteria that we will focus on are operational closure and structural determinism, and we will show that both can be applied to a basic example of a physically instantiated Turing machine. We will also address the question of precariousness, and briefly suggest that a precarious Turing machine could be designed. Our aim in this paper is to (...) challenge the assumption that computational systems are necessarily heteronomous systems, to try and motivate in enactivism a more nuanced and less rigid conception of computational systems, and to demonstrate to computational theorists that they might find some interesting material within the enactivist tradition, despite its historical hostility towards computationalism. (shrink)

Autonomy has been central to moral and political philosophy for millenia, and has been positioned as a critical aspect of both justice and wellbeing. Research in psychology supports this position, providing empirical evidence that autonomy is critical to motivation, personal growth and psychological wellness. Responsible AI will require an understanding of, and ability to effectively design for, human autonomy (rather than just machine autonomy) if it is to genuinely benefit humanity. Yet the effects on human (...) class='Hi'>autonomy of digital experiences are neither straightforward nor consistent, and are complicated by commercial interests and tensions around compulsive overuse. This multi-layered reality requires an analysis that is itself multidimensional and that takes into account human experience at various levels of resolution. We borrow from HCI and psychological research to apply a model (“METUX”) that identifies six distinct spheres of technology experience. We demonstrate the value of the model for understanding human autonomy in a technology ethics context at multiple levels by applying it to the real-world case study of an AI-enhanced video recommender system. In the process we argue for the following three claims: 1) There are autonomy-related consequences to algorithms representing the interests of third parties, and they are not impartial and rational extensions of the self, as is often perceived; 2) Designing for autonomy is an ethical imperative critical to the future design of responsible AI; and 3) Autonomy-support must be analysed from at least six spheres of experience in order to approriately capture contradictory and downstream effects. (shrink)

An attractive form of social stability is realized when the members of a well-ordered society give that society’s organizing principles their free and reflective endorsement. However, many political philosophers are skeptical that there is any requirement to show that their principles would engender this kind of stability. This skepticism is at the root of a number of objections to political liberalism, since arguments for political liberalism often appeal to its ability to be stable in this way. The aim of this (...) paper is to address skepticism about the stability condition by putting forward a novel defense of it. My defense builds on the claim that stable principles are necessary to secure the full autonomy of those who live under them. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the (...) context of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)