Our aim in the present paper is to approach the nature of life from the perspective of autonomy, showing that this perspective can be helpful for overcoming the traditional Cartesian gap between the physical and cognitive domains. We first argue that, although the phenomenon of life manifests itself as highly complex and multidimensional, requiring various levels of description, individual organisms constitute the core of this multifarious phenomenology. Thereafter, our discussion focuses on the nature of the organization of individual living (...) entities, proposing autonomy as the main concept to grasp it. In the second part of the article we show how autonomy is also fundamental to explaining major evolutionary transitions, in an attempt to rethink evolution from the point of view of the organizational structure of the entities/organisms involved. This gives further support to the idea of autonomy not only as a key to understanding life in general but also the complex expressions of it that we observe on our planet. Finally, we suggest a possible general principle that underlies those evolutionary transitions, which allow for the open-ended redefinition of autonomous systems: namely, the relative dynamic decoupling that must be articulated among distinct parts, modules or modes of operation in these systems. (shrink)

History's judgment on the success of bioethics will not depend solely on the conceptual creativity and innovation in the field at the level of ethical and political theory, but this intellectual work is not insignificant. One important new development is what I shall refer to as the relational turn in bioethics. This development represents a renewed emphasis on the ideographic approach, which interprets the meaning of right and wrong in human actions as they are inscribed in social and cultural practices (...) and in structures of lived meaning and interdependence; in an ideographic approach, the task of bioethics is to bring practice into theory, not the other way around. The relational turn in bioethics may profoundly affect the critical questions that the field asks and the ethical guidance it offers society, politics, and policy. The relational turn provides a way of correcting the excessive atomism of many individualistic perspectives that have been, and continue to be, influential in bioethics. Nonetheless, I would argue that most of the work reflecting the relational turn remains distinctively liberal in its respect for the ethical significance of the human individual. It moves away from individualism, but not from the value of individuality.In this review essay, I shall focus on how the relational turn has manifested itself in work on core concepts in bioethics, especially liberty and autonomy. Following a general review, I conclude with a brief consideration of two important recent books in this area: Jennifer Nedelsky's Law's Relations and Rachel Haliburton's Autonomy and the Situated Self. (shrink)

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls (...) for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

Autonomy and authority are often regarded as opposites. In this paper, I argue that autonomy should be conceived of as a specific form of (practical) authority and that this perspective is useful for identifying the conditions of personal autonomy. I will first highlight some structural analogies in the functioning of the concepts "autonomy" and "authority" and explain the resulting constraints on accounts of personal autonomy. I will then show that the problems of certain internalist and (...) externalist accounts of autonomy are rooted in a false understanding of the foundation on which the authority that is characteristic of autonomy rests. To conclude, I present an account in which this foundation is given by a person’s maturity (Mündigkeit), defensiveness (Wehrhaftigkeit) and participation (Mitsprache): Thus, a person is autonomous to the extent that she can cope with her own affairs, can defend herself against external encroachments and can participate in common affairs. (shrink)

Hat die subjektive Erfahrung, uns selbst und anderen als eine bestimmte Person zu erscheinen, eine ethische Orientierungsfunktion? Und wenn ja, was geschieht, wenn wir uns auf eine Weise verändern, die uns an der Kontinuität dieser Erfahrung zweifeln lässt? Ausgehend von Schilderungen von Nicht-Authentizitäts-Erfahrungen wird in diesem Buch der Versuch unternommen, einen Begriff personaler Authentizität zu rekonstruieren, der für Fragen der angewandten Ethik handhabbar ist. Dabei verbindet das Buch auf innovative Weise zwei Diskussionsstränge aus der Bioethik und der praktischen Philosophie: die (...) bioethische Diskussion um das Neuro-Enhancement und die Debatte um das richtige Verständnis »personaler Autonomie« in der analytischen Philosophie. Dieser Ansatz erlaubt zu zeigen, dass der Begriff der Authentizität nicht im Begriff der Autonomie aufgeht und dass ersterer für die angewandte Ethik am besten als eine Fähigkeit zu rekonstruieren ist. Dadurch kann nicht nur die Bedeutung von Selbstwissen für eine verantwortungsvolle technische Selbstgestaltung thematisiert, sondern auch die in der Enhancement-Debatte häufig stiefmütterlich behandelte Perspektive des guten Lebens hervorgehoben werden. (shrink)

