Behavioural variant frontotemporal dementia (bvFTD) is characterized by an absence of obvious cognitive impairment and presence of symptoms such as disinhibition, social inappropriateness, personality changes, hyper-sexuality, and hyper-orality. Affected individuals do not feel concerned enough about their actions to be deterred from violating social norms, and their antisocial behaviours are most likely caused by the neurodegenerative processes in the frontal and anterior temporal lobes. BvFTD patients present a challenge for the traditional notion of autonomy and the medical and criminal (...) justice systems. Antisocial behaviour is often the earliest recognized manifestation of bvFTD. Given that the symptoms are not specific and that atrophy of the frontal lobes is only observable with structural neuroimaging in the later stages of the disease, it is hard to ascertain their autonomy. Recently proposed re-conceptualizations of autonomy (Dworkin’s, Jaworska’s, and Dubljević’s) can, however, be sufficiently redefined to provide explicit rules and offer nuanced guidance in such cases. A combination of notions of autonomy gives the most nuanced guidance with three modifications: 1) including socio-moral judgement in the notion of “normal cognitive competence,” 2) excluding in-principle un-endorsable ideals from the notion of “capacity to value,” and 3) redefining ideal-typical degrees of compulsion (mild, severe, and total). (shrink)

In this essay, “The Principle of Autonomy in Kant’s Moral Theory: Its Rise and Fall,” Pauline Kleingeld notes that Kant’s Principle of Autonomy, which played a central role in both the Groundwork for the Metaphysics of Morals and the Critique of Practical Reason, disappeared by the time of the Metaphysics of Morals. She argues that its disappearance is due to significant changes in Kant’s political philosophy. The Principle of Autonomy states that one ought to (...) act as if one were giving universal laws through one’s maxims. The criterion of just legislation that Kant accepted in the mid-1780s does not require any actual consent on the part of the citizens—genuine universality is sufficient for a law to be just. Hence, at that time, Kant could indeed explicate the criterion governing the moral permissibility of one’s maxims by drawing an analogy with the criterion governing the justice of political laws. In the Metaphysics of Morals and in other works in the 1790s, however, he added the further condition that laws must be given with the consent of the citizens. With this further condition, the moral criterion was no longer fully analogous to the criterion for political laws being just. Accordingly, Kleingeld argues, Kant dropped the Principle of Autonomy, which was firmly based on that analogy. (shrink)

Pauline Kleingeld has argued persuasively that Kant’s Principle of Autonomy draws an analogy between two relationships: 1) that between an individual agent and their maxim, and 2) that between a legislator and their legislation. She also suggests that Kant’s evolving views on the normative significance of popular elections made his analogy inapt, which explains its disappearance from his later writings. This comment concurs with Sorin Baiasu that the merits of Kant’s analogy were untouched by his evolving political views. (...) The analogy presupposes that when lawmakers legislate, they do so as representatives of the people, but even Kant’s mature writings posit that unelected lawmakers are representatives of the people in the necessary sense. Facts about whether a lawmaker acquired legislative authority by election, heredity, or conquest do have normative implications in the larger context of Kant’s political theory, but such facts are necessarily temporally upstream of the relation between legislator and legislation, just as facts about how an agent became rational are upstream of the relation between individual agent and maxim. Because the analogy focuses exclusively on these two relationships, it cannot be damaged by such upstream facts. Moreover, we should consider the possibility that Kant’s Principle of Autonomy compares a human will to the united general will of the people itself rather than to the will of a fallible public official or institution. On this alternative reading, it is even more clear that Kant’s evolving views on the significance of elections could have no possible relevance to the Principle of Autonomy. (shrink)

With appreciation toward those who commented and provided insight on “From reciprocity to autonomy in physician assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert H...

Etymologically, autonomy is the ability to give oneself rules and follow them. It is an important principle of medical ethics, which can sometimes raise some tensions in the care relationship. We propose a new definition of ethics, the ethics of heteronomy: a self-normative, discursive and responsible autonomy. Autonomy cannot be considered without the responsibility each person must have towards others. In the care relationship, autonomy would be more the ability of each person to reach out (...) to others than the ability to decide alone. The care relationship must be seen as an accompaniment of equals where each person allows the other to be rephrased. Autonomy would then no longer be absolute but relative to each situation. Being autonomous would become an ability for adaptation of the patient-doctor pair. The accompaniment allows the birth of a relationship of trust, giving the patient and the doctor the ability to touch and let themselves be touched, thus making each one progress in this reciprocal dialectic. The care relationship becomes the possibility of considering autonomy as a collective and not as an individual notion only. Paradoxically, by promoting the autonomy of the patient-doctor pair, they both develop their own autonomy. (shrink)

