This chapter contains sections titled: Notes.

Adolescents, in many jurisdictions, have the power to consent to life saving treatment but not necessarily the power to refuse it. A recent defence of this asymmetry is Neil Manson's theory of ‘transitional paternalism’. Transitional paternalism holds that such asymmetries are by-products of sharing normative powers. However, sharing normative powers by itself does not entail an asymmetry because transitional paternalism can be implemented in two ways. Manson defends the asymmetry-generating version of transitional paternalism in the clinical context, arguing that it (...) maximizes respect for adolescent autonomy. This article offers an alternative argument in favour of the asymmetry-generating form of transitional paternalism, one that makes appeal to obligations that individuals have to develop self-governance in others. We should share normative powers asymmetrically in the clinical context for three reasons. First, the asymmetric version of transitional paternalism takes seriously duties to support adolescents’ developing autonomy, alongside other duties that adults have to young people. It does so by enabling young people to be involved in important decisions that they would otherwise be excluded from. This is of value because participation of this sort is central to the cultivation of their self-governance. Second, only the asymmetric version gives young people a voice in respect of all clinical actions, and only the asymmetric version leaves open the possibility that the coarse lines of legislation might be ‘fine-tuned’ in individual cases. Third, the asymmetric sharing of normative powers is consistent with the kind of social arrangements that best support autonomy. (shrink)

Traditional theories of autonomy argue for rational agents who are free to make decisions about the moral law and justice. Adopting these theories entails that children lack of autonomy; they are not fully developed rational agents, and, because of that, they are unable to engage in the complex cognitive capacities required by autonomy, such as critical self-reflection or substantive independence. Amy Mullin who, as part of a new area of philosophy called Philosophy of Childhood, argues for (...) granting children minimal or local autonomy. She argues that children's attachments to those they love can be a source of autonomy in a minimal sense. She claims that it is in the relationship with those the child loves that the child is able to find meaningful activities and is able to care for someone or something. I argue that Jeff Lemire’s Essex County Vol. 1 Tales from the Farm, is a depiction of childhood that illustrates Mullin’s ideas. However, I will argue that through the use of images as a form of language, Lemire offers an insight that is unique to the medium of the graphic novel. Lemire as an artist negotiates the optical physical surfaces and uses these surfaces as a language to bridge the gap between the child and the adult and help us understand the mind of children as autonomous agents. This is an important contribution since it will allow us to understand how children can demonstrate autonomy in some of the ways in which they conduct their lives and how this may be reason enough to grant them a voice when decisions that would affect their lives are made on their behalf, such as custody cases or end of life decisions. (shrink)

IBERTARIANS hold that we have such duties as: not to directly and significantly harm others or their property, to keep agreements, to refrain from lying and certain other sorts of deception, and to compensate those whom we wrong. They also hold that we have a duty not to interfere with the liberty of others as long as they are fulfilling these duties. This duty of non-interference, they have thought, has protected the privacy of the home, and hence (...) parental autonomy, for it insures that others have no authority over or responsibility for (except in extreme circumstances) how parents raise or treat their children. (Why parental autonomy has been held to be protected by this duty of non—in_terference should be clear enough: for if (as is surely plausible) the main effect of that duty is to secure for adults the liberty (within limits) to live their private lives as they choose, then, on the natural assumption that the matter of how to raise one`s children falls within the domain of the private lives of adults, intervention by others, and in particular by the state, for the purpose of ensuring that children get raised in one way rather than another, would be impermissible.) More specifically to our purposes now, libertarians have supposed that the duty of non-interference leaves intact parents` perogative to decide if, and in what way, their children are to be educated. That this is crucial both to the degree and to the point of parental autonomy is clear enough. For it goes both to the matter of keeping out of the private home those who would provide education for children (if such is the wish of the parents), and to the matter of parents` entitlement to instill in their children the values that they (the parents) wish their children to have. Libertarians, however, have not had very much specific to say about the moral status of children. Are children owned by their parents? Do they have all the rights and duties that normal adults have'? Or is their status somewhere in between these extremes? Given that libertarians haven't said, there are different possible ways of extending traditional libertarian theory so as to cover children.. (shrink)

ABSTRACT In contemporary American medical practice, certain physicians are critical and wary of the current emphasis on patient autonomy in medicine, questioning whether it really serves the complex needs of severely ill patients. Physicians such as Eric Cassell and Thomas Duffy argue that the duty of beneficence should override the duty to respect autonomy when conflicts arise in clinical situations. After evaluating their claim that severe illness robs patients of their autonomy, I will argue that (...) this perceived conflict between beneficence and autonomy is ill‐conceived, resting on misperceptions about both the capacity for autonomy and the meaning of hope. Considering insights on hope from phenomenologist Gabriel Marcel and theologian William Lynch, as well as drawing upon a case study involving a bone marrow patient, I claim that respecting and nurturing patients’ capacity for autonomy is a necessary condition for acting beneficently and fostering authentic hope. (shrink)