_Personal Autonomy and Social Oppression_ addresses the impact of social conditions, especially subordinating conditions, on personal autonomy. The essays in this volume are concerned with the philosophical concept of autonomy or self-governance and with the impact on relational autonomy of the oppressive circumstances persons must navigate. They address on the one hand questions of the theoretical structure of personal autonomy given various kinds of social oppression, and on the other, how contexts of social oppression make (...) autonomy difficult or impossible. (shrink)

In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued (...) that autonomy and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of Socratic autonomy is introduced. (shrink)

A growing body of research has explored well-being in diverse cultural contexts, and indicates that the definition and perception of well-being vary according to cultural context. Little is known, however, about whether intercultural differences in China (i.e., Tibetan and Han) lead to different perceptions of well-being and how social contexts and personal characteristics are associated with well-being in Tibetan and Han emerging adults. Using a self-determination framework, the current study examines the relationship between parental autonomy support (PAS) and psychological (...) well-being (PWB) in Tibetan and Han emerging adults in China. Guided by implicit theory and self-regulatory theory, we propose a serial multiple mediation model of growth mindset and grit in the association between PAS and PWB. Propensity score matching was used to balance the two ethnic groups in terms of age, gender, socioeconomic status (SES), with a ratio of one to two. Finally, 59 Tibetan (71.2% girls) and 118 Han (69.5% girls) emerging adults aged from 18 to 25 years were included in the current study, and completed an online questionnaire survey. Findings suggest that (a) Tibetan emerging adults perceived higher levels of PWB than their peers from the Han ethnic group; (b) a serial multiple mediation model for the association between PAS and PWB was supported in Han emerging adults; (c) the indirect effects between PAS and PWB varied between Tibetan and Han emerging adults. Our findings suggest that PAS and grit contribute to PWB of emerging adults in both cultural contexts, whereas growth mindset may be beneficial for Han emerging adults only. (shrink)

Recent feminist accounts of autonomy have focused both on autonomous agents’ relationships to others and on their self-regarding attitudes or self-relations. This chapter focuses on the attitude of practical self-care, arguing that autonomous agents must care about themselves in a sense that amounts to caring about their practical reasons. While self-care is primarily a self-relation, it also implies a form of interpersonal relationality. Caring about one’s reasons requires caring about intersubjective assessments thereof, and the relation of self-care thus implies (...) openness to the reasons of others and a disposition to hold oneself answerable for one’s identity-constituting concerns. (shrink)

An increase in autonomy and freedom is often considered one ofthe main arguments in favour of a broad use of genetic testing.Starting from Gerald Dworkin's reflections on autonomy and choicethis article examines some of the implications which accompanythe increase in choices offered by prenatal genetic diagnosis.Although personal autonomy and individual choice are importantaspects in the legitimation of prenatal genetic diagnosis, itseems clear that an increase in choice offered by prenatalgenetic diagnosis also leads to various implications that maynegatively (...) influence the freedom of the persons involved. (shrink)

ABSTRACT There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements. We present six neuroenhancement scenarios and analyse how autonomy accounts (...) evaluate them. Some cases are considered differently by criminal courts; we demonstrate where academic autonomy theories and legal reasoning diverge and ascertain whether courts should reconsider their concept of autonomy. We argue that authenticity is not an appropriate condition for autonomy and that new enhancement technologies pose no unique threats to personal autonomy. (shrink)

