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 starting point regarding consent has to be that it is both extremely important, and that it is often suspicious. In this article, the author tries to make sense of both of these claims, from a largely liberal perspective, tying consent, predictably, to the value of autonomy and distinguishing between autonomy as sovereignty and autonomy as nonalienation. The author then discusses adaptive preferences, claiming that they suffer from a rationality flaw but that it's not clear that this (...) flaw matters morally or politically. What matters is whether they suffer from an autonomy flaw. To answer this question, the author develops an account of autonomy failure, according to which a preference is nonautonomous if an injustice played an appropriate role in its causal history. The author then discusses the moral implications—and in an initial way, the political ones as well—of proclaiming a preference, or consent based on it, nonautonomous in this way. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices (...) are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

This paper aims to provide a clarification of the long debate on whether enhancement will or will not diminish authenticity. It focuses particularly on accounts provided by Carl Elliott and David DeGrazia. Three clarifications will be presented here. First, most discussants only criticise Elliott’s identity argument and neglect that his conservative position in the use of enhancement can be understood as a concern over social coercion. Second, Elliott’s and DeGrazia’s views can, not only co-exist, but even converge together as an (...) autonomy based theory of authenticity. Third, the current account of autonomy provided by DeGrazia fails to address the importance of rationality and the ability of self-correction, which, as a result impedes the theory to provide a fully developed account for authenticity. In conclusion, a satisfactory account of authenticity cannot focus only on identity or subjective preference. (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)

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)

Adaptive preferences are preferences formed in response to circumstances and opportunities – paradigmatically, they occur when we scale back our desires so they accord with what is probable or at least possible. While few commentators are willing to wholly reject the normative significance of such preferences, adaptive preferences have nevertheless attracted substantial criticism in recent political theory. The groundbreaking analysis of Jon Elster charged that such preferences are not autonomous, and several other commentators have since followed Elster’s lead. On a (...) second front, Capacity Theorists Martha Nussbaum and Amartya Sen have objected that adaptive preferences lead people away from objective goods and constitute an impediment to progressive change in developing countries. In this paper I argue that the criticisms of Elster, Sen and Nussbaum fail on the one hand to take into account what may be positively said in favour of this type of preference formation, and fail on the other hand to distinguish between different types of psychological changes – with the result that many of the critiques offered have a narrower purview than is currently allowed. My analysis of adaptive preferences, even in their most ideal form, is however not entirely positive; I adduce reasons why we can be cautious about allowing adaptive preferences to play certain types of roles in political processes, even as we accept those very preferences as normative and autonomous for the agent holding them. [International scholars without access to the AJPAE are invited to email [email protected] for a pdf copy of this article.]. (shrink)

In this paper, I discuss a subset of preferences in which a person desires the fulfillment of a choice they have made, even if it involves the violation of their desires, as in rape fantasies. I argue that such cases provide us with a unique insight into personal autonomy from a proceduralist standpoint. In its first part, I analyze some examples in light of Frankfurt's endorsement theory and argue that even when we cannot endorse a practical decision that involves (...) being violated, we nonetheless regard those cases as instances of autonomy. Therefore, autonomy does not necessarily require endorsement. Instead, I propose that the nature of the relevant highest-order volition dictates the procedure that should be established in one’s desire structure for its fulfillment. In the second part, I discuss how an agent may effectively consent to the violation of their decision by another person. Ordinary consent typically refers to actions but fails to communicate one's higher-order desires or commitments. To address this limitation, I propose a practical tool that accomplishes this by signaling shifts in the normative context where the agents are interacting. (shrink)

Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy to the all-or-nothing (...) problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

Inspired by the recent trends in education towards learner autonomy with their emphasis on the interests and desires of the students, and borrowing ideas from philosophy (particularly ethics), the present study is an attempt to investigate the discrepancy in the findings of the studies addressing error correction in L2 writing instruction, and suggest the (oft-neglected) students’ beliefs, interests and wants as what can point the way out of confusion. To this end, a questionnaire was developed and 56 advanced adult (...) EFL learners were asked to complete the questionnaire. The opinions of 20 EFL teachers were also collected using another questionnaire. Twenty-three of the students and 13 of the teachers were then interviewed in an attempt to collect explanations for their answers in the questionnaires. The results indicated that all the learners wanted the errors in their writings to be corrected. About 90 percent of them believed that all the errors in their writings should be corrected and only less than 10 percent of them agreed that there is no need to correct all the errors and that only “important” errors should be rectified. On the contrary, of the teachers who participated in the study, only 20 percent believed that all the errors in the students’ writings should be corrected. While most of the interviewed students attributed their preference of choice to feeling more confident and efficient in learning when they can recognize all the errors in their written assignments, most of the teachers believed that by correcting important errors (and not all errors), learners can get the most of their writings. Given the incongruity between teachers’ and (advanced) students’ beliefs over writing error correction, and considering advanced students as legitimate decision makers for their own learning, some suggestions are offered for EFL writing teachers. -/- . (shrink)

Advancements in machine learning have fuelled the popularity of using AI decision algorithms in procedures such as bail hearings, medical diagnoses and recruitment. Academic articles, policy texts, and popularizing books alike warn that such algorithms tend to be opaque: they do not provide explanations for their outcomes. Building on a causal account of transparency and opacity as well as recent work on the value of causal explanation, I formulate a moral concern for opaque algorithms that is yet to receive a (...) systematic treatment in the literature: when such algorithms are used in life-changing decisions, they can obstruct us from effectively shaping our lives according to our goals and preferences, thus undermining our autonomy. I argue that this concern deserves closer attention as it furnishes the call for transparency in algorithmic decision-making with both new tools and new challenges. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting (...) patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