The cultural-historical approach provides the deep theoretical grounds for the analysis of children’s play. Vygotsky suggested three critical features of play: switching to an imaginary situation, taking on a play role, and acting according to a set of rules defined by the role. Collaboration, finding ideas and materials for creating an imaginary situation, defining play roles, and planning the plot are complex tasks for children. However, the question is, do children need educator’s support during the play to (...) develop their executive functions, and to what extent? This experimental study was aimed at answering this inquiry. The four modes of sociodramatic play were created which differed in the adult intervention, from non-involvement in the play to its entire organization. The play could be child-led, adult-led, or free ; and there was also a control group where the children heard the same stimulus stories as the other groups but then followed them up with a drawing activity instead of a play activity. The study revealed that, firstly, the ways of educator’s involvement in the play differed in their potential in respect to the development of executive functions, and, secondly, this influence was not equal for different components of executive functions. Free play in the experiment was not a beneficial condition for the development of any of the studied components of executive functions, compared to the conditions involving the participation of an adult in the play. Furthermore, the type of adult intervention stimulated the development of various executive functions. The entire organization of the play by the adult had a positive impact of their general development. In contrast, the adult’s assistance in the organization of the children’s play had a positive effect on the development of inhibitory control. The study results can be helpful when considering educational practices within a cultural-historical approach to engaging the potential of play in children’s learning and development around the world. (shrink)

Children are treated differently to adults in liberal societies with respect to their right to bodily integrity. A commonly given justification for treating them differently is that they supposedly lack the sort of autonomy that is normally attributed to neurotypical adults. As such children fall through the cracks when it comes to protecting their bodily integrity: they are viewed as less than fully autonomous persons in philosophical, medical, and legal settings. With this editorial, we analyse (...) current treatments of the concept of the child's right to bodily integrity and how this relates to their (developing or future) autonomy on various conceptions. (shrink)

For many people the idea that children are autonomous agents whose autonomy the parents should respect and the state should protect is laughable. For them, such an idea is the offspring of idle academics who never had, or at least never seriously interacted with, children. Autonomy is the province of full fledged rational adults, not immature children. It is easy to see why many people embrace this view. Very young children do not have (...) the experience or knowledge to make informed decisions about matters of momentous significance. However, from this fact many people infer (or talk as if they infer) that all children are helpless moppets, wholly incapable of making any informed decisions. (shrink)

The relationship between adults and children in liberal democracies is based on two flawed assumptions that are widespread: first, that childhood is an impediment, a passing phase of impaired maturity; and second, that children benefit from the proliferation of rights ascribed to them. Social institutions, and particularly the education system, are correspondingly misconstrued. This article focuses on the combined effect of vulnerability and autonomy as they construct contemporary childhood. I conclude that adults' obligations rather (...) than children's rights are the appropriate social, political and educational basis for adult society's relations with children. (shrink)

Martha Nussbaum grounds her version of the capabilities approach in political liberalism. In this paper, we argue that the capabilities approach, insofar as it genuinely values the things that persons can actually do and be, must be grounded in a hybrid account of liberalism: in order to show respect for adults, its justification must be political; in order to show respect for children, however, its implementation must include a commitment to comprehensive autonomy, one that ensures that (...) class='Hi'>children develop the skills necessary to make meaningful choices about whether or not to exercise their basic capabilities. Importantly, in order to show respect for parents who do not necessarily recognize autonomy as a value, we argue that the liberal state, via its system of public education, should take on the role of ensuring that all children within the state develop a sufficient degree of comprehensive autonomy. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix (or, indeed, any person pursuing gender-affirming interventions) as a ‘whole person in context’ (p5)2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’ (p1),4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’ (p5).2 We agree with these authors that identity (including gender identity) development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression (OPS), D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender (trans) and gender diverse (TGD) individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (shrink)

_ Source: _Volume 13, Issue 6, pp 720 - 738 I argue that under the right conditions young dependent children owe their parents gratitude for the care they receive from them and further that parents have an obligation to motivate their children to be grateful in appropriate circumstances. Gratitude is appropriate even though parents have a duty to care for their children but it is only warranted when parents act both benevolently and with respect for (...) their children’s partial autonomy. Moreover, gratitude is uncalled for until children can recognize that they have received a benefit provided benevolently and respectfully. Gratitude is not appropriate if a benefit was provided in a context of abuse or if the beneficiary has reason for moral disapproval of the provision of the benefit. I distinguish gratitude from indebtedness and discuss important benefits associated with gratitude between parents and children for both parties. (shrink)