Significant criticisms have been raised regarding the ethical and psychological basis of living wills. Various solutions to address these criticisms have been advanced, such as the use of surrogate decision makers alone or data science‐driven algorithms. These proposals share a fundamental weakness: they focus on resolving the problems of living wills, and, in the process, lose sight of the underlying ethical principle of advance care planning, autonomy. By suggesting that the same sweeping solutions, without opportunities for choice, be applied (...) to all, individual patients are treated as population‐level groups—as a theoretical patient who represents a population, not the specific patient crafting his or her individualized future care plans. Instead, advance care planning can be improved through a multimodal approach that both mitigates cognitive biases and allows for customization of the decision‐making process by allowing for the incorporation of a variety of methods of advance care planning. (shrink)

This collection of articles, mostly by philosophers, but including two doctors and an economic historian, is intended as a contribution to applied ethics and medical ethics. The articles tackle two questions: how can the autonomy of the elderly be increased, and how can a just proportion of medical resources be secured for them? The seven articles dealing with the first question apply work in the theory of ethics on the nature and limits of autonomy to the particular case (...) study of the elderly: there are a number of detailed conclusions about what can and should be done, and a general consensus that, while the right to die with dignity is important, even more important is the improvement of the quality of life. The seven articles dealing with resources examine the problems created by an ageing population and the arguements for discriminating against the elderly: the main conclusions is that none of these arguments are sound or convincing. Overall the book seeks to make both a theoretical and a practical contribution to this field. (shrink)

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

Recent criticism of the role of respect for autonomy in bioethics has focused on that principle's status as ‘dogma’ or ‘ideology’. I suggest that lying beneath many applications of respect for autonomy in medical ethics are some influential dogmas — propositions accepted, not as explicit premises or as a consequence of reasoned argument, but simply because moral problems are so frequently framed in such terms. Furthermore, I will argue that rejecting these dogmas is vital to secure and protect (...) an autonomy worthy of respect. The concept of autonomy that is widely applied in clinical ethics emphasises decision-making competence, at the expense of considering the authenticity of those decisions. Respect for such autonomy is interpreted in largely synchronic and individual terms — concerned with the isolated decisions of individual agents — and thus neglects the diachronic and social dimensions of many moral dilemmas arising in the health care context. I will examine how these unwritten rules lead to an impoverished understanding of respect and a systematic neglect in bioethics of certain kinds of ethical consideration, and draw on insights from feminist and communitarian work on autonomy to sketch an alternative approach to understanding respect, modelled on the norms of respectful conversation — a respect that is firstly concerned with engaging with the another as a potential giver and bearer or reasons, and working with them to promote both individual and social flourishing. (shrink)

In contemporary political philosophy, reflections on poverty demand careful treatment in the light of key ethical concepts—especially autonomy. While the negative effects of poverty on autonomy are acknowledged, the welfare dependency of the poor is seen as an autonomy-undermining factor, which I call the “autonomy–poverty dilemma.” This chapter discusses contemporary political theories about autonomy and poverty in terms of how they relate to this dilemma. The features and problems of three pertinent theories are addressed in (...) such a way as to resolve the autonomy–poverty dilemma. The first is luck egalitarianism, which weighs individual responsibility in defining just distributions, but may leave some of the incapacitated unattended in order not to annul their personal responsibility and may stigmatize those who are dependent (such as people with mental disabilities) who are not personally responsible. Such stigmatization is also a problem with relational egalitarianism, which bases egalitarian justice on the equal standing of individuals, in that the ideal of socially embedded autonomous agents could be degrading to the dependent. While the capability approach overcomes that problem by providing a powerful buttress for the dependent and allowing them to emerge from poverty, it runs the risk of a paternalistic, perfectionist idealism. In closing, this chapter proposes an alternative view, which I call the “radical pluralist view of egalitarian justice,” based on a consideration of the features and problems of these three key theories. (shrink)

In The Autonomy of Morality Charles Larmore challenges two ideas that have shaped the modern mind. The world, he argues, is not a realm of value-neutral fact, nor does human freedom consist in imposing principles of our own devising on an alien reality. Rather, reason consists in being responsive to reasons for thought and action that arise from the world itself. Larmore shows that the moral good has an authority that speaks for itself. Only in this light does the (...) true basis of a liberal political order come into view, as well as the role of unexpected goods in the makeup of a life lived well. (shrink)