Recently, Jardas _et al_ have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas _et al_. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas (...) _et al._. (shrink)

Here I will re-purpose Nozick’s (1974) “Experience Machine” thought experiment against hedonism into an argument against Veritic Epistemic Consequentialism. According to VEC, the right action, epistemically speaking, is the one that results in at least as favorable a ratio of true to false belief as any other action available. A consequence of VEC is that it would be epistemically right to outsource all your cognitive endeavors to a matrix-like “True Belief Machine” that uploads true beliefs through artificial stimulation. Rather than (...) reflecting, inferring or inquiring, all of your beliefs would be the product of updates coming from the machine. This implication of VEC is counter intuitive. I will spend much of the paper considering defensive maneuvers and showing them to be lacking. The problem with going in for the True Belief Machine seems to be that the subject forfeits her autonomy. There has been much work lately on the virtue of intellectual autonomy and some of it has the potential to explain what is epistemically amiss about plugging into the machine. However, I will argue that the proponent of VEC cannot appeal to it without abandoning her preferred order of explanation. (shrink)

This paper studies the relationship between promoting people's welfare and respecting their autonomy of choice under risk. I highlight a conflict between these two aims. Given compelling assumptions, welfarists end up disregarding people's unanimous preference, even when everyone involved is entirely rational and only concerned with maximizing their own welfare. Non-welfarist theories of social choice are then considered. They are shown to face difficulties, too: either they fail to respect the value of welfare in at least one important (...) sense, or they end up prioritizing different people's welfare differently in non-risky choices, on the basis of their attitudes to risk, which are intuitively irrelevant in this context. (shrink)

Populism, as I shall understand the term here, is a style of political rhetoric that posits a Manichean conflict between the people and corrupt elites. In the present decade, populism has played a particularly salient role in the politics of the United States and Europe. Moreover, populism is commonly associated with a kind of skepticism about expertise, on which the opinions of non- experts are to be preferred to any expert consensus. In light of all this, populist expertise skepticism appears (...) to be a kind of pathology of excessive intellectual autonomy. I shall argue, however, that this connection between populism and intellectual autonomy is mere appearance: populist expertise skepticism does not involve excessive intellectual autonomy, because it does not involve a disposition for non-deferential belief, but rather a disposition for deference to “alternative” sources of information. (shrink)

It is common in the autonomy literature to claim that some more demanding theories of autonomy disrespect certain individuals by giving the result that those individuals lack autonomy. This claim is often made in the context of the debate between substantive and content-neutral theories of autonomy. Proponents of content-neutral theories often argue that, in deeming certain people non-autonomous—especially certain oppressed people who seem to have internalized their oppression in certain ways—the substantive theories disrespect those people. They (...) take this as reason to accept content-neutral views over substantive views. Despite its ubiquity, this concern about disrespect is hard to pin down precisely. In this paper, I articulate two questions that need to be answered before we can understand the disrespect objection. First: Who, exactly, is supposedly being disrespected by substantive views? Second: Why is it that excluding people with these features is disrespectful? I consider a number of possible answers to each of these questions, and I argue that none of them gives us a plausible explanation of why we should think substantive theories of autonomy are disrespectful to anyone. No matter how we fill in the details, I will argue, there is simply no reason to prefer content-neutral theories of autonomy over substantive ones on the grounds of respect. (shrink)

Causal Determinism (CD) entails that all of a person’s choices and actions are nomically related to events in the distant past, the approximate, but lawful, consequences of those occurrences. Assuming that history cannot be undone nor those (natural) relations altered, that whatever results from what is inescapable is itself inescapable, and the contrariety of inevitability and freedom, it follows that we are completely devoid of liberty: our choices are not freely made; our actions are not freely performed. Instead of disputing (...) the soundness of this reasoning, some philosophers prefer to maintain that we could yet have a small measure of freedom were CD true of our world: although being unable to choose or act differently, one could at least under normal circumstances truly claim to be acting ‘on one’s own’, beyond the control of ‘outside forces’, in a word, autonomous. They further argue that being free in this sense suffices for moral responsibility. Call their philosophy ‘Autonomy Compatibilism’ (AC). -/- In adopting here reactive attitudes towards an agent, one is choosing to highlight the fact that the individual in question is of sound mind, reasoning and acting free from the interference of others. These facts alone, the adherent of AC claims, justify his stance, despite the necessity of the agent’s choices. Why would we not regard a sane individual who is not being coerced, intimidated, deceived or unduly put upon as in charge of his life so as to be responsible for his activities? -/- The Manipulation Argument (MA) is supposed to cut off this line of retreat. Its authors hold that, were CD true of our world, we would be no more autonomous than a victim of “covert, non-constraining control” (CNC): manipulation whereby one person causes another, through the use of methods such as brainwashing or circumspect operant conditioning, to ‘do his bidding’ without the latter being aware of his subjugation or feeling in any way coerced. Since a CNC victim obviously lacks autonomy, then so must “persons” living in a deterministic universe. Defenders of AC have, then, the following argument with which to contend: -/- 1. Victims of CNC (obviously) lack autonomy. 2. Thus, AC would be true only if some definition of autonomy succeeds in specifying a freedom relevant difference between victims of CNC and agents whose choices/actions are necessary consequences of prior events. 3. There could be no such definition. 4. Therefore, AC must be false. -/- The challenge issued here is clear: find a way to refute the claim that being subject to natural laws would be tantamount to being a victim of CNC, to show that Nature is no manipulator. Moreover, this challenge cannot be met by responding with a Frankfurt case: a situation in which things have been surreptitiously arranged so that an agent is unable to avoid doing something that he manages to do ‘on his own’, thus, being autonomous despite his inability to act otherwise. For, even if CD is not inconsistent with autonomy because it eliminates the ability to do otherwise per se, it may yet entail that no human agent ever does act of his own accord, an implication of which would be a lack of alternatives on anyone’s part. In other words, the fact that causally determined beings could never act differently than they do does is perhaps only symptomatic of the reason why such beings would lack autonomy: forces beyond their control would have dominion over their psychological development. Thus, AC advocates must show that the way that an agent’s character would be shaped, were she (merely) subject to natural laws, would leave unimpaired an ability that CNC would destroy. What follows is a definition of this ability, which I also use to solve the Problem of Freedom and Foreknowledge. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the (...) variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