Metabolic Bariatric Surgery (MBS) has gained significant popularity over the past decade. Legally and ethically, physicians should obtain the patient’s voluntary and informed consent before proceeding with the surgery. However, the decision to undergo MBS is often influenced by external factors, prompting questions about their impact on the patient’s ability to choose voluntarily. In addressing this issue, the study focuses on two key questions: first, which factors influence MBS candidates during the decision-making process, and second, whether these influences undermine the (...) candidates' ability to make decisions voluntarily, according to theories of autonomy. The study employed a qualitative methodology, conducting 21 in-depth semi-structured interviews with adults who had undergone bariatric surgery. The conclusions were drawn from an inductive analysis of the interview data conducted using a grounded theory approach, and by applying theories of autonomy to the empirical findings. Our study indicates that interviewees were exposed to different external influences, which had diverse effects on the interviewees' decision to undergo MBS. Category 1 influences included intentional attempts to induce people, through arguments and reason, to accept the attitudes advocated by the persuader in support of the surgery. Applying theoretical accounts of autonomy to these influences suggests that they did not compromise the interviewees’ autonomy. Category 2 influences included threats made by a physician or a family member. These influences were found to undermine autonomy. Category 3 influences included emotional manipulation, informational manipulation, and the construction of medical and social norms. Manipulations and norms were experienced differently by different interviewees, and their impact on autonomy varies depending on the theoretical framework applied. Acknowledging that the influences exerted on MBS candidates may undermine their ability to make autonomous decisions regarding surgery, we suggest reformulating the duties that apply to medical practitioners with respect to informed consent to MBS. Medical practitioners who discuss the option of MBS with candidates should be aware of the various factors that influence this choice, and actively promote the candidates’ ability to make autonomous decisions. (shrink)

A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory (...) that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy. (shrink)

In this paper I show the short-comings of autonomy-based justifications for exemptions from paternalism and appeal to the value of settling to defend an alternative well-being-based justification. My well-being-based justification, unlike autonomy-based justifications, can 1) explain why adults but not children are exempt from paternalism; 2) show which kinds of paternalism are justified for children; 3) explain the value of the capacity of autonomy; 4) offer a plausible relationship between autonomy and (...) exemption from paternalism; and 5) give political philosophers a justification for exempting persons from paternalism even if broad scepticism about the capacity for autonomy is justified. (shrink)

Social inclusion can refer to the ability of individuals and groups to participate in social activities and the extent to which they feel included and recognized as valuable and able to make contributions. I explore the social inclusion of children in K-12 education (ages 4 - 18), and argue it is vital for the development and exercise of attitudes and capacities such as hope and local autonomy. Since schools are tasked with developing children's skills and knowledge, the (...) extent to which they succeed will play a large role in limiting or enabling children's social inclusion both when they become adults and as children. Children's relationships are an important aspect of their school experiences, as they affect not only whether they feel connected to others but also what they deem to be the grounds of their inclusion. Schools can also equip children with the skills and experiences required for social interactions with others in better and worse ways, fostering children's attitudes towards themselves, others, and the world and affecting whether they think they have the resources to have an impact on their environment and society and can achieve both personal and shared goals. (shrink)

One way to read Kierkegaard’s Works of Love is as an all out assault on the Enlightenment ideal of moral autonomy from a religious point of view. Kant is the locus classicus of this ideal, just as Descartes and Locke are, respectively, for the correlative ideals of epistemic and political autonomy. Since these three components belong to the central core of what we have come to think of as the modern understanding of the subject, Kierkegaard’s critique has (...) a distinctively postmodern flavour. But, as we shall see, it is postmodern precisely by the way it is biblically premodern.The first thing Kant says about the relation of religion to morality in his ‘Fourth Critique’ is that “morality does not need religion at all.” Because morality presupposes “man as a free agent who, just because he is free, binds himself through his reason to unconditioned laws, it stands in need neither of the idea of another Being over him, for him to apprehend his duty, nor of an incentive other than the law itself, for him to do his duty.”Kant has a more positive way of relating morality and religion. “Religion is the recognition of all duties as divine commands.” But this moral role of religion is qualified in three important ways. First, it presupposes only faith and not theoretical knowledge of God. Second, as we have already seen, the God relation cannot play any essential role either in determining the content of my duty or in motivating me to do it. The autonomy of the moral agent precludes both possibilities. Third, it involves no “special duties” to God “over and above the ethico-civil duties of humanity ...”Kierkegaard will agree to the first proviso . But his ethics is theonomous, and thus heteronomous, and he will vigorously reject the second and third constraints on the ethics of divine command he develops in Works of Love. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Kantian Ethics and Economics: Autonomy, Dignity, and CharacterIvan A. BoldyrevMark D. White. Kantian Ethics and Economics: Autonomy, Dignity, and Character. Stanford, CA: Stanford University Press, 2011. Pp. xi + 270. Cloth, $55.00.This remarkable book provides a new ethical perspective for economics based on Kantian ethics of autonomy and dignity. There are two main messages in it that I find particularly important. First, Mark White derives (...) from Kant the idea of irreducible moral principles that govern the behavior of economic agents independently of welfarist and, more generally, consequentialist concerns. These principles of duty and the “incomparable worth” (21) of human dignity, as well as justice or rights, may not be economically traded off against some other motivations; hence, they simply evade economic reasoning altogether.Second, White endorses a version of libertarian Kantianism that treats people as individuals in essence (“autonomous”) and social in orientation (respecting the rights and the choices of the others). In discussing individualism, White attacks the conventional wisdom of economics and claims that preferences alone do not account for the identity of individuals [End Page 298] in space and time, although their unique characters do. Persons should be given free choice (absent in deterministic rational-choice models) and hence responsibility for their choices that incorporates the social factors in decision-making. However, White never mentions the almost insurmountable difficulties associated with fleshing out the truly individual features of a given person. Although he allows for a person’s identity and character changing over time, he does not recognize that character itself is in many respects a social construction.White criticizes paternalistic economic policies that suggest manipulating choice environments in order to follow the “true” preferences of the individuals. Instead, real consent, as satisfying both relevant preferences and principles (e.g. rights and human dignity), is, in his view, the sole criterion for justifying particular policy measures—not Pareto-efficiency or Kaldor-Hicks compensation. Economists’ obsession with efficiency leading to the misconceived notions such as “efficient level of crime” or “manageable level of terrorism” is also severely criticized.For White, the most popular formalistic version of the categorical imperative is less important than the other two—prohibiting treating other people simply as means and instituting the “Kingdom of Ends.” Formalism is reserved merely for the negative evaluation of actions and providing strict perfect duties that give clear guidance concerning what should not be done. White’s “Kantian-economic” model of decision-making incorporates perfect duties as constraints, and imperfect (positive) duties as preferences. He also stresses that for Kant, duties derived from the imperative depend on empirical knowledge, the context of decision-making, and judgment as a unique personal interpretation of the moral law. He further emphasizes the intersubjective role of Kantian morality: moral law should be universalizable to all rational persons (the “Kingdom of Ends” formula of the imperative), whereas rationality means not just following the patterns of behavior developed in the preference-oriented choice model, but rather acting on one’s beliefs and desires or choosing not to follow them, thus exhibiting genuine autonomy.The new and important contribution to the discussion is an explicit treatment of will as an inner faculty that, together with judgment, constitutes a person’s character or “self,” and helps to overcome the mere inclination to follow duty. Will is the missing link between decision and action and should be “well-trained” for bringing about true morality.The book is clearly written, and the author has upheld the interdisciplinary appeal of the topic, demonstrating an outstanding knowledge of the vast literature on ethics (both Kantian and not) and economics. White’s emphasis on the irreducibility of moral principles is absolutely relevant for current economic and political debates. However, some reservations are in order.There is an ambiguity concerning the status of his analysis. If in its positive aspect White’s recommendations for economists is to accept the Kantian vision of morality, then almost no arguments are given for this, and his modifications of the standard choice model are introduced in an ad hoc manner, just to reconcile it with the Kantian framework. Are an individual’s decisions to act on principles and to overcome mere inclinations really... (shrink)