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of (...) the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions. These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her ‘depressive disabilities’. Lastly, I will compare this manner of life-conduct with the constellation of includence, as described by Tellenbach, and discuss the limitations of this study. (shrink)

In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in (...) claiming that impulsivity can serve to undermine an agent’s autonomy. I then explain that we are already able to reduce impulsivity through the use of pharmacological interventions, as is evidenced by the use of Methylphenidate in the treatment of ADHD. (shrink)

What can theology offer to philosophical discussions of autonomy? In this distinctive collection of essays, Insole and DeSpain lead a cadre of academics from across the world in answering this question. In doing so, they challenge the narrow conception of 'liberalism' that has characterised much of the discussion around relational autonomy. The contributions analyse modern and concrete examples relating to autonomy. These scenarios include essays on trauma, transgender issues, disability and end-of-life debates. Additionally, they explore broader political (...) issues that relate to autonomy such as democracy, the economy and migration. (shrink)

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults (...) of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change. (shrink)

In this paper I look at various ways that interpersonal and social relations can be seen as required for autonomy. I then consider cases where those dynamics might play out or not in potentially paternalistic situations. In particular, I consider cases of especially vulnerable persons who are attempting to reconstruct a sense of practical identity required for their autonomy and need the potential paternalist’s aid in doing so. I then draw out the implications for standard liberal principles of (...) paternalism, specifically in clinical or therapeutic situations. The picture of potential paternalism that emerges here is much more of a dynamic, interpersonal scenario rather than a case of two separate individuals making decisions independent of each other. (shrink)

It has been argued that Thomson's defense of abortion, if successful, implies that abortion is permissible only until the point of viability. After that point, if one wanted to end a pregnancy, one must do so by birthing the fetus through induction or cesarean. In this paper, I argue that Thomson's defense of abortion does, in fact, imply that abortion after the point of viability is sometimes permissible. To show this, I point out that the process of birthing a fetus (...) makes use of the body of the pregnant person in significant ways. Indeed, the body of the pregnant person is as much a part of this process as it is a part of the process of carrying a fetus during pregnancy. Thus, just as it is sometimes morally permissible to choose to have an abortion rather than continue a pregnancy, it is sometimes morally permissible to choose to have an abortion rather than undergo an induction or cesarean. Those who support Thomson's defense of abortion, then, have reason not to support the view that induction or cesarean are the only permissible procedures for ending an unwanted pregnancy with a viable fetus. I then use this discussion to suggest that autonomy rights are more complicated than initially thought. Given the extent to which the body is involved in detaching the fetus, it is not merely that one has a right to detach a fetus, but also a right to actualize one's reasonable preferences over the method of detachment. (shrink)

Meaningful work is a key element of positive functioning of employees, but what makes work meaningful? Based on research on self-determination theory, basic psychological needs, and prosocial impact, we suggest that there are four psychological satisfactions that substantially influence work meaningfulness across cultures: autonomy (sense of volition), competence (sense of efficacy), relatedness (sense of caring relationships), and beneficence (sense of making a positive contribution). We test the relationships between these satisfactions and perceived meaningful work in Finland (n = 594, (...) employees of several organizations), India (n = 342, collected through Mturk), and the USA (n = 373, collected through Mturk). Regression analyses show that – except for competence in USA – all four satisfactions are significantly and independently associated with meaningful work. Moreover, structural equation modeling shows that they fully mediated the relationship between occupational position and work meaningfulness in India and in the USA. In sum, the results support the importance of these four satisfactions in explaining the psychological underpinnings of meaningful work. (shrink)