Cognitive incompetence cannot adequately explain the special character of children's moral status. It is, in fact, because children lack preference structures that are sufficiently stable over time that they are not ’temporally extended agents’. They are best viewed as 'special agents’, and parents have the responsibility of fostering the development of temporally extended agency and other necessary related moral capacities. Parental authority should be exercised with the view to assisting children to acquire the capacities that facilitate their transition from (...) 'special agents’ to full and functioning members of the moral community. (shrink)

Many economists and social theorists hypothesize that most societies could soon face a ‘post-work’ future, one in which employment and productive labor have a dramatically reduced place in human affairs. Given the centrality of employment to individual identity and its pivotal role as the primary provider of economic and other goods, transitioning to a ‘post-work’ future could prove traumatic and disorienting to many. Policymakers are thus likely to face the difficult choice of the extent to which they ought to satisfy (...) individual citizens’ desires to work in a socioeconomic environment in which work is in permanent decline. Here I argue that policymakers confronting a post-work economy should discount, or at least consider problematic, the desire to work because it is very likely that this desire is an adaptive preference. An adaptive preference is a preference for some state of affairs within a limited set of options formed under unjust conditions. The widespread desire for work has been formed under unjust labor conditions to which individuals are compelled to submit in order to meet material and ethical needs. Furthermore, the prevalence of the ‘work dogma’ in contemporary societies precludes nearly all individuals from seeing alternatives to work as live options. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle (...) of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

Nudges are small changes in the presentation of options that make a predictable impact on people's decisions. Proponents of nudges often claim that they are justified as paternalistic interventions that respect autonomy: they lead people to make better choices, while still letting them choose for themselves. However, existing work on nudges ignores the possibility of “hard choices”: cases where a person prefers one option in some respects, and another in other respects, but has no all‐things‐considered preference between the (...) two. In this paper, I argue that many significant medical decisions are hard choices that provide patients with an opportunity to exercise a distinctive sort of “formative autonomy” by settling their preferences and committing themselves to weigh their values in a particular way. Since nudges risk infringing formative autonomy by depriving patients of this opportunity, their use in medical contexts should be sensitive to this risk. (shrink)

Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to (...) respect patients’ dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently. There are no data in this work. (shrink)

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter (...) of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program. (shrink)

Desire', 'preference', 'utility', '(utility-aggregating) moral desirability' are terms that build on each other in this order. The article follows this definitional structure and presents these terms and their justifications. The aim is to present welfare-ethical criteria of the common good that define 'moral desirability' as an aggregation, e.g. addition, of individual utility: utilitarianism, utility egalitarianism, leximin, prioritarianism.

Value capture occurs when an agent’s values are rich and subtle; they enter a social environment that presents simplified — typically quantified — versions of those values; and those simplified articulations come to dominate their practical reasoning. Examples include becoming motivated by FitBit’s step counts, Twitter Likes and Re-tweets, citation rates, ranked lists of best schools, and Grade Point Averages. We are vulnerable to value capture because of the competitive advantage that such crisp and clear expressions of value have in (...) our private reasoning and our public justification. There is, however, a price. In value capture, we take a central component of our autonomy — our ongoing deliberation over the exact articulation of our values — and we outsource it. And the metrics to which we outsource usually engineered for the interests of some external force, like a large-scale institution’s interest in cross-contextual comprehensibility and quick aggregability. That outsourcing cuts off one of the key benefits to personal deliberation. In value capture, we no longer adjust our values and their articulations in light of own rich experience of the world. Our values should often be carefully tailored to our particular selves or our small-scale communities, but in value capture, we buy our values off the rack. In some cases – like decreasing CO2 emissions – the costs of non-tailored values are outweighed by the benefit of precise collective coordination. In other cases, like in our aesthetic lives, they are not. This suggests that we should want different values suited to different scales. We should want value federalism. Some values are perhaps best pursued at the largest-scale level, others at smaller scales. The problem occurs when we exhibit an excess preference for the largest-scale values – when we consistently let the universal metrics swamp our quieter interests. (shrink)

The author examines two proposals to expand legal recognition of individual control over physical integrity. Protections for individual autonomy are discussed in relation to the right to die, euthanasia, medical treatment, and consensual and assaultive sexual behaviours. The author argues that at present, the legal doctrine of consent protects only those individual preferences which are seen to be congruent with dominant societal values; social preferences and convenience override all other individual choices. Under these conditions, more freedom to waive rights (...) of physical integrity can only place socially vulnerable persons at great risk of abuse. (shrink)

L’objectif de cette article est de comprendre la neutralité axiologique non pas comme une exigence épistémologique, mais plutôt comme un idéal éducationnel. Max Weber propose une science basée sur la description factuelle, de laquelle on exclut la formulation de jugements de valeur. Or, il faut démontrer pourquoi il est préférable de séparer les jugements descriptifs des jugements évaluatifs. L’objectif de Weber est de préserver l'autonomie intellectuelle des étudiants. Pour Weber, la classe et l'académie en général sont des lieux politiques. Ces (...) rapports au sein de la classe sont nécessaires pour transmettre des connaissances, des méthodes et le goût de l'autonomie intellectuelle. Or, il serait contraire au principe d'autonomie de laisser le professeur influencer et convaincre ses étudiants, de façon partisane, d'adhérer à certaines thèses normatives. Weber propose ainsi un mécanisme pour éviter que le professeur n'ixnfluence ses étudiants de manière illégitime. (shrink)