The COVID-19 pandemic has exacerbated many social problems and put the already vulnerable, such as racial minorities, low-income communities, and older individuals, at an even greater risk than before. In this paper we focus on older adults’ well-being during the COVID-19 pandemic and show that the risk-mitigation measures presumed to protect them, alongside the generalization of an ageist public discourse, exacerbated the pre-existing marginalization of older adults, disproportionately affecting their well-being. This paper shows that states have duties to (...) adopt and put into practice redress measures to compensate for the negative consequences of COVID-19 public health policies on older adults’ overall well-being. These duties flow from the minimal ethical requirement of respect for persons. We show that respect is a morally basic attitude that presupposes taking the others’ interests into account, with the aim of advancing their well-being. This duty is not limited to kinship, relatives, and friends but it extends to states and the rest of the civil society. In the conclusion, we draw lessons from the COVID-19 pandemic and sketch some redress measures that could compensate for the decrease in older adults’ well-being as a result of the adoption of measures to contain the spread of the virus. (shrink)

Distinguishes basic and more extreme ideas underlying three related Kantian themes: that fundamental questions of moral philosophy require an a priori method, that moral duties are conceived as categorical imperatives, and that moral agents have autonomy of the will. Arguably, an a priori method is needed for analysis and assessment of rationality claims, and we can act on moral reasons implicit in the humanity formula without a sense of constraint or an objectionably impartial attitude. The idea of a noumenal (...) world is not a premise of Kantian ethics, but a conclusion to which Kant thought his ethics inevitably led. (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental illness as the (...) sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-me dical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.67695 04. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

Some transgender and nonbinary people undergo phalloplasty and/or metoidioplasty as part of their medical transition process. Across surgical disciplines, a variety of resources are used to assist patients who are preparing for surgeries, including educational materials, workshops, peer support, and lifestyle changes. For gender-affirming surgeries, patients undergoing assessments to discern whether they are ready to undergo the surgery, and to assist them in achieving preparedness when needed. Little research investigates what resources are useful in helping patients to feel prepared to (...) undergo phalloplasty or metoidioplasty, and how assessments and resources can promote patient autonomy in the process. Respect for patient autonomy is one of the central tenets of ethical healthcare, yet historically, scholarship related to pre-surgical assessments for gender-affirming surgery has focused determining the ideal surgical candidate rather than respecting patient autonomy and ascertaining individual patient needs. This study sought to fill this gap by utilizing data from PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction), a cross-sectional, community-based survey of trans and nonbinary adults from the United States of America and Canada who had undergone one or more of these surgeries. Results revealed most participants (86%, n = 186) felt prepared to undergo surgery, though the majority of our sample (53%, n = 105) did not find referral letter assessments to be helpful. Peer support such as online resources/blogs were rated as highly useful, along with surgical consults. In a multivariable logistic regression, higher perceived preparedness was associated with identifying as queer (inclusive of gay, bi and pansexual compared to being straight), and feeling that one’s assessment process was useful (as opposed to not useful). Type of assessment was not significantly associated with preparedness; therefore, what is most useful when preparing for surgery may vary across individuals. Healthcare professionals who interact with preparing patients should develop new or utilize existing resources to assist patients in identifying their preparation needs and achieving preparedness. Our data supports assessments that center surgical care planning rather than assessing level of gender dysphoria. Future longitudinal research could further refine which assessment processes are most effective in helping patients who are preparing for these surgeries. Assessments should ensure that patients are appropriately prepared to undergo and recover from surgery through a robust process of informed consent. (shrink)

