Socialization enforces gendered standards of politeness that encourage men to be dominating and women to be deferential in mixed-gender discourse. This gendered dynamic of politeness places women in a double bind. If women are to participate in polite discourse with men, and thus to avail of smooth and fortuitous social interaction, women demote themselves to a lower social ranking. If women wish to rise above such ranking, then they fail to be polite and hence, open themselves to a wellspring of (...) social discord, dissention, and antagonism. The possibility for women’s politeness in mixed-gender conversation threatens more than cooperation, it undermines the possibility for self-respect and autonomy. (shrink)

Algorithmic systems and predictive analytics play an increasingly important role in various aspects of modern life. Scholarship on the moral ramifications of such systems is in its early stages, and much of it focuses on bias and harm. This paper argues that in understanding the moral salience of algorithmic systems it is essential to understand the relation between algorithms, autonomy, and agency. We draw on several recent cases in criminal sentencing and K–12 teacher evaluation to outline four key ways (...) in which issues of agency, autonomy, and respect for persons can conflict with algorithmic decision-making. Three of these involve failures to treat individual agents with the respect they deserve. The fourth involves distancing oneself from a morally suspect action by attributing one’s decision to take that action to an algorithm, thereby laundering one’s agency. (shrink)

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant (...) to the concerns of medical ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity—as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires. (shrink)

According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this (...) paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy. (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)

Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from (...) Beauchamp and Childress’s theory, this article develops a non-ideal authenticity-based conceptualization of personal autonomy. Factors that indicate inauthentic decision-making are explicated, and the full concept is defended from three expected objections. The theory is then tested on a paradigm case which has concerned theorists and practitioners for some time, namely the possible inauthenticity of anorexia nervosa patients’ decision-making. It is concluded that the theory seems to be fruitful in analyses of the degree of autonomy of patients’ decision-making, and that it succeeds in providing reliable action-guidance in practical contexts. (shrink)

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' (...) notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously. (shrink)

Philosophers who defend a person’s right, under certain circumstances, to end his own life or to have a physician end it for him typically appeal both to respect for patient autonomy and to considerations of beneficence. Neither autonomy alone nor beneficence alone can ground a persuasive case for euthanasia. I argue, however, that the standard argument for euthanasia is unsound. It is not possible to combine the principles of autonomy and beneficence in such a way as (...) to justify euthanasia for those who request it and are either incurably ill, in irremediable pain, or fearful of future incapacity, while excluding both involuntary euthanasia and assisted death for those who request it despite being neither incurably ill, in irremediable pain nor fearful of future incapacity. (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)

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)

Like the ‘thoughts and prayers’ so commonly offered by politicians in the aftermath of disaster, it is incredibly common to hear ‘autonomy and dignity’ invoked together in response to some threat to human wellbeing. As such, it seems natural to assume they must bear some kind of relation to one another. But are they merely two core human interests, that happen to be vulnerable to the same kinds of threat? Or are they interrelated in a deeper way? What I (...) aim to do in this chapter is draw on the philosophical literature on both concepts to consider how they might be connected, and explore whether certain ways of connecting them are more fruitful than others. I argue that the two most prominent connections drawn in the philosophical literature – that dignity is grounded in autonomy, and that respect for dignity is synonymous with respect for autonomy – are both highly problematic. Instead, I suggest we see autonomy and dignity as mutually supportive. Doing so has both practical and theoretical benefits: it can help us identify threats to both autonomy and dignity; and it exposes theoretical lacunae, especially within the autonomy literature. (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)

What is it about a person's becoming an adult that makes it generally inappropriate to treat that person paternalistically any longer? The Standard View holds that a mere difference in age or stage of life cannot in itself be morally relevant, but only matters insofar as it is correlated with the development of capacities for mature practical reasoning. This paper defends the contrary view: two people can have all the same general psychological attributes and yet the mere fact that one (...) person is at the beginning of a life and another in the middle of one can justify treating the younger person more paternalistically than the older one. Recognising the moral relevance of age, moreover, is crucial if one is to accommodate both the liberal moral ideal of respect for autonomy and our demanding educational aims, given that these otherwise come into conflict with one another. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes (...) for which a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