Mill’s proscription that ‘the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others’ has become almost axiomatic in bioethics. 1 Bolstered by the rise of patient autonomy during the mid-20th century, Millian conceptions of freedom have become so embedded in bioethical theory, that attempts to justify paternalism have typically involved making one of two claims. Either, they have involved refuting the significance of (...) class='Hi'>autonomy as an ethical principle, and questioning whether it should always be taken to outweigh other ethical principles. Or, they have sought to cast doubt on the autonomous quality of specific decisions, challenging them as non-autonomous in some important way. Both approaches are readily apparent in discussions about the moral authority of advance directives, where people have questioned both whether precedent autonomy should always outweigh the person’s current best... (shrink)

This essay discusses two contributions of the principle of sufficient autonomy to educational justice. In Just Enough, Liam Shields criticizes instrumental accounts of autonomy. According to these accounts, autonomy is valuable insofar as it contributes to well-being. Shields argues that instrumental arguments fail to support mandatory autonomy education in all cases, while his non-instrumental principle of sufficient autonomy does support this. This essay develops a version of the instrumental argument and argues this version (...) can do the work of supporting mandatory autonomy education. Another contribution of the principle of sufficient autonomy is the requirement of talents discovery. According to Shields, the requirement of talents discovery renders Rawls’s principle of fair equality of opportunity more plausible, since one’s chances of accessing a given economic position depend on one’s opportunities to discover one’s innate talents. This essay argues that Rawlsian fair equality of opportunity does not have the same implications as the principle of sufficient autonomy as to which types of talents should be discovered and to what extent. (shrink)

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of (...) caregivers regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes. (shrink)

The view from inside : gendered embodiment and the medical representation of sex / Shelley Wall -- The politics of medico-legal recognition : the terms of gendered subjectivity in the UK Gender Recognition Act / Sarah Burgess -- Journeys of choice? : abortion, travel, and women's autonomy / Christabelle Sethna and Marion Doull -- The code of ethics in medicine : intertextuality and meaning in Plato's Sophist and Hippocrates' oath / Twyla Gibson -- Sleeping ethics : gene, episteme, and (...) the body politic / Deborah Lynn Steinberg -- The last temptation of Marion Woodman : the anorexic remainder in bone : dying into life / David L. Clark. (shrink)

Most contemporary bioethicists believe that Western bioethical principles, such as the principle of autonomy, are universally binding wherever bioethics is found. According to these bioethicists, these principles may be subject to culturally‐conditioned further interpretations for their application in different nations or regions, but an ‘abstract content’ of each principle remains unchanged, which provides ‘an objective basis for moral judgment and international law’. This essay intends to demonstrate that this is not the case. Taking the principle of (...) autonomy as an example, this essay argues that there is no such shared ‘abstract content’ between the Western bioethical principle of autonomy and the East Asian bioethical principle of autonomy. Other things being equal, the Western principle of autonomy demands self‐determination, assumes a subjective conception of the good and promotes the value of individual independence, whilst the East Asian principle of autonomy requires family‐determination, presupposes an objective conception of the good and upholds the value of harmonious dependence. They differ from each other in the most general sense and basic moral requirement. (shrink)

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental (...) importance of understanding persons within the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging. (shrink)

This article presents results from a qualitative empirical investigation of how Danish oncology physicians and Danish molecular biologists experience the principle of respect for autonomy in their daily work.

Turkey has a complex character, which has differences from the Western world or Eastern Asia as well as common points. Even after more than a century of efforts to modernise and integrate with the West, Turkish society has values that are different from those of the West, as well as having Western values. It is worth questioning whether ordinary Turkish people show an individualistic character. The principle of respect for individual autonomy arises from a perception of oneself as (...) an individual, and the person’s situation may affect the applicability of the principle. Patients who perceive themselves to be members of a community rather than free persons and who prefer to participate in the common decisions of the community and to consider the common interest and the common value system of the community concerning problems of their life rather than to decide as independent, rational individuals may not be competent to make an autonomous choice. Expectations that such patients will behave as autonomous individuals may be unjustified. The family, rather than the patient, may take a primary role in decisions. A flexible system considering cultural differences in the concept of autonomy may be more feasible than a system following strict universal norms. (shrink)