The present study investigates how laughter features in the everyday lives of 3-5-year old children in Swedish preschools. It examines and discusses typical laughter patterns and their functions with a particular focus on children’s and intergenerational (child-adult/educator) laughter in early education context. The research questions concern: who laughs with whom; how do adults respond to children’s laughter, and what characterizes the social situations in which laughter is used and reciprocated. Theoretically, the study answers the call for (...) sociocultural approaches that contextualize children’s everyday social interaction, e.g., in different institutions or homes, to study the diverse conditions society forms for learning, sociality and socialization and development of shared norms. Methodologically, the study makes use of mixed methods: it uses descriptive statistics that identify prevalent patterns in laughter practices and, on the basis of these results, examines social-interactional situations of children’s laughter in detail. It was found that children’s laughter tended to be directed to children and adults’ laughter tended to be directed to adults. 87% of children’s laughter was directed to other children, and adults directed their laughter to other adults 2,7 times as often as to children. The qualitative interaction analysis shows that children and adults exhibited different patterns of laughter. Children primarily sought and received affiliation through laughter in the peer group, and the adults were often focused on the institutional and educational goals of the preschool. Overall, the study shows that intergenerational reciprocal laughter was a rare occurrence and suggests that laughter between generations is interesting in that it can be seen as indicative of how children and adults handle alterity in their everyday life. By deploying multiple methods, the present study points to the importance of viewing emotion and norm sharedness in social interaction not just as a matter of communicating an emotion from one person to another, but as an intricate process of inviting the others into or negotiating the common emotional and experiential ground. (shrink)

This paper addresses the questions of how we should interpret the autonomy of children and of how we should identify the treatment their autonomy demands of others. In examining this question, the paper casts doubt on two views of the nature and relevance of the autonomy of children. It criticises Joel Feinberg’s well-known view that the autonomy claims of children are reducible to the autonomy claims of the future adults the (...) class='Hi'>children will become. It also raises objections to Matthew Clayton’s proposal that the treatment of children should be constrained not only by their future autonomy, but also by a particular component of their autonomy, namely, their independence. We believe Clayton’s proposal has the merit that it does not, unlike Feinberg’s proposal, restrict the basis of the autonomy-claims of children purely to the future autonomy they will enjoy as adults. Nevertheless, we do not believe that the concern with independence adequately captures the autonomy claims of children. After considering these alternative views, the paper proposes that the autonomy claims of children are in fact routed in their evolving capacities for autonomous decision-making. We argue that this proposal both fits with some common-sense ideas about how children ought to be treated, and upholds Clayton's radical proposal that parents should not enrol their children into their comprehensive views about the good life, including their religious views. (shrink)

This paper argues that the demands of respect for autonomy in the context of biobanking are fewer and more limited than is often supposed. It discusses the difficulties of agreeing a concept of autonomy from which duties can easily be derived, and suggests an alternative way to determine what respect for autonomy in a biobanking context requires. These requirements, it argues, are limited to provision of adequate information and non-coercion. While neither of these is in itself (...) negligible, this is a smaller set of demands than is often suggested. In particular, it is argued here that securing ‘one time consent’ is consistent with respect for autonomy. Finally, the paper notes that while the demands of respect for autonomy may be less than some suppose, respecting autonomy is not the only way in which biobanks and their users may have moral duties to donors. (shrink)

This study concerns the sociotechnical bases of human autonomy. Drawing on recent literature on AI ethics, philosophical literature on dimensions of autonomy, and on independent philosophical scrutiny, we first propose a multi-dimensional model of human autonomy and then discuss how AI systems can support or hinder human autonomy. What emerges is a philosophically motivated picture of autonomy and of the normative requirements personal autonomy poses in the context of algorithmic systems. Ranging from consent (...) to data collection and processing, to computational tasks and interface design, to institutional and societal considerations, various aspects related to sociotechnical systems must be accounted for in order to get the full picture of potential effects of AI systems on human autonomy. It is clear how human agents can, for example, via coercion or manipulation, hinder each other’s autonomy, or how they can respect each other’s autonomy. AI systems can promote or hinder human autonomy, but can they literally respect or disrespect a person’s autonomy? We argue for a philosophical view according to which AI systems—while not moral agents or bearers of duties, and unable to literally respect or disrespect—are governed by so-called “ought-to-be norms.” This explains the normativity at stake with AI systems. The responsible people (designers, users, etc.) have duties and ought-to-do norms, which correspond to these ought-to-be norms. (shrink)