Goffman’s (1959) dramaturgical identity theory requires modification when theorising about presentations of self on social media. This chapter contributes to these efforts, refining a conception of digital identities by differentiating them from ‘corporatised identities’. Armed with this new distinction, I ultimately argue that social media platforms’ production of corporatised identities undermines their users’ autonomy and digital well-being. This follows from the disentanglement of several commonly conflated concepts. Firstly, I distinguish two kinds of presentation of self that I collectively refer (...) to as ‘expressions of digital identity’. These digital performances (boyd 2007) and digital artefacts (Hogan 2010) are distinct, but often confused. Secondly, I contend this confusion results in the subsequent conflation of corporatised identities – poor approximations of actual digital identities, inferred and extrapolated by algorithms from individuals’ expressions of digital identity – with digital identities proper. Finally, and to demonstrate the normative implications of these clarifications, I utilise MacKenzie’s (2014, 2019) interpretation of relational autonomy to propose that designing social media sites around the production of corporatised identities, at the expense of encouraging genuine performances of digital identities, has undermined multiple dimensions of this vital liberal value. In particular, the pluralistic range of authentic preferences that should structure flourishing human lives are being flattened and replaced by commercial, consumerist preferences. For these reasons, amongst others, I contend that digital identities should once again come to drive individuals’ actions on social media sites. Only upon doing so can individuals’ autonomy, and control over their digital identities, be rendered compatible with social media. (shrink)

L’idéal démocratique est accusé d’être irréaliste. Le gouvernement du peuple par le peuple et pour le peuple serait une chimère dans les sociétés contemporaines. Il faudrait lui préférer les visées plus modestes associées à l’élection : un droit de vote égal et la satisfaction du plus grand nombre. La démocratie ne se laisse pourtant pas réduire à la compétition électorale. Les acteurs et les institutions politiques qui s’en réclament invoquent non seulement un marché, où rivalisent des intérêts privés, mais un (...) forum, où s’affrontent des visions adverses de la justice. Ils attendent de la délibération collective qu’elle serve l’autonomie politique et le bien commun, mais savent aussi qu’elle peut les menacer, lorsque la liberté, l’égalité ou la publicité lui font défaut. Cette enquête philosophique interroge la pertinence de l’idéal démocratique pour des sociétés complexes, dotées d’institutions représentatives et soumises à la communication de masse. Elle montre à quelles conditions cet idéal peut aujourd’hui orienter la critique et l’action. Les citoyens peuvent encore aspirer à se gouverner eux-mêmes, donc à délibérer en égaux. -/- The democratic ideal is accused of being unrealistic. Government of the people by the people and for the people would be a chimera in contemporary societies. The more modest aims associated with election should be preferred: equal suffrage and the satisfaction of the greatest number. But democracy cannot be reduced to electoral competition. The political actors and institutions that claim it invoke not only a market, where private interests compete, but also a forum, where opposing visions of justice confront each other. They expect collective deliberation to serve political autonomy and the common good, but they also know that it can threaten them when it lacks freedom, equality or publicity. This philosophical inquiry questions the relevance of the democratic ideal for complex societies with representative institutions and subject to mass communication. It shows under what conditions a deliberative understanding of this ideal can today orient criticism and action. Citizens can still aspire to govern themselves, hence to deliberate as equals. (shrink)

This chapter defends the view that manipulated behaviour is explained by an injustice. Injustices that explain manipulated behaviour need not involve agential features such as intentionality. Therefore, technology can manipulate us, even if technological artefacts like robots, intelligent software agents, or other ‘mere tools’ lack agential features such as intentionality. The chapter thus sketches a comprehensive account of manipulated behaviour related to but distinct from existing accounts of manipulative behaviour. It then builds on that account to defend the possibility that (...) we are being manipulated by technology. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. (...) In this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

Privacy and surveillance scholars increasingly worry that data collectors can use the information they gather about our behaviors, preferences, interests, incomes, and so on to manipulate us. Yet what it means, exactly, to manipulate someone, and how we might systematically distinguish cases of manipulation from other forms of influence—such as persuasion and coercion—has not been thoroughly enough explored in light of the unprecedented capacities that information technologies and digital media enable. In this paper, we develop a definition of manipulation that (...) addresses these enhanced capacities, investigate how information technologies facilitate manipulative practices, and describe the harms—to individuals and to social institutions—that flow from such practices. -/- We use the term “online manipulation” to highlight the particular class of manipulative practices enabled by a broad range of information technologies. We argue that at its core, manipulation is hidden influence—the covert subversion of another person’s decision-making power. We argue that information technology, for a number of reasons, makes engaging in manipulative practices significantly easier, and it makes the effects of such practices potentially more deeply debilitating. And we argue that by subverting another person’s decision-making power, manipulation undermines his or her autonomy. Given that respect for individual autonomy is a bedrock principle of liberal democracy, the threat of online manipulation is a cause for grave concern. (shrink)