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and (...) that the methods offered for specification and balancing of principles are inadequate. (shrink)

BackgroundThe Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding (...) informed consent and potential limitations to the principle of respect for autonomy in African communities.MethodsWe conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.ResultsBased on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.ConclusionsWe conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities. (shrink)

We establish the thesis that in moral education, particularly in the first years of the child’s development, unreflexive acts or unreflexiveness in certain behaviours of adults is a condition for the development of the personality structure and virtues that enable autonomous ethical reflection and a relation to the Other. With the notion of unreflexiveness we refer to resolvedness in the response of adults when it is necessary to establish a limit, or cut, in the child’s demand for pleasure, as well (...) as to resolvedness as one of the structurally essential elements in behaviours with which the adult subordinates the child to the symbolic order or language. In philosophy, a symptomatic position in this context is represented by Kant’s theory of education. On the basis of the “traditional” concept of “negative education”, and through Freud’s and Lacan’s psychoanalytic concepts, we identify two principles that should, in contemporary times, be an essential part of the moral educational behaviours of adults: the principle of a delimited response to the child’s demand for the satisfaction of pleasure, and the principle of reasoned, reflected, but nevertheless certain, persevering, resolved unreflexiveness in the subordination of the child’s desire to the symbolic order . On the basis of the preceding analysis, we highlight certain consequences of this structure of the subject for the contexts of particular theoretical discussions and for school practice. (shrink)

Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to (...) make a valid refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)

It is suggested that the current hierarchical (Frankfurt-Dworkin) model of personal autonomy in philosophical anthropology gives expression to the fundamental presupposition of self-determination in much educational practice and pedagogical theory. Radical criticisms are made of the notions of self-identification and self-evaluation which are of the utmost importance to this model. Instead of relying on such ‘acts of the will’ as decision and choice for the explanation of self-identification and self- evaluation, the non-intentional as well as the non-individualistic character of (...) these processes is stressed and analysed in terms of volitional necessity and social dependence. The consequence of this criticism is the substitution of the concept of extreme personal autonomy by that of caring about oneself as the first principle of education. (shrink)

Discusses the relationship between the exercise and development of autonomy and analyses their implications for liberalism and liberal education. Section 2.1 proves that since the liberal state values adults’ exercise of autonomy, it must also value children's development of autonomy. Section 2.2 argues that state paternalism towards children, in particular, state efforts to help children develop the capacity for autonomy even against their parents’ wishes, is consistent with liberal principles. Section 2.3 argues that parents have privileges (...) rather than rights to control their children's upbringing, but that these privileges nonetheless offer ample scope for parents to exert independent paternalistic control. Finally, Section 2.4 argues that the liberal ideal of autonomy not merely permits but requires the intrusion of the state into the child's life, specifically in the form of compulsory, ‘detached’, autonomy‐driven schools. (shrink)

The acquaintance principle (AP) and the view it expresses have recently been tied to a debate surrounding the possibility of aesthetic testimony, which, plainly put, deals with the question whether aesthetic knowledge can be acquired through testimony—typically aesthetic and non-aesthetic descriptions communicated from person to person. In this context a number of suggestions have been put forward opting for a restricted acceptance of AP. This paper is an attempt to restrict AP even more.

By laying bare the philosophical prejudices underlying certain modern deprecations of Confucianism, this article defends the integrity of Confucian civilization and reclaims its significance for the modern world. Taking on a typical criticism of Confucian Ethics by Alsadire MacIntyre, I argue that the ideal of Confucian self can be defined neither in terms of Western concepts of autonomy nor heteronomy; it consists rather in a kind of virtuosity as inspired by the empathetic openness of the self. Through a comparative (...) study of Confucian and typical Western ethical theories, I will demonstrate further how the empathetic embodiment of the Confucian self informs an order of ritual that may still be relevant for the modern world in promoting harmonious social and political orders that can elevate the conventional and current power hierarchies into the virtuous rule of benefaction. (shrink)

The ethics of care, adopted in much of the nursing literature, is usually framed in opposition to the Kantian ethics of principle. Irrespective of whether the ethics of care is grounded in gender, as with Gilligan and Noddings, or inscribed on Heidegger's ontology, as with Benner, Kant remains the philosophical adversary, honouring reason rather than emotion, universality rather than context, and individual autonomy rather than interdependence. During the past decade, however, a great deal of Kantian scholarship – including (...) feminist scholarship – has rendered this series of oppositions questionable, challenging the view that an ethics of care and Kant's moral law are irreconcilable. This paper therefore re‐examines Kant's writings, drawing on recent scholarship, and argues both that they provide the care ethicists with everything they require, and that they offer something beyond an ethics of care, something that repairs the deficits in philosophies of caring. It concludes by suggesting that a Kantian ethics of care has significant implications for the construction of nursing knowledge. (shrink)