Adult children’s particular obligations to their parents are filial obligations. The gratitude of filial obligations that treats one’s filial obligations as duties of gratitude to one’s parents is a mainstream view. However, in terms of the requirements of such obligations, the gratitude account fails to provide practical guidance. The general requirement seems that children should benefit their parents as the beneficiary should benefit the benefactor. The question is what kinds of benefits adult children should provide to their (...) parents? In some cases, adult children feel obligated to provide particular benefits to their parents like paying their medical bills or spending time with them. While in some other cases, it seems that they can use their own discretion to decide how to satisfy the filial obligations so long as what they do benefits their parents. In this article, I am trying to argue that although the general requirement of the filial obligations is to benefit the parents, there are two kinds of benefits that adult children are strongly obligated to provide. These are special goods that parents can only get from their children and things that meet their parents’ basic needs. In addition, although adult children have filial obligations to benefit their parents, there should be some limitations on the requirements of filial obligation. Namely, adult children do not have a filial obligation to meet their parents’ desires that could only be satisfied at the cost of adult children’s liberty related to significant aspects of their lives, or to meet their parents’ desires that could only be satisfied at the cost of infringing their capacity to fulfil other important duties. (shrink)

Philosophical anarchists have made their living criticizing theories of state legitimacy and the duty to obey the law. The most prominent theories of state legitimacy have been called into doubt by the anarchists' insistence that citizens' lack of consent to the state renders the whole justificatory enterprise futile. Autonomy requires consent, they argue, and justification must respect autonomy. In this essay, I want to call into question the weight of consent in protecting our capacity for autonomy. (...) I argue that if we care about all of the preconditions for autonomy, then we have good reasons to leave the state of nature. This leaves the philosophical anarchist with a dilemma. If she truly cares about autonomy, then she must welcome the state. But if she wants to deny the legitimacy of the state because of the value of consent, then she needs to downplay the moral significance of autonomy in people's lives. If autonomy matters, the state does too. If it doesn't, then consent doesn't. The philosophical anarchist can't have it both ways. (shrink)

Respect is a cardinal virtue in schools and foundational to our common ethical beliefs, yet its meaning is muddled. For philosophers Kant, Mill, and Rawls, whose influential theories span three centuries, respect includes appreciation of universal human dignity, equality, and autonomy. In their view children, possessors of human dignity, but without perspective and reasoning ability, are entitled only to the most minimal respect. While undeserving of mutual respect they are nonetheless expected to show unilateral respect. Dewey and Piaget, (...) scions of the same liberal tradition, grant children a larger degree of autonomy and equality thereby approximating the full respect conditions reserved for adults in the prior theories. In this article, after reviewing the premises of respect, I attempt to blend the divide - between minimal and full respect - by separating respect-due from respect-earned . While the former, premised on human dignity, should be granted unconditionally to all, the latter is contingent upon qualities that one possesses or acquires over time. Adding the notion of respect-due is a constraint on the prevalent school practice of turning respect into demands for deference. The relevance of this distinction is discussed in terms of student-teacher relationships. (shrink)

For centuries, humans have contemplated the minds of gods. Research on religious cognition is spread across sub-disciplines, making it difficult to gain a complete understanding of how people reason about gods' minds. We integrate approaches from cognitive, developmental, and social psychology and neuroscience to illuminate the origins of religious cognition. First, we show that although adults explicitly discriminate supernatural minds from human minds, their implicit responses reveal far less discrimination. Next, we demonstrate that children's religious cognition (...) often matches adults' implicit responses, revealing anthropomorphic notions of God's mind. Together, data from children and adults suggest the intuitive nature of perceiving God's mind as human-like. We then propose three complementary explanations for why anthropomorphism persists in adulthood, suggesting that anthropomorphism may be an instance of the anchoring and adjustment heuristic; a reflection of early testimony; and/or an evolutionary byproduct. (shrink)

Gratitude, a significant Christian value, is regarded as a duty among Indians. The present study examines the role played by spiritual development in gratitude among the Indian population. The participants were emerging Indian male adults, aged between 18 and 30 years. The first sample is from 495 Catholic Indian seminarians with intensive spiritual training, and the second is from 504 Catholic Indian nonseminarians. We use the Gratitude Questionnaire-6 and the Spiritual Assessment Inventory in the study. The (...) results show that the factors of SAI, Awareness and Realistic Experience, had medium-size correlations with gratitude in both samples. Awareness predicted gratitude in both samples and Realistic Acceptance predicted gratitude only in seminarians. The study shows that individuals with an awareness of God's presence tend to be highly grateful. Spiritually mature individuals who undergo spiritual training were also more grateful. (shrink)

Call generalism about children’s and adults’ wellbeing the thesis that the same theory of wellbeing applies to both children and adults. Our goal is to examine whether generalism is true. While this question has not received much attention in the past, it has recently been suggested that generalism is likely to be false and that we need to elaborate different theories of children’s and adults’ wellbeing. In this paper, we defend generalism against the main (...) objections it faces and make a positive case for it. (shrink)

The prelims comprise: Introduction Controversial Choices Kinds of Normative Reasons for Action Limits on Respect for Autonomy Children and Controversial Choice Controversial Choices and the Duty to Strive Toward Perfection and Full Autonomy Acknowledgments Notes References.