This paper presents a relational account of autonomy showing that a technological imperative impedes autonomy through undermining women’s capacity to resist use of technology in the context of labor and birth. A technological imperative encourages dependence on technology for reassurance whenever possible through creating a (i) separation of maternal and fetal interests; and (ii) perceived need to use technology whenever possible. In response I offer an account of how women might promote autonomy through cultivating self-trust and self-confidence. (...) Autonomy is not simply a matter of choosing freely and acting on our choices, it is also a matter of possessing the ability to resist social contexts undermining choice and action. An important implication of this view is that respecting autonomy requires more than simply respecting persons’ ability to make and act on choices. Respecting patient autonomy requires a recognition of patients’ need to resist factors impeding autonomy and support for that resistance. (shrink)

Multiple realization historically mandated the autonomy of psychology, and its principled irreducibility to neuroscience. Recently, multiple realization and its implications for the reducibility of psychology to neuroscience have been challenged. One challenge concerns the proper understanding of reduction. Another concerns whether multiple realization is as pervasive as is alleged. I focus on the latter question. I illustrate multiple realization with actual, rather than hypothetical, cases of multiple realization from within the biological sciences. Though they do support a degree of (...) autonomy for higher levels of explanation and organization, they do not have the dire consequences critics of multiple realization fear. †To contact the author, please write to: Department of Philosophy, University of Cincinnati, P.O. Box 210374, Cincinnati, OH 45221‐0374; e‐mail: [email protected]. (shrink)

In this article the various descriptions and interpretations ofprofessional autonomy, as have been given in the articles from Belgium,Italy and the UK are subjected to a further analysis. The implicit claimthat professional autonomy of physicians is beneficial for the health ofpatients is scrutinized and is proven to be untrue and invalid. Theconclusion is that professional autonomy is more directed at theinterests of physicians than of those of patients and deserves nospecial place in health care.

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals’ formation of choices. In response to this problem, I will present a brief overview of Diana Meyers’s account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, (...) self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical ‘self-reading’. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills. (shrink)

Self-creation and autonomy -- Creation, society and the imaginary -- Self and world -- The living body -- The human psyche -- The whole world and more : the meaning of the monadic psyche and its fate -- Magmas -- Determination and the logic of indeterminate being -- Indeterminacy and interpretation -- Autonomy and meaning.

This book uses the example of informed consent guidelines for international research on human subjects to demonstrate how a philosophical analysis can assist in understanding how underlying concepts affect public policy; how and why such policies are exclusionary; and what methodology can be used to remedy injustices in public policy and practice. Epidemics, such as AIDS, have resulted in an increase in medical research in less developed countries. In an attempt to be more globally applicable, current international guidelines for research (...) on human subjects have attempted to acknowledge the importance of community. This book explains how these attempts fail to adequately acknowledge the importance community has for many people in less developed countries, and how these guidelines fail to attend to constraints to autonomy that oftentimes get magnified once community is involved in the informed consent process. The book further explains how these problems can be traced to a mistaken underlying notion of autonomy and what policymakers can do to remedy these problems . (shrink)

Since Darwin, Biology has been framed on the idea of evolution by natural selection, which has profoundly influenced the scientific and philosophical comprehension of biological phenomena and of our place in Nature. This book argues that contemporary biology should progress towards and revolve around an even more fundamental idea, that of autonomy. Biological autonomy describes living organisms as organised systems, which are able to self-produce and self-maintain as integrated entities, to establish their own goals and norms, and to (...) promote the conditions of their existence through their interactions with the environment. Topics covered in this book include organisation and biological emergence, organisms, agency, levels of autonomy, cognition, and a look at the historical dimension of autonomy. The current development of scientific investigations on autonomous organisation calls for a theoretical and philosophical analysis. This can contribute to the elaboration of an original understanding of life - including human life - on Earth, opening new perspectives and enabling fecund interactions with other existing theories and approaches. This book takes up the challenge. (shrink)

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient’s autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that (...) our answer to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing. (shrink)