In biomedical ethics the principle of autonomy is closely connected with the moral and legal claim to informed consent. After World War II and the dramatic misuse of medicine in Nazi Germany, informed consent regulations were expected to help avoid similar misuse in the future, to help overcome the traditional medical paternalism, and to advance the liberty rights of patients and human subjects of research. With the rise of the new field of bioethics in the 1970s, the traditional (...) beneficence-based model of medical ethics shifted in the direction of an individual autonomy model. (shrink)

In summary, the question of how to construe the procedure called reversibility cannot be given an absolute answer. No one moral interpretation of the principle is universally applicable, that is, applicable to all moral issues. The decision concerning which to apply cannot be made a priori, but only in context - that is, only when we are faced with a particular moral problem. Moreover, there appears to be no rule which would enable us to choose which version is correct (...) in a particular case. It is a matter of judgment.That the various versions represent a moral progression from lower to higher constructions is debatable. We have seen that the altruism of reversibility3 - the ethic of care - may recommend itself in some personal relations to the point of making either version of reversibility4 irrelevant. Similarly, it is not clear that reversibility3 is always higher than reversibility2. For example, parents in trying to decide what is morally best for a young child should often - in the spirit of the second construction - substitute the judgment of their mature selves for the judgment of the immature self of the child. Moreover, this substitution may not be justifiable in terms of either utility or autonomy.If I seem to have ignored reversibility1 in this discussion that is because I consider it outside morality: it is, if anything, a principle of self-interested calculation. If Baier is correct in holding that we teach children to think morally when we get them to take the standpoint of others, that requires, I believe, getting them beyond the stage of crude reciprocity. If Piaget and Kohlberg are correct in their developmental claims, we cannot immediately teach children reversibility4 but must help them progress through the other two versions. There is some basis for thinking that children can transcend egoism and sympathize with others much earlier than Kohlberg allows - an important consideration in the development of a system of moral education. That point has been pursued by Michael Pritchard in his critique of Kohlberg. Pritchard, p 44. My point is a different one: even granting Kohlberg's theory of development (which asserts, for example, that a particular cognitive ability is required to think like a Kantian), it does not follow that the moral thinking which accompanies the highest cognitive stage is morally superior to the moral thinking which accompanies the lesser cognitive stages. That it is cognitively easier to master reversibility3 than reversibility4 does not settle the question of which is morally superior. Rather than arguing about which moral version of reversibility is morally best- a pointless debate if the desirability of a version is understood as contingent upon appropriateness with respect to context - we should instead celebrate the richness of the concept of reversibility. In teaching students the moral point of view by getting them to put themselves in another's place, we would not be asking them to master a rigid formula, but rather to be sensitive to the decisional context and to make a thoughtful judgment about which version of reversibility is most appropriate to that context. We would not be teaching them either moral relativism or moral absolutism, but the complexity of trying to make a moral decision by applying an ancient and philosophically rich ethical principle. (shrink)

Respect for Autonomy has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and (...) utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons. (shrink)

Thomas Hobbes based his natural philosophy on definitions and general principles of matter in motion, which he refrained from calling “laws of nature.” Across the channel, René Descartes had presented his own account of matter in motion in such a way that laws of nature play a central causal-explanatory role. Despite some notable differences in the two systems of natural philosophy, the content of the three Cartesian laws of nature is shared by Hobbesian principles of motion. Why is it the (...) case that Hobbes never ‘transferred’ the concept of law of nature from the sphere of civil society to the realm of nature? What is the status of the Hobbesian principles of motion if they are not laws? Answering these questions is the main aim of this article. It is shown that Hobbes made available an importantly different and genuinely original way to do natural philosophy, which renders it free of metaphysics and eschews the need to ground it in anything other than ‘natural reason’. Briefly put, Hobbes took the category of ‘laws of nature’ to involve commitments that cannot be met in the natural world, unless natural philosophy loses its autonomy from theology and metaphysics. (shrink)