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)

This article explores the tensions between autonomy and expectations of mother-caregivers, in the context of normative trends in post-separation parenting law. Going back to first principles of feminism, the article asks what scope for autonomy there is for modern mothers in the face of socio-legal norms that prioritise shared parenting. The very relationship between mother-caregivers and children illustrates the important connection between relationships and autonomy: the caregiving that mothers provide enables children to become autonomous persons (...) yet, at the same time, this caregiving relationship constrains maternal autonomy. In the current context that encourages shared parenting, the potential for maternal autonomy may be even more compromised—a deep irony in a supposedly post-feminist era. A responsible mother is now expected to nurture a child’s relationship with the father, unless he is proven to be harmful. The ability of women to be at all autonomous from the fathers of their children in the face of this normative expectation is dubious, even when the adults live separately. Moreover, the dominance of the heterosexual and patriarchal family—always a challenge for women’s autonomy—is reproduced in this imposition of equal parenting in the name of children’s rights. This article uses a contextual approach to relational autonomy to point to an approach that might challenge the normative climate of shared parenting. (shrink)

The volume offers a unique collection of articles on pediatric neuroenhancement from an international and multidisciplinary perspective. In recent years, the topic of “neuroenhancement” has become increasingly relevant in academia and practice, as well as among the public. While autonomous adults are free to choose neuroenhancement, in children it presents its own ethical, social, legal, and developmental issues. A plethora of potential enhancement agents are on the market. While the manifold issues surrounding the topic have been extensively (...) discussed, there is little work on the specific questions that arise in children and adolescents. This book addresses this gap in the literature: Next to conceptual and normative work on autonomy and self-control, the collection explores the implications for parenting and schooling, and provides input for a discussion of public attitudes. It is a valuable resource for the different academic communities confronted with questions of how to evaluate and approach enhancement in children and is of interest to neuroethicists, scholars in applied ethics and neurology, psychiatrists and psychologists as well as scientists developing enhancement interventions for children. (shrink)

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (“children”). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or “endosex” females) there is a near-universal ethical consensus in the Global North. This consensus holds that (...) clinicians may not perform any nonvoluntary genital cutting or surgery, from “cosmetic” labiaplasty to medicalized ritual “pricking” of the vulva, insofar as the procedure is not strictly necessary to protect the child’s physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit–risk calculations, but on a fundamental concern to respect the child’s privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter’s sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians’ widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity. (shrink)

Feminists have argued that autonomous thought and decision-making are attained through respectful parenting and are blighted or destroyed when the parenting is disrespectful or abusive. However, it can be argued that young children are already capable of thinking and deciding things for themselves, so when sexist or abusive parenting leads to an adult incapable of such autonomy, the parenting or other social influences have destroyed what was originally there. It turns out, too, that the thinking and deciding sides (...) of autonomy are actually inseparable aspects of one and the same personal trait/virtue, and it can be shown that the other major human virtues—and human rationality as a whole—also have this dual aspect. We can go on to see that this duality is best interpreted in terms of the indissoluble complementarity of yin 陰 and yang 陽. (shrink)

Aulisio and Arora argue that the moral significance of value imposition explains the moral distinction between traditional conscientious objection and non-traditional conscientious objection. The former objects to directly performing actions, whereas the latter objects to indirectly assisting actions on the grounds that indirectly assisting makes the actor morally complicit. Examples of non-traditional conscientious objection include objections to the duty to refer. Typically, we expect physicians who object to a practice to refer, but the non-traditional conscientious objector physician refuses to (...) refer. Aulisio and Arora argue that physicians have a duty to refer because refusing to do so violates the patient’s values. While we agree with Aulisio and Arora’s conclusions, we argue value imposition cannot adequately explain the moral difference between traditional conscientious objection and non-traditional conscientious objection. Treating autonomy as the freedom to live in accordance with one’s values, as Aulisio and Arora do, is a departure from traditional liberal conceptions of autonomy and consequently fails to explain the moral difference between the two kinds of objection. We outline how a traditional liberal understanding of autonomy would help in this regard, and we make two additional arguments—one that maintains that non-traditional conscientious objection undermines society’s autonomy, and another that maintains that it undermines the physician-patient relationship—to establish why physicians have a duty to refer. (shrink)

Previous scientific contributions show that interactive learning environments have contributed to promoting learners' learning and development, as interaction and dialogue are key components of learning. When it comes to students with special needs, increasing evidence has demonstrated learning improvements through interaction and dialogue. However, most research focuses on children's education, and there is less evidence of how these learning environments can promote inclusion in adult learners with SEN. This article is addressed to analyse a case study of an interactive (...) learning environment shared by adults with and without special needs. This case shows several improvements identified by adult learners with special needs participating in this study. Based on a documental analysis and a qualitative study, this study analyses a context of participatory and dialogic adult education. From the analysis undertaken, the main results highlight some improvements identified in the lives of these adult women and men with SEN, covering educational improvements, increased feeling of social inclusion, and enhanced well-being. (shrink)