La théorie démocratique contemporaine entretient une relation ambivalente avec les élections. Alors que les points de vue agrégatifs et minimalistes les considèrent comme une institution centrale de la démocratie représentative , les conceptions plus riches de la démocratie n’ont pas nécessairement de penchant pour elles. Les théories délibératives ont tendance à négliger les élections pour se concentrer sur la délibération publique, c’est-à-dire sur le processus continu de formation de l’opinion et d’échange de raisons qui se produit entre les élections . (...) Les théories participatives ont également tendance à les écarter en faveur d’une vision moins agonistique et plus coopérative de l’action politique . Par conséquent, peu d’attention normative a été accordée dans la littérature récente à ce moment très distinctif de la vie démocratique, à quelques notables exceptions près . Une conséquence naturelle est que la plupart des théoriciens font appel à des expériences délibératives telles que les jurys de citoyens et les mini-publics comme réponse efficace aux préoccupations démocratiques actuelles . Le tirage au sort peut ainsi être présenté comme une alternative préférable à l’élection, car il garantit une représentation descriptive, évite la capture de l’État par des élites puissantes et promet des résultats substantiellement meilleurs. Alors que de nombreux théoriciens s’intéressent aux moyens de compléter les institutions électorales par des organes délibératifs non électoraux , certains chercheurs se débarrasseraient volontiers des élections . Le moment est-il venu de les abandonner ? Cet article se concentre sur une affirmation spécifique que beaucoup de partisans du tirage au sort ont avancée, à savoir que celui-ci serait plus égalitaire que les élections, et vise à la rejeter. D’autres chercheurs ont déjà critiqué le tirage au sort pour diverses raisons. Landa et Pevnick , ainsi qu’Umbers objectent qu’il ne permet pas d’obtenir les améliorations instrumentales du gouvernement promises par ses promoteurs ; Ceva et Ottonelli , ainsi que Lafont nient que les critiques lotocratiques des élections reflètent une compréhension adéquate de l’autorité démocratique en tant que forme d’autonomie collective ; et Umbers soutient également que la lotocratie est en contradiction avec les principes de justice distributive et d’égalité sociale . En complément à ces critiques récentes, nous soutenons que la vision de l’égalité politique qui sous-tend le tirage au sort est problématique et peu convaincante. (shrink)

Equal Justice explores the role of the idea of equality in liberal theories of justice. The title indicates the book’s two-part thesis: first, I claim that justice is the central moral category in the socio-political domain; second, I argue for a specific conceptual and normative connection between the ideas of justice and equality. This pertains to the age-old question concerning the normative significance of equality in a theory of justice. The book develops an independent, systematic, and comprehensive theory of equality (...) and egalitarianism. The principal question is about the importance of equality in a theory of justice. More precisely, we should pose questions in four contracting circles: 1. Is justice the supreme value guiding our setup of the basic structure of society, or are there other, equally important values, such as recognition, care, communal belonging? 2. If justice is the highest guiding principle, which competing ideals—especially equality and freedom—ought to have precedence in a policy oriented toward justice? What status does the ideal of equality have in that framework? 3. If equality is a basic ideal of just policy, how should it be practically realized? What sort of equality (equal opportunity, equality of welfare, resource equality) should be demanded? 4. What patterned distribution of which specific goods does the ideal of equality demand? Which principles of distribution can be justified according to our justice ideal? To conclude and summarize: 5. What is the essential core of an egalitarian theory of justice, as opposed to an inegalitarian theory? These five questions structure the work’s order of argumentation. Part A elaborates the conceptual foundations and basic moral principles of justice and equality. Chapter I sets out to install justice as the central moral category in the socio-political domain. At the beginning of the first chapter, the conceptual foundations of justice are clarified. While not eliminating the classical distinctions between different forms of justice, I argue that the distributive paradigm is of primary importance. The primacy of justice in the socio-political domain is developed out of a confrontation with alternative positions, those which maintain either that justice generally, or distributive justice in particular, are subsidiary virtues. At the end of Chapter I, the first of the questions mentioned above is answered in a way that establishes justice as the guiding normative concept for the foundation and evaluation of any social order. To clarify the role of equality in a theory of justice, Chapter II separates the idea of equality into four different principles. They are organized in a way that begins with the most general and uncontroversial principle of equality, and progresses towards increasingly detailed and contested principles. There are two theses that articulate and defend the significance of equality for justice: First there is a conceptual connection between justice and equality, in that principles of formal and proportional equality are necessary in order to explicate the concept of justice. These two principles establish an unbreakable bond between justice and equality. Justice can only be explained—or so I argue—by reference to these and other (normative) principles of equality. The second thesis posits a normative relationship between justice and equality, which is disclosed by three substantive principles of equality: moral equality, the presumption of equality, and the principle of responsibility. I argue that the normative core of an egalitarian theory of justice is expressed by the latter two principles, which are themselves based on the first principle, that of moral equality. When we view one another as persons, what form of equality or equal treatment is normatively demanded? I argue that the answer to this question is given by the procedural principle of the presumption of equality: regardless of their apparent differences, all persons deserve strictly equal treatment, unless certain kinds of differences have whatever particular relevance would justify, on generally acceptable grounds, unequal treatment or unequal distribution. The justification of the presumption of equality is central to this work and has considerable importance. If the presumption principle’s validity can be justified by enlisting the principle of general justification, then the primacy of equality, and the essential argument for an egalitarian theory of justice, is established. This would likewise provide a procedure for the construction of a material theory of justice. The second question is answered thereby at the end of Chapter II: Equality should have primacy over competing ideals within a justice-oriented policy. The presumption of equality establishes this primacy and, at the same time, offers an appropriate metric and guideline for the construction of a material theory of distributive justice. The presumption of equality in Part B offers an elegant procedure for the development of a theory of distributive justice. Chapter III clearly sets out the necessary prerequisites that a theory of distribution must satisfy in order to determine a liberal-egalitarian distributional framework. We need to specify in which situation the distribution takes place; which goods are and are not to be distributed; in which respect the presumptive equality is to be produced; and by and to whom, and for what period, the relevant goods are to be distributed. The distribution is based on resources understood as general-purpose means. It is necessary to divide goods into different categories, since the justification for unequal treatment in one domain will not carry over into another. This makes presumptive equality necessarily complex. To that end, four spheres of justice are distinguished: (1) the political sphere, which involves allocating rights through the distribution of civil liberties; (2) the democratic sphere, in which political power and the rights of political participation are regulated; (3) the economic sphere, in which income and property are distributed; (4) the social sphere, in which social positions and opportunities are distributed. This framework of distributive justice answers the third of our guiding questions, about the nature of equality, in terms of equality of resources. Chapters IV and V set out the egalitarian distributive criteria for each sphere. I argue that the generally accepted, fundamental rights of classical liberalism are more effectively reconstructed by reference to the equal resource distribution presumptively required in those spheres. Chapter IV shows that when it comes to the first two spheres, those involving basic rights and freedoms and entitlement political participation, there can be no justified exceptions to the equal distribution of the relevant goods. That section argues, contrary to what we commonly find in theories of freedom or popular sovereignty, that the value of freedom and self-determination as the political basis of autonomy is best realized through the presumption of equal distribution. Chapter V deals with the other two spheres, those of economic goods and social positions, and argues for justified exceptions to equal distribution. In the economic sphere we find one principal reason favouring unequal distribution of resources, and three restrictions and compensations limiting that inequality. The basic exception to equal economic distribution arises from the unequal consequences of personal responsibility. From a suitably egalitarian standpoint, the principle of responsibility is the normative principle that determines which reasons justify economic inequality. Here the basic idea is that unequal shares of social goods are fair if they result from the choices and deliberate actions of the relevant parties. That individuals have to bear the costs of their own choices is a condition of autonomy. However, benefits or disadvantages arising from arbitrary and unmerited differences in social circumstances or natural endowments is unfair. The unequal consequences of independent decision-making and action must therefore be limited by compensating first for preferences, secondly for disadvantages, and thirdly by redistributing wealth in aid of the worse-off. I situations of emergency, compensating for disadvantages has priority over all other claims, owing to the urgency of the situation. Social inequalities go beyond the permissible limit if it is possible to improve the long-term social or economic situation of the worse-off by redistributing wealth to them. These exceptions lead to a complex system of free economic action within a framework of compensatory tax and transfer mechanisms. Finally, in the social sphere, the distribution of social positions, offices and opportunities must be structured to ensure that equally talented and motivated citizens have roughly equal chances of obtaining those offices or positions, irrespective of their economic or social class backgrounds. This compromise is permissible for reasons of freedom and prudence, and it makes a certain measure of inequality acceptable. The fourth of our guiding questions is answered accordingly. There are five principles of justice for the basic structure of society, and five legal principles that govern the special distribution of goods in the respective spheres—all are ranked according to their most defensible grounds of priority, ensuring that everyone is accorded equal justice. Chapter VI recapitulates the initial question of equality’s value. The conception of equal justice developed in this work postulates five principles of equality and five principles of law; these constitute an egalitarian framework because they support and promote social justice. Equality has value with respect to them, but is not given any independent, intrinsic value. That is why I call the account developed here a form of constitutive egalitarianism: justice is realized through the realization of equality, itself accomplished by applying the five postulates of equality and five distributive principles of law. This is an egalitarianism on two levels. The first level is involves the claim that morality or justice is conceptually connected with equality. The second level gives equality a substantial weight in what is conceptually validated at the first level, namely the presumption of equality, and constructs an appropriate interpretation and conception of distributive justice through principles of distribution for the individual spheres. The weight and importance of equality is shown by the distributive criteria applied to those spheres. This answers our final guiding question about the nature of an egalitarian theory. (shrink)