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. (...) Second, neuroscience itself needs a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.Sabine MNeuroScienceAndNorms: Ethical and Legal Aspects of Norms in Neuroimaging at Bonn University Hospital, Germany. Her main research interests are in neuroethics. She is coauthor of three German books about neuroethics and bioethics.Henrik Walter, M.D., Ph.D., is Full Professor of Medical Psychology at the University of Bonn, Germany, and vice-director of the Department of Psychiatry and Psychotherapy at the University Clinic of Bonn. He is author of Neurophilosophy of Free Will and editor of the book From Neuroethics to Neurolaw?. His research fields are biological psychiatry, cognitive neuroscience, neuroimaging, neurophilosophy, and neuroethics. (shrink)

Aesthetic hedonism is the view that to be aesthetically good is to please. For most aesthetic hedonists, aesthetic normativity is hedonic normativity. This paper argues that Kant’s third Critique contains resources for a nonhedonic account of aesthetic normativity as sourced in autonomy as self-legislation. A case is made that the account is also Kant’s because it ties his aesthetics into a key theme of his larger philosophy.

This dissertation is dedicated to developing a principle of autonomy that is suited to human rational agents situated in particular and contingent settings. In doing so, I start out by examining a very influential conception of autonomy which defines autonomy in terms of an agent's ability to "transcend" her particular and contingent life-situation. I call such a conception of autonomy deontological autonomy. I argue that there is an inherent inconsistency in the deontological approach since (...) deontological autonomy cannot accommodate the inescapable contingency in the concrete and particular life of each individual. I propose the notion of procedural autonomy as a more plausible conception of autonomy for humans, since it is achievable in one's particular and concrete setting. ;What makes us procedurally autonomous in contingent human conditions is the process of critical deliberation which consists of two stages: The first stage requires that an agent should examine hierarchically lower intentions and beliefs with her plan of life, the hierarchically most prior set of intentions and beliefs. In the second stage an agent must choose an adequate plan of life for herself, which can be chosen only when the agent is fully aware of various alternative life plans and has given each serious consideration for adoption. The injunction that an agent should be engaged in the two stages of critical deliberation in order to be procedurally autonomous is termed the Principle of Procedural Autonomy. This principle is an ethical principle that is hierarchically prior to moral principles, and it is a procedural principle which is primarily concerned with how one should act rather than what ends should be attained. ;I conclude by applying the Principle of Procedural Autonomy to the debate concerning moral maturity of rational agents in which certain feminist objections have been raised against the concept of autonomy; I argue that procedural autonomy escapes their criticism. ;In developing my position I consider Kant and Aristotle, and a number of contemporary thinkers including J. Rawls, M. Bratman, D. Parfit, B. Williams, C. Gilligan and N. Noddings, among others. (shrink)

Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of (...) patient agency. Deficiencies in the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)

The target article by Laacke et al. focuses on the specific context of identifying people in social media with a high risk of depression by using artificial intelligence technologies. I...

Beauchamp and Childress here collaborate to provide a set of action-guides or principles which in their judgment apply to a wide range of biomedical problems. Their work consists of eight chapters and two appendices. In the first two chapters attention centers on the nature of a moral dilemma and moral reasoning and on types of normative ethical theories. Chapters 3 through 6 discuss the principles of autonomy, nonmaleficence, beneficence, and justice, while chapters 7 and 8 deal, respectively, with the (...) professional-patient relationship and with the role that virtues, ideals, personal integrity, and conscience have to play in the moral life. Appendix I provides twenty-nine case studies illustrating dilemmas in biomedical ethics, and reference to those studies is made throughout the text. Appendix II gives the texts of important biomedical codes of ethics. (shrink)

The purpose of this article is to set out an Aristotelian account of individual autonomy. Individual autonomy is the capacity of the individual to make and act upon judgments for which he is held morally accountable. This sense of autonomy may be contrasted to a number of other senses. Of these, the most important are political or legal autonomy and Kantian principled autonomy. Political or legal autonomy concerns the environment in which an individual operates. (...) It exists where individuals are able to operate reasonably freely.1 For the most part we will not consider this sense except insofar as it is necessary to explain the importance placed on respecting individual autonomy. Kantian principled autonomy has been described recently by Onora O‟Neill in a series of writings.2 On this account, autonomy is seen as a characteristic of the principle behind action rather than of action per se and is not a characteristic of agents at all. (shrink)