Political liberals argue that the classical conception of autonomy must be discarded because it is sectarian and metaphysical. This article rejects that a commitment to autonomy necessarily leads to sectarianism and questions the notion that respect for persons is separable from the commitment to autonomy. It defends a Kantian approach to autonomy, as belonging to the standpoint of practical reason, and argues that in this approach autonomy is a norm regulating how we should treat (...) each other as opposed to a good to be promoted. This approach also avoids the metaphysical idea of autonomy as self-origination of binding principles. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity (...) for rational choice in alignment with one's values and goals). (shrink)

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the (...) implications for autonomy theory of these understandings of the relation between culture, FGC, and women’s agency. I review the range of worldwide FGC practices – including “corrective” surgery for “ambiguous genitalia” in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value‐neutral accounts of autonomy nor restrictive, value‐saturated accounts adequately explain women’s agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy‐disabling cultural alienation, promote autonomy‐within‐culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence. (shrink)

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

My central thesis is that philosophers considering questions of epistemic value ought to devote greater attention to the enduring nature of beliefs. I begin by arguing that a commonly drawn analogy between beliefs and actions is flawed in important respects, and that a better, more fruitful analogue for belief would be desire, or a similarly enduring state of an agent. With this in hand, I argue that treating beliefs as enduring, constitutive states of agents allows us to capture the importance (...) of accessible, justified, and true beliefs to sustaining personal identity, autonomy, self-control, and authenticity. We thus arrive at a significant value to such beliefs through their crucial role in our personal, practical identities. (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)

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

The ancient Stoics had an uneven track record with regard to women’s standing. On the one hand, they recognized women as fully capable of rationality and virtue. On the other hand, they continued to hold that women’s roles were in the home. These views are consistent, given Stoic value theory, but are unacceptable on liberal feminist grounds. Stoic value theory, given different emphasis on the ethical role of choice, is shown to be capable of satisfying the liberal feminist requirement that (...) autonomy must be respected. In turn, a model for Stoic feminism is proposed. (shrink)

It has recently been asserted that legislative moves to consider plants as ethical subjects are philosophically foolish because plants lack autonomy. While by no means the sole basis or driving criterion for moral behavior, it is possible to directly challenge skeptical attitudes by constructing a human-plant ethics centered on fundamental notions of autonomy. Autonomous beings are agents who rule themselves, principally for their own purposes. A considerable body of evidence in the plant sciences is increasingly recognizing the capacity (...) of plants to assess, perceive, and act on their environment. The primary purpose of their doing so is to generate the conditions for their own flourishing. With these plant purposes in mind, it is evidentially inappropriate to treat plants purely as instruments. In this age of environmental crisis, knowledge of plant intelligence and autonomy opens up a new debate on respecting and promoting the well-being of the plants that make life on Earth possible. (shrink)

According to the common view, conscientious objection is grounded in autonomy or in ‘freedom of conscience’ and is tolerated out of respect for the objector's autonomy. Emphasising freedom of conscience or autonomy as a central concept within the issue of conscientious objection implies that the conscientious objector should have an independent choice among alternative beliefs, positions or values. In this paper it is argued that: (a) it is not true that the typical conscientious objector has such (...) a choice when they decide to act upon their conscience and (b) it is not true that the typical conscientious objector exercises autonomy when developing or acquiring their conscience. Therefore, with regard to tolerating conscientious objection, we should apply the concept of autonomy with caution, as tolerating conscientious objection does not reflect respect for the conscientious objector’s right to choose but rather acknowledges their lack of real ability to choose their conscience and to refrain from acting upon their conscience. This has both normative and analytical implications for the treatment of conscientious objectors. (shrink)