Some of the challenges in Sanders et al. (this issue) can be aptly illustrated by means of charity nudges, that is, nudges designed to increase charitable donations. These nudges raise many ethical questions. First, Oxfam’s triptychs with suggested donations are designed to increase giving. If successful, do our actions match ex ante or ex post preferences? Does this make a difference to the autonomy of the donor? Second, the Behavioural Insights Team conducted experiments using social networks to nudge people (...) to give more. Do these appeals steer clear of exploiting power relations? Do they respect boundaries of privacy? Third, in an online campaign by Kiva, donors are asked to contribute directly to personalized initiatives. In many cases, the initiative has already been funded and donor money is funnelled to a new cause. Is such a “pre-disbursal” arrangement truthful and true to purpose as a social business model? (shrink)

Background: Several countries have recently changed their model of consent for organ donation from opt-in to opt-out. We undertook a systematic review to determine public knowledge and attitudes towards these models in Europe. Methods: Six databases were explored between 1 January 2008 and 15 December 2017. We selected empirical studies addressing either knowledge or attitudes towards the systems of consent for deceased organ donation by lay people in Europe, including students. Study selection, data extraction, and quality assessment were conducted by (...) two or more reviewers independently. Findings: Awareness of the consent model was lower in opt-out countries than in opt-in countries. A majority of the public agrees with opt-in, regardless of the law in their own country. There are ambivalent attitudes regarding the opt-out system. The public tend to prefer opt-in and mandatory choice over opt-out when several options are offered. Interpretation: The assumption that people in opt-out countries are aware of the legal requirements to be excluded from the pool of potential donors is not supported by the results of this review. This is a concern, since ignorance hinders people's autonomy regarding organ donation decision-making. Higher awareness of consent model in opt-in countries may reflect greater efforts to inform the public through campaigns to motivate donation. Legal moves towards opt-out are at odds with people's expressed preferences. Main limitations of this review are the lack of data from some countries, study population heterogeneity, and methodological shortcomings. (shrink)