Autonomy, an individual's right to make personal decisions regarding his/her own health, represents one of the major ethical principles of medicine. While there are many examples citing the benefits this right provides for the individual, the impact that personal healthcare decisions have on others is often neglected. Here, evidence from end-stage renal disease is reviewed to hypothesise the creation of a universal kidney donation programme that although provides unparalleled benefits to its citizens, relies on the participation of a large (...) proportion of the society. Given that this essay also addresses the public's major concerns regarding kidney donation, one of the only remaining implementation barriers is the individuals' right not to participate. Therefore, irrespective of the humane and complex emotionally laden reasons for not enrolling in such programmes, this essay provides some estimates of the significant resource and quality of life costs associated with autonomy. Assuming humans are competent to make informed personal healthcare choices, similar to recent efforts to increase awareness about the negative impact of certain lifestyle choices on global warming, citizens should also be better informed about the medical costs their autonomy has on society. (shrink)

The current debate on euthanasia in the Lowlands is a perfect examplification of the predominance of the principle of respect for autonomy in present-day medical-ethical decisionmaking. The aim of this article is the exploration of the more fundamental philosophical issues concerning the current status of autonomy in medical ethics. The starting point for this exploration is an analysis of the principle of respect for autonomy. The authors argue that the view on autonomy in contemporary (...) bioethical discussions is more related to the Millian understanding of autonomy rather than to Kant’s conception of respect for autonomy. The uncompromising veneration of personal autonomy and the subsequent view on the human self as unencumbered is placed under critique because this portrayal of the human person is rather unreal especially in medical-ethical decisionmaking where the fragility of human life is at stake. Furthermore, extending the claims of autonomy risks to undermine the public sphere. The defence of the principle of autonomy is taken on by the quality-of-life ethic that values human life because of its qualities. Being capable of making autonomous decisions is one of this main qualities. By this, the quality-of-life approach runs counter to an idea that is deeply ingrained in medicine, viz. the sanctity of human life that holds both the inviolability and the equal value of human life. These two approaches can, however, be integrated in Christian ethics by adopting a view on quality-of-life judgements in which the proportionality of benefits and burdens has a pivotal function. To conclude this article, the authors argue for a non-absolutist account of autonomy based on two modes of decentrement of the human self: the fundamental passivity at the core of the human person and the intersubjectivity of the human existence. (shrink)

Não apenas distantes no tempo, Kant e Levinas são distantes em suas respectivas propostas de ética. Este trabalho visa analisar reflexivamente os princípios morais dos dois autores com o intuito de introduzir o acadêmico aos conceitos fundamentais em dois grandes expoentes da ética. Desta forma, Kant propõe uma moral baseada na razão (pura prática), livre de toda inclinação sensível. Nada alheio a razão pode fundar uma lei. Por conseguinte, o único princípio da determinação da vontade é a lei moral, de (...) forma que ser moral é ser racional. Logo, na medida em que as máximas do agir concordarem com a lei moral expressa no imperativo categórico tem-se uma ação com valor moral. Levinas, por sua vez, faz uma crítica a toda à tradição ética pelo fato de ter subjugado o outro ao Eu. Na tradição o outro foi reduzido a “objeto”, a conceito. Por isso, para Levinas, a ética é filosofia primeira, na qual afirma que o outro interpela e causa irrecusavelmente responsabilidade por ele. Tal responsabilidade é fundada antes mesmo do sujeito se constituir como Eu consciente. Logo, o rosto do outro é um mandamento que exige minha responsabilidade. (shrink)

Although the need of freedom is definite, the concept of individual freedom, while being interpreted with legal terms, causes not only theoretical, but also practical problems. The observed two extremes of freedom are defined as any human self-expression as well as the license, where the state power is generally attributed to disregard personal freedom. In this article the freedom of expression and state enforcement jurisdiction dichotomy are addressed by discussing positive and negative conceptions of freedom and the relationship between the (...) interpretations of political liberalism and Kant and Hegel‘s philosophies. This paper aims to prove that the positive liberty is the assumption of the negative liberty. The paper based on Hegel‘s philosophy shows that freedom is the characteristic of human nature to seek identity. It is also argued that human identity can take many forms and, therefore, a person has a number of inherent rights and liberties. It is human psycho-physical identity that provides the right to life and health care; human creative identity, providing the right to privacy and freedom of occupation; human moral identity, which provides the right of dignity, and the moral autonomy of person’s social and political identity, providing the political and social rights and freedoms. This article concludes that while a person uses the given rights with integrity and the state is limiting people’s arbitrariness, there is no conflict between the freedom and state violation. (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)