Why has autonomy been a leading idea in philosophical writing on bioethics, and why has trust been marginal? In this important book, Onora O'Neill suggests that the conceptions of individual autonomy so widely relied on in bioethics are philosophically and ethically inadequate, and that they undermine rather than support relations of trust. She shows how Kant's non-individualistic view of autonomy provides a stronger basis for an approach to medicine, science and biotechnology, and does not marginalize untrustworthiness, while (...) also explaining why trustworthy individuals and institutions are often undeservingly mistrusted. Her arguments are illustrated with issues raised by practices such as the use of genetic information by the police or insurers, research using human tissues, uses of new reproductive technologies, and media practices for reporting on medicine, science and technology. Autonomy and Trust in Bioethics will appeal to a wide range of readers in ethics, bioethics and related disciplines. (shrink)

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including (...) self-conception, self-worth, memory, and the imagination. (shrink)

Individuals use their capacity for autonomy to express preferences regarding food choices. Food choices are fundamental, universal, and reflect a diversity of interests and cultural preferences. Traditionally, autonomy is cast in only epistemic terms, and the social and political dimension of it, where autonomy obstruction tends to arise, is omitted. This reflects problematic limits in the Cartesian notion of the individual. Because this notion ignores context and embodiment, the external and internal constraints on autonomy that extend (...) from social location are not considered. Therefore, reconceptions of the individual and autonomy which emphasize social location and relational interdependency are needed. To combat autonomy obstruction, individuals can appeal to community and community autonomy as a social mechanism. Communities are social groups characterized by people living in places with shared goals. Recognizing their interdependency, individuals can organize as communities in order to accomplish objectives that they cannot on their own. While community autonomy is valuable unto itself, it can also enhance individual autonomy. (shrink)

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient (...) class='Hi'>autonomy. These different manifestations of autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

This chapter contains sections titled: Introduction A. The Formula of Autonomy – Initial Statements B. The Formula of Autonomy, the Formula of Universal Law, and the Formula of Humanity C. The Kingdom of Ends D. Price and Dignity E. Critical Remarks and Worries F. The Formula's Larger Implications References.

The concept of autonomy as self-sovereignty is developed in this essay through an examination of the thought of American transcendentalist philosophers Emerson and Thoreau. It is conceived as the quality of living in accordance with one’s inner nature or genius. This conception is grounded in a transcendentalist moral anthropology that values independence, self-reliance, spirituality, and the capacity to find beauty in the world. Though still exerting considerable popular and academic influence, both the concept of autonomy as self-sovereignty and (...) the underlying anthropology diverge in important ways from counterparts that are prominent in contemporary bioethics. Autonomy as self-sovereignty calls into question the manifold ways that patients (and citizens) are brought to heel by institutional (and political) values they do not themselves affirm. It also emphasizes the inevitable deep plurality of moral visions of health and appropriate healthcare, rejecting tendencies (strong in mainstream bioethics) to regard “health” as a univocal concept or healthcare as a basic need, to attempt to conform “reasonable” clinical decision-making to a single model, and to appoint government as a guarantor of access to healthcare or a regulator of healthcare standards. Autonomy as self-sovereignty, like its competitors, can justify itself only in question-begging terms. Still, bioethics might do well to recognize it within the mix of moral visions. (shrink)

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of (...) class='Hi'>autonomy, and argue that a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons (...) underpinning the choice are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy depends (...) upon such responsiveness to reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

This article addresses the increasingly widespread view that Bourdieu's sociological analysis is flawed by excessive determinism and thus is anti-rationalist in its socio-political implications. Against this contention, it argues that works such as Distinction should be viewed as critiques of an absolutist universalism rather than of universalism as such. Moreover, Bourdieu's logic of practice, it is claimed, caters not only for a degree of autonomy at the level of the individual, but also identifies two key intellectual fields as pivotal (...) cultural accumulators of autonomous or critical thought: the artistic field and the scientific field. In this context, it is particularly important that one of his very late works, Science of Science and Reflexivity, gives such a vital role to the free `corporation' of scientists as judges of scientific reputations. His concept of artistic autonomy is further explored by illustrations from casestudies in historical sociology, by writers who have been decisively influenced by his sociology of literature. The article ends with an application of his ideas to contemporary newspaper obituaries of cultural producers. This illuminates in particular an underlying issue in his sociology: current dangers to artistic autonomy. (shrink)