Both autonomy and agency play central roles in the emerging enactive vocabulary. Although some treat these concepts as practically synonymous, others have sought to be more explicit about the conditions required for agency over and above autonomy. I attempt to be self-conscious about the role of the observer (or scientist) in such discussions, and emphasise that the concept of agency, in particular, is deeply entwined with the nature of the observer and the framing of the observation. This is (...) probably well known to enactivists, but runs the risk of being badly misunderstood if it is not made explicit. A heightened awareness of the role of the observer in the attribution of agency may allow us to make advances in questions in which progress is hindered by assuming a single split between subject and object. I argue that human experience is characterized by our embedding in webs of meaning arising from our participation in systems of many sorts, and that this richness demands a corresponding lightness of touch with respect to the identification of agentive subjects. (shrink)

Citizens are politically autonomous insofar as they are subject to laws that are (a) justified by reasons acceptable to them and (b) authorized by them via their political institutions. An obstacle to the equal realization of political autonomy is the plurality of religious, moral, and philosophical views endorsed by citizens. Decisions regarding certain fundamental political issues (e.g., abortion) can involve citizens imposing political positions justified in terms of their respective worldviews upon others. Despite citizens’ disagreements over which worldview is (...) correct, ‘political liberalism’ claims that there is a form of political autonomy that is realizable within pluralist societies. (Political liberalism differs from ‘comprehensive liberalism’ by, inter alia, being ‘freestanding’ vis-à-vis citizens’ different worldviews.) Citizens can be politically autonomous if they enjoy equal political power and justify its exercise with ‘public reasons.’ A political liberal education would aim at ensuring that all students can become politically autonomous citizens by teaching them how to exercise their democratic rights effectively and how to engage in public reasoning. Some political and educational theorists, however, argue that teaching students how to be politically autonomous amounts to teaching them how to be ‘comprehensively’ autonomous. If this is so, then the distinction between political liberalism and comprehensive liberalism collapses, at least with respect to education. This chapter outlines the main elements of political liberalism, summarizes the main requirements of a political liberal citizenship education, and surveys three arguments in support of and against the thesis that a political liberal education amounts to an education for comprehensive autonomy. (shrink)

Desire satisfaction theorists and attitudinal-happiness theorists of well-being are committed to correcting the psychological attitudes upon which their theories are built. However, it is not often recognized that some of the attitudes in need of correction are evaluative attitudes. Moreover, it is hard to know how to correct for poor evaluative attitudes in ways that respect the traditional commitment to the authority of the individual subject's evaluative perspective. L. W. Sumner has proposed an autonomy-as-authenticity requirement to perform this (...) task, but this article argues that it cannot do the job. Sumner's proposal focuses on the social origins of our values and overlooks the deep psychological roots of other evaluative attitudes that are just as problematic for welfare. If subjective theories of welfare are to be at all plausible they may need to abandon or modify their traditional commitment to the authority of the individual subject. (shrink)

In this paper, I provide a novel account of gaslighting according to which gaslighting involves mistakenly failing to see oneself as a source of reasons with respect to some domain. I argue that this account does a nice job of explaining what's gone wrong in various popular examples of gaslighting, and that it captures what different instances of gaslighting have in common even when they are quite different in other respects. I also show how this account of gaslighting explains (...) a common intuition according to which gaslighting is autonomy-undermining--something other accounts, I argue, have failed to do. And finally, I show that this explanation of why gaslighting is autonomy-undermining also shows that certain forms of oppressive socialization are autonomy-undermining as well, thus providing us with an argument in favor of more substantive theories of autonomy according to which a certain kind of self-respect is necessary for autonomy. (shrink)