In the practice of medicine there has long been a conflict between patient management and respect for patient autonomy. In recent years this conflict has taken on a new form as patient management has increasingly been shifted from physicians to insurers, employers, and health care bureaucracies. The consequence has been a diminshment of both physician and patient autonomy and a parallel diminishment of medical record confidentiality. Although the new managers pay lip service to the rights of patients (...) to confidentiality of their records, in fact they advocate very liberal medical records access policies. They argue that a wide range of parties has a need to know the contents of individually identifiable medical records in order to control costs, promote quality of care, and undertake research in the public interest. Broad interpretations of the need to know, however, are at odds with strict interpretations of the right to confidentiality. Strict confidentiality policies require that, with few exceptions, patient consent be obtained whenever a patient's record is used outside the treatment context. The traditional criterion for overriding the consent requirement has been that without the override some harm would directly result. This rule is now challenged by the claim that patients have a duty to make their records available for a wide range of research and public health purposes. The longstanding tension between physician responsibility for patient welfare and respect for patient autonomy is being replaced by a debatable requirement that both physician and patient autonomy be subordinated to the goals of data collection and analysis. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, such as the (...) USA, Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation (...) of situational vulnerability and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (shrink)

ABSTRACT We argue that in societies like our own the prevailing view that parents have both special responsibilities for and special rights over their children fails to give a proper understanding of the autonomy both of parents and of children. It is our claim that there is a logical priority of the separable interests of a child over the autonomy of its parents in the fulfilment of their special responsibilities for and the exercise of their special (...) rights over their children. However, we believe that in acknowledging the child as a distinct locus of interests appropriate weight can still be given to parental autonomy. In particular, since raising a child is a long‐term commitment which plays a central role in the life‐plans of many adults it will be a legitimate exercise of an adult's autonomy strongly to influence the future of any children involved in such a plan. Such influence will be quite separate from paternalistic concern for those children. But the logical priority of the child's interests will at the same time show why parents are not entitled to behave proprietorially toward their children, even when paternalistic concern is called for. (shrink)

Multisensory integration (MSI) allows us to link sensory cues from multiple sources and plays a crucial role in speech development. However, it is not clear whether humans have an innate ability or whether repeated sensory input while the brain is maturing leads to efficient integration of sensory information in speech. We investigated the integration of auditory and somatosensory information in speech processing in a bimodal perceptual task in 15 young adults (age 19–30) and 14 children (age 5–6). (...) The participants were asked to identify if the perceived target was the sound /e/ or /ø/. Half of the stimuli were presented under a unimodal condition with only auditory input. The other stimuli were presented under a bimodal condition with both auditory input and somatosensory input consisting of facial skin stretches provided by a robotic device, which mimics the articulation of the vowel /e/. The results indicate that the effect of somatosensory information on sound categorization was larger in adults than in children. This suggests that integration of auditory and somatosensory information evolves throughout the course of development. (shrink)

: Genetics professionals have been reluctant to test children for adult-onset conditions because they believe this would create psychosocial harm to children not counterbalanced by significant benefits. An additional concern they express is that such testing would violate the autonomy of these children as adults. Yet weighing the harms and benefits of such testing results in a draw, with no substantial harms proven. Moreover, such testing can enhance, rather than violate the adult autonomy of (...) these children. In deciding whether to proceed with predictive testing of children, parents, mature children, and health care professionals should consider a complex of factors relevant to the particular child. The importance of these factors will vary depending on the condition at issue, the age and stage of development of the child, family dynamics, and the concerns, values, and objectives of the parents and mature child. The final decision whether to test a child for an adult-onset condition should rest with the parents and the mature child. (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)

Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the (...) conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient’s best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible. (shrink)

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of (...) human dignity, which features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. (shrink)

Doctors hold coexisting ethical duties to avoid causing deliberate harm to their patients (non-maleficence), to act in patients’ best interests (beneficence), to respect patients’ right to self-determination (autonomy) and to ensure that costs and benefits are fairly distributed among patients (justice). In the context of non-directed altruistic kidney donations (NDAKD), doctors’ duties of autonomy and justice are in tension with those of non-maleficence and beneficence. This article examines these competing duties across three scenarios in which general practitioners (GPs) (...) could promote NDAKD to healthy adults. In the first—when a healthy adult patient prompts the GP to discuss NDAKD—the GP is ethically obligated to counsel the patient about NDAKD to respect their autonomy, yet this does not constitute any form of promotion of NDAKD. In the remaining scenarios, healthy adult patients are unaware of the possibility of NDAKD. In the second, it is ethically permissible for GPs to indirectly raise awareness of NDAKD among healthy adults by displaying recruitment campaign material to non-specified groups of patients in their waiting rooms. In the third, it is ethically impermissible for GPs to directly promote NDAKD to individual healthy adults by raising the possibility of NDAKD with such individuals. The major counterarguments raised against this position are problems with kinds of counselling that fail to reach expected professional standards, rather than problems with the ethical claims made in this article. (shrink)