In this paper we analyze the non-coercive ways in which researchers can use knowledge about the decision-making tendencies of potential participants in order to motivate them to consent to research enrollment. We identify which modes of influence preserve respect for participants’ autonomy and which disrespect autonomy, and apply the umbrella term of manipulation to the latter. We then apply our analysis to a series of cases adapted from the experiences of clinical researchers in order to develop a framework (...) for thinking through the ethics of manipulating people into research participation. All manipulation disrespects autonomy and is therefore pro tanto wrong. However, only deceptive manipulation invalidates the consent that results from it. Use of the other forms of manipulation can be permissible, but only if the outcome of using manipulation is sufficiently good and if the research cannot be carried out using ethically preferable means to obtain consent. (shrink)

It is well known that on the Internet, computer algorithms track our website browsing, clicks, and search history to infer our preferences, interests, and goals. The nature of this algorithmic tracking remains unclear, however. Does it involve what many cognitive scientists and philosophers call ‘mindreading’, i.e., an epistemic capacity to attribute mental states to people to predict, explain, or influence their actions? Here I argue that it does. This is because humans are in a particular way embedded in the process (...) of algorithmic tracking. Specifically, if we endorse common conditions for extended cognition, then human mindreading (by website operators and users) is often literally extended into, that is, partly realized by, not merely causally coupled to, computer systems performing algorithmic tracking. The view that human mindreading extends outside the body into computers in this way has significant ethical advantages. It points to new conceptual ways to reclaim our autonomy and privacy in the face of increasing risks of computational control and online manipulation. These benefits speak in favor of endorsing the notion of extended mindreading. (shrink)

I have two major aims in this chapter, which is philosophical in nature. One is to draw upon values that are salient in the southern African region in order to construct a novel and attractive conception of human dignity. Specifically, I articulate the idea that human beings have a dignity in virtue of their communal nature, or their capacity for what I call ‘identity’ and ‘solidarity’, which contrasts the most influential conception in the West, according to which our dignity inheres (...) in our rationality or autonomy. The second aim is to invoke this Afro-communitarian conception of human dignity in order to advance a new conception of why poverty is morally problematic and of what people, particularly states, are ethically required to do with regard to it. Common conceptions of poverty focus on it in terms of people lacking income, preference satisfaction (‘utility’) or general-purpose means (‘social primary goods’ in the Rawlsian jargon). In contrast, if what is special about human beings is our ability to commune with one another in a certain way, then the respects in which poverty can be an injustice and the ways that it must be fought must be understood in more communitarian or relational terms, which I both specify with several concrete examples in a South African context and contrast with the more dominant approaches. (shrink)

Artificial Social Agents (ASAs), which are AI software driven entities programmed with rules and preferences to act autonomously and socially with humans, are increasingly playing roles in society. As their sophistication grows, humans will share greater amounts of personal information, thoughts, and feelings with ASAs, which has significant ethical implications. We conducted a study to investigate what ethical principles are of relative importance when people engage with ASAs and whether there is a relationship between people’s values and the ethical principles (...) they prioritise. The study uses scenarios, embedded with the five AI4People ethical principles (Beneficence, Non-maleficence, Autonomy, Justice, and Explicability), involving ASAs taking on roles traditionally played by humans to understand whether these roles and behaviours (including dialogues) are seen as acceptable or unacceptable. Results from 268 participants reveal the greatest sensitivity to ASA behaviours that relate to Autonomy, Justice, Explicability, and the privacy of their personal data. Models were created using Schwartz’s Refined Values as a possible indicator of how stakeholders discern and prioritise the different AI4People ethical principles when interacting with ASAs. Our findings raise issues around the ethical acceptability of ASAs for nudging and changing behaviour due to participants’ desire for autonomy and their concerns over deceptive ASA behaviours such as pretending to have memories and emotions. (shrink)

Objective. Study of the validity and reliability of the discourse approach for the psycholinguistic understanding of the nature, structure, and features of the linguistic consciousness functioning. -/- Materials & Methods. This paper analyzes artificial neural network models built on the corpus of texts, which were obtained in the process of experimental research of the coronavirus quarantine concept as a new category of linguistic consciousness. The methodology of feedforward artificial neural networks (multilayer perceptron) was used in order to assess the possibility (...) of predicting the leading texts semantics based on the discourses ranks and their place in the respective linear sequence. Same baseline parameters were used to predict respondents' self-assessments of changes in their psychological well-being and in daily life routine during the quarantine, as well as to predict their preferences of the quarantine strategies. The study relied on basic ideas about discourse as a meaning constituted by the dispersion of other meanings (Foucault). The same dispersion mechanism realizes itself in interdiscourse interaction, forming a discursive formation at a higher level. The method of T-units (Hunt) was used to identify and count discourses in the texts. The ranking of discourses was provided based on the criterion of their semantic-syntactic autonomy. -/- Results. The conducted neural network modeling revealed a high accuracy in predicting the work of the linguistic consciousness functions associated with retrospective self-assessment and anticipatory imagination of the respondents. Another result of this modeling is a partial confirmation of the assumption concerning existence a relationship between the structural parameters of the discursive field (the rank of the discourses and their place in the respective linear sequence) and the leading semantics of the text. -/- Conclusions. A discourse approach to the study of linguistic consciousness, understanding of its structure and functioning features seems to be reasonably appropriate. The implementation of the approach presupposes the need to form a base of linguistic corpora with the inclusion in each text markup of such parameters as: the presence of specific discourses, their ranks, positions in the linear sequence of discourses. (shrink)