In a series of reflections published in the wake of the Covid-19 crisis, Giorgio Agamben expresses a number of concerns related to the way the pandemic has altered the very fabric of our societies, potentially changing it forever. While maintaining a certain scepticism towards the threat represented by the virus itself, Agamben claims that the response to the contagion shows how easy it is for authorities to limit individual freedoms in the name of public health, and how readily they are (...) willing to put such limitations in place. At the same time, the pandemic shows how easy it is for individuals to accept this situation as the new normal, and how readily they are willing to give up their freedoms and relationships. In this paper I offer a brief overview of Agamben’s worries, focussing on two issues in particular: the loss of individual freedom of movement and association, and the moral and political implications of social distancing. I then approach these issues from a different angle, making use of relational theory to propose an alternative framework which relies on the notion of vulnerability. While agreeing with Agamben that there is reason to worry about the state seizing the opportunity to exercise unchecked power over its citizens, I argue that we should pay attention to the ways in which social distancing measures can be grounded in solidarity and respect for the autonomy of vulnerable individuals. (shrink)

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important (...) challenges stem from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how (...) patient autonomy is acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

The present study aimed to examine how to improve the effectiveness of moral exemplar-applied interventions based on the pillars of the Self-Determination Theory (SDT) framework, autonomy, competence, and relatedness. Past research has mainly focused on the relatedness and attainability of moral exemplars for predicting motivation outcomes. The data for this study consisted of synthesized data sets from previous studies examining the motivational impacts of distinct moral exemplars and intervention methods. The main syntheses for these data sets used Multilevel Modeling (...) (MLM) focusing on relatability, attainability, and intervention methods, corresponding to relatedness, competence, and autonomy in the SDT, respectively, as predictors. In general, there was a significant interaction effect between the attainability or relatability, and the intervention method. Autonomous instruction methods, which support autonomy, were demonstrated to boost motivational outcomes. Implications from this study support the employment of SDT to examine the use of moral exemplars in moral education and were consistent with previous exemplar studies. (shrink)

There is a long-standing debate in the philosophy of mind and philosophy of science regarding how best to interpret the relationship between neuroscience and psychology. It has traditionally been argued that either the two domains will evolve and change over time until they converge on a single unified account of human behaviour, or else that they will continue to work in isolation given that they identify properties and states that exist autonomously from one another (due to the multiple-realizability of psychological (...) states). In this paper, I argue that progress in psychology and neuroscience is contingent on the fact that both of these positions are false. Contra the convergence position, I argue that the theories of psychology and the theories of neuroscience are scientifically valuable as representational tools precisely because they cannot be integrated into a single account. However, contra the autonomy position, I propose that the theories of psychology and neuroscience are deeply dependent on one another for further refinement and improvement. In this respect, there is an irreconcilable codependence between psychology and neuroscience that is necessary for both domains to improve and progress. The two domains are forever linked while simultaneously being unable to integrate. (shrink)

This open access book revises Kant’s ethical thought in one of its most notorious respects: its exclusion of animals from moral consideration. The book gives readers in animal ethics an accessible introduction to Kant’s views on our duties to others, and his view that we have only ‘indirect’ duties regarding animals. It then investigates how one would have to depart from Kant in order to recognise that animals matter morally for their own sake. Particular attention is paid to Kant’s ‘Formula (...) of Humanity,' the role of autonomy and the moral law, as well as Kant’s notions of practical reason and animal instinct. The result is a deliberately amended version of Kantianism which nevertheless remains faithful to central aspects of Kant’s thought. The book’s final part illustrates the framework’s use in applied contexts, addressing the issues of using animals as mere means, the ethics of veganism and vegetarianism, and environmental protection. Nico Dario Müller shows how, when furnished with duties to animals, Kant's moral philosophy can be a powerful resource for animal ethicists. (shrink)

Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden (...) for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine. (shrink)

Recent studies have explored the effectiveness of open-label placebos for a variety of conditions, including chronic pain, cancer-related fatigue and irritable bowel syndrome. OLPs are thought to sidestep traditional ethical worries about placebos because they do not involve deception: with an OLP, patients or subjects are told outright that they are not given an active substance. As deception is framed as the primary hurdle to ethical placebo use, the door is ostensibly opened to ethical studies of OLPs. In this article, (...) I suggest that even though OLPs seemingly do not involve deception, there are other ethical considerations in their clinical investigation and subsequent use. Research ethics often focusses on informed consent—of which, deception and honesty are a piece—as a means to justify research practices with human subjects. Yet, it is but one of the ethical considerations that should be taken into account. With research into placebo effects in particular, I argue that the history of clinical placebo use grounds special considerations for OLP research that go beyond respect for the autonomy of individual patients through informed consent and encompass structural concerns about the type of patient for whom a placebo has historically been thought appropriate. (shrink)

The Substituted Judgment Standard for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, I offer an alternative (...) standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy. (shrink)

In this paper, I try to make sense of the possibility of several forms of voluntarily undertaken “sexual obligation.” The claim that there can be sexual obligations is liable to generate worries with respect to concerns for gender justice, sexual freedom, and autonomy, especially if such obligations arise in a context of unjust background conditions. This paper takes such concerns seriously but holds that, despite unjust background circumstances, some practices that give rise to ethical sexual obligations can actually (...) ameliorate some of the problems caused by such background conditions. Similarly, despite a surface appearance that sexual obligation and sexual autonomy are in tension, this need not be the case. By understanding how practices and conventions regulate the way such obligations can arise, this paper shows how supporting the possibility of sexual obligation can actually facilitate individual efforts to achieve sexual autonomy. (shrink)

In October 2021, the Inclusive Framework of the Organisation for Economic Co-operation and Development (OECD) adopted a new international tax deal, which has been hailed as a major step towards a fair and effective global corporate tax system. In this article, we question this verdict. We analyse this deal on the basis of three complementary fairness principles: preventing free riding by multinational corporations (MNCs), respect for and promotion of the fiscal autonomy of countries, and the limitation of distributive (...) and relational inequalities. We argue that the tax deal is unlikely to lead to a substantial improvement in fairness. We do, however, welcome the deal’s recognition of the need to tax multinational corporations as unitary entities subject to a global minimum effective tax rate. We argue that this recognition creates opportunities for fairer reforms that should be pursued through a more inclusive global decision-making process. (shrink)

Contrary to what we might initially think, domestic violence is not simply a violation of respect. This characterization of domestic violence misses two key points. First, the issue of respect in connection with domestic violence is not as straightforward as it appears. Second, domestic violence is also a violation of care. These key points explain how domestic violence negatively affects a victim’s autonomy and agency—the ability to choose and pursue her own goals and life plan.We have a (...) moral responsibility to respond to the problem of domestic violence as individuals. But the state also has a responsibility to respond. According to Kant in the Doctrine of Right, one of the purposes of the state is to secure just treatment for everyone. I argue that this includes an obligation to put in place policies and services that will promote the autonomy and agency of victims of domestic violence. (shrink)

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory (...) hygiene efforts—such as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains. (shrink)