Excerpt: 1. Introduction This chapter provides insight into the diverse ethical debates on genetics and epigenetics. Much controversy surrounds debates about intervening into the germline genome of human embryos, with catchwords such as genome editing, designer baby, and CRISPR/Cas. The idea that it is possible to design a child according to one’s personal preferences is, however, a quite distorted view of what is actually possible with new gene technologies and gene therapies. These are much more limited than the editing and (...) design metaphors suggest. Such metaphors are therefore highly problematic phrases in the context of new gene technologies, for two reasons. On one hand, to design a child of choice by modifying the genome would require modifying any gene of choice, which is more than can be done with current gene technologies, such as CRISPR/Cas. On the other hand, a modification of genes would need to be enough to create any characteristic of choice in the future child. The latter presupposes the assumption of genetic determinism. Moreover, the CRISPR/Cas technology can not only be used in a potentially therapeutic manner at the germline level. In addition, there is the (more likely) scenario of a future clinical therapeutic use of these new gene technologies for modifying the DNA sequence of other cells of the body (somatic genome editing). There is also the option of modifying the epigenome, that is, the spatial configuration of DNA (epigenome editing) (see table 1). Like genetics and genome editing, epigenetics has been at the center of recent popular scientific and ethical discourse as well as scientific debates. The concept of epigenetics has given rise to very different notions of inheritability and responsibility for health, which, however, are oftentimes based on scientifically controversial basic assumptions. That there continues to be covert genetic determinism in the form of epigenetic determinism (see table 2) in debates about epigenetics has been pointed out in ethical analyses of epigenetics. Neither genetic determinism nor epigenetic determinism has been confirmed scientifically. It is therefore important to recognize the concepts that are discussed (and sometimes harshly criticized) in debates about genome editing and epigenetics—for example, concepts about the causal role of DNA for our own life course. This importance is based on the fact that if we understand such controversial concepts, we will be able to remain critical when evaluating scientific knowledge and ethical arguments about genome editing and epigenetics. This chapter, therefore, explains some of these concepts. For an ethical analysis of epigenetics as well as of genome editing, it is necessary to understand and critically reflect upon the underlying concepts of genetic determinism and other, related -isms. The following section offers a detailed introduction to these -isms (section 2; see also table 2). Section 3 provides an ethical analysis of genome editing and epigenetics based on the explanations in section 2. Section 3 focuses on inheritability and responsibility, justice, safety, the problem of consent, and the effects of genome editing and epigenetics on embryos and future generations. This section does not discuss in detail further points that can be found in ethical debates about epigenetics as well as in ethical debates about genome editing. These points include (among others): • fear that the findings of epigenetics and that the methods of genome editing are misused—this also with respect to eugenics and enhancement; • naturalness—an issue we mention in passing a few times in the following analysis; • a possible connection between the genome/epigenome and the concept of human dignity, and the derived danger of instrumentalization and infringement of autonomy when intervening in the genome or epigenome. Since current discourse about ethical issues associated with genome editing focuses mainly on germline interventions, which are, for instance, interventions into a human embryo’s genome, we mainly focus on germline interventions when comparing the debates on genome editing and on epigenetics in section 3. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...) to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

A strong moral reason for prohibiting doping in sport is to be found in the bad choices that would be faced by clean athletes in a sporting world that tolerated doping. The case against doping is not, however, to be grounded in the concept of coercion. Instead, it is grounded in a general duty of sport to afford fair opportunity to the goods that are distinctively within sport's sphere of control. The moral reason to prohibit doping need not be balanced (...) against any autonomy claim of athletes who would prefer to dope because, upon closer examination, such claims have no force. The moral reason to prohibit doping does, however, need to be balanced against the enforcement costs imposed on all athletes by effective prohibition. (shrink)

Patient-centered care (PCC) is an approach to healthcare that values patients’ preference, need, and autonomy. The estimation of healthcare partly depends on how well PCC is implemented. In addition, the result of clinical research can inform the assessment of the implementation of PCC. In clinical research, health-related quality of life (HRQL) theoretical models offer a conceptual toolbox that informs clinical research and guides the hypotheses generation. Wilson and Cleary (1995) developed the most widely used HRQL theoretical model (Bakas (...) et al., 2012). Ontological assumptions about causation in Wilson and Cleary’s model will influence which kind of hypotheses will be generated. I will argue that Wilson and Cleary’s model instilled a kind of causal bias into hypothesis generation in clinical research on HRQL. Causation from biomedical factors to non-biomedical factors is frequently hypothesized while causation from non-biomedical factors to biomedical factors is rarely hypothesized. It leads to that the interdependence and interaction between constituent parts of patients are ignored, which is an obstacle to the implementation of PCC. In addition, I will propose a revised HRQL theoretical model which avoids the causal bias brought by Wilson and Cleary’s model. By doing so, I leave room for the improvement of the practice of healthcare by analyzing the ontological assumptions about causation. (shrink)

In this article, the Golden Rule, a central ethical value to both Judaism and Confucianism, is evaluated in its prescriptive and proscriptive sentential formulations. Contrary to the positively worded, prescriptive formulation – “Love others as oneself” – the prohibitive formulation, which forms the injunction, “Do not harm others, as one would not harm oneself,” is shown to be the more prevalent Judaic and Confucian presentation of the Golden Rule. After establishing this point, the remainder of the article is dedicated to (...) an inquiry into why this preference between the two Golden-Rule-formulations occurs. In doing so, this article discovers four main benefits to the proscriptive formulations: I) harm-doing, as opposed to generalizable moral goodness, is easier for individuals to subjectively comprehend II) the prevention of harm-doing is the most fundamental ethical priority III) the proscriptive formulation preserves self-directed discovery of what is good, thus preserving moral autonomy IV) individuals are psychologically pre-disposed toward responding to prohibitions rather than counsels of goodness. (shrink)