In this paper I will use sex by deception as a case study for highlighting some of the most tricky concepts around sexuality and moral psychology, including rape, consensual sex, sexual rights, sexual autonomy, sexual individuality, and disrespectful sex. I begin with a discussion of morally wrong sex as rooted in the breach of five sexual liberty rights that are derived from our fundamental human liberty rights: sexual self-possession, sexual autonomy, sexual individuality, sexual dignity and sexual privacy. I (...) then argue (against the standard interpretation) that experimental findings in moral psychology show that the principle of respect for persons—a principle that grounds our human liberty rights—drives our intuitive moral judgments. In light of this discussion, I examine a puzzle about sex by deception—a puzzle which at first may seem to compel us to define 'rape' strictly in terms of force rather than sexual autonomy. I proceed by presenting an argument against the view that, as a rule, sex by deception undermines consent—a position held by prominent thinkers such as Philippe Patry (2001), Onora O’Neill (2003), Rubenfeld (2012), Tom Dougherty (2013a, 2013b), Joyce M. Short (2013), and Danielle Bromwich and Joseph Millum (2013, 2018). As we will see, sex following deception to increase your chances does not always constitute rape. Lying about your age, education, job, family background, marital status, or interest in a relationship, for example, does not make your sex partner incapable of consenting, which is to say that sex by deception need not be rape. I even go so far as to say that sex with another person that is facilitated by withholding information about having a venereal disease shouldn't be classified as rape. Although sex by deception doesn't compromise consent, it nonetheless violates the principle of respect for persons, not by vitiating sexual autonomy and compromising consent, but by failing to respect other sexual rights, such as our rights to sexual dignity, individuality, and privacy. (shrink)

This chapter explores the foundation and content of the duty to respect persons. The authors argue that it is best understood as a duty to recognize people’s rights. Respect for persons therefore has specific implications for how competent and non-competent persons ought to be treated in research. For competent persons it underlies the obligation to obtain consent to many research procedures. The chapter gives an analysis of the requirements for obtaining valid consent. It then considers respect for (...) persons as it relates to four common topics: the therapeutic misconception, research with children and adolescents, the use of deception in research, and research on competent adults without their consent. (shrink)

Autonomous e-coaching systems offer their users suggestions for action, thereby affecting the user's decision-making process. More specifically, the suggestions that these systems make influence the options for action that people actually consider. Surprisingly though, options and the corresponding process of option generation --- a decision-making stage preceding intention formation and action selection --- has received very little attention in the various disciplines studying decision making. We argue that this neglect is unjustified and that it is important, particularly for designers of (...) autonomous e-coaching systems, to understand how human option generation works. The aims of this paper are threefold. The first aim is to generate awareness with designers of autonomous e-coaching systems that these systems do in fact influence their users' options. The second is to show that understanding the interplay between a person's options and the e-coaching system's suggestions is important for improving the effectiveness of the system. The third is that the very same interplay is also crucial for designing e-coaching systems that respect people's autonomy. (shrink)

When and why do socially constructed norms—including the laws of the land, norms of etiquette, and informal customs—generate moral obligations? I argue that the answer lies in the duty to respect others, specifically to give them what I call “agency respect.” This is the kind of respect that people are owed in light of how they exercise their agency. My central thesis is this: To the extent that (i) existing norms are underpinned by people’s commitments as agents (...) and (ii) they do not conflict with morality, they place moral demands on us on agency-respect grounds. This view of the moral force of socially constructed norms, I suggest, is superior to views that deny the moral force of such norms, and it elegantly explains certain instances of wrongdoing that would otherwise remain unaccounted for. (shrink)

As liberals, we would like each person to direct her own life in accordance with her will. However, because of the complexities of the human mind, it is very often not clear what a person wills. She may choose one thing though she prefers another, while having false beliefs the correction of which would cause her to prefer some third thing. I propose, against this background, that to respect a person’s will or self-direction is to respect both her (...) choices and her preferences, with some priority given to those preferences that are informed and coherent. This is a pluralist answer to the neglected question, “respect for what?”. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Usually a relational approach, such as one appealing to care or love, is contrasted with an account of justice. In this chapter, however, I argue that distributive justice is well conceived as itself a matter of honouring people in virtue of their capacity to love and to be loved. After spelling out a familiar conception of love, I explain how treating people with respect in light of this capacity provides a plausible basis for human rights, one that rivals influential (...) individualist foundations such as Kantian respect for autonomy and Catholic honor of human life. I also articulate an egalitarian conception of how to allocate wealth that I argue is also a function of treating people's ability to love as special and that can compete against views salient in Anglo-American political philosophy such as cost-benefit analysis and John Rawls’ difference principle. (shrink)