Pre-commitment directives or Ulysses contracts are often defended as instruments that may strengthen the autonomous self-control of episodically disordered psychiatric patients. Autonomy is understood in this context in terms of sovereignty ("governing" or "managing" oneself). After critically analyzing this idea of autonomy in the context of various forms of self-commitment and pre-commitment, we argue that what is at stake in using Ulysses contracts in psychiatry is not autonomy as sovereignty, but autonomy as authenticity. Pre-commitment directives do not function to protect (...) autonomous self-control. They serve in upholding the guidance that is provided by one's deepest identity conferring concerns. We elucidate this concept of autonomy as authenticity, by showing how Ulysses contracts protect the possibility of being "a self.". (shrink)

In September 2020, the surgeon Paulo Macchiarini, who used stem cell technology to enable the transplants of artificial and donor trachea, was charged with aggravated assault in Sweden. In this comment, we argue that the Ethics Council of the Karolinska Institute should have considered issues from philosophy of science when they were brought to their attention, rather than dismiss them as irrelevant to research ethics. We demonstrate how conceptual issues of a philosophy-of-science-kind about clinical research and medical practice should be (...) integral to research ethics. (shrink)

The moral authority of advance directives as a vehicle of precedent autonomy is highly problematic in cases of severe dementia of the Alzheimer’s type. It is unclear how personal values and interests can be enforced by means of such an advance directive; at the stage of severe dementia the distal binding powers of precedent autonomy have expired; and the moral costs of removing another human being from life are very high. It transpires that in fine drawing up an advance directive (...) in the face of Alzheimer is an inappropriate method of orchestrating one’s future care and death. This leaves persons diagnosed with Alzheimer’s disease with two morally preferable alternatives. One is that they accept that, when severe dementia is setting in, autonomy is not an issue; others decide. The second is that they commit pre-emptive suicide after Alzheimer’s disease is diagnosed. (shrink)

The stories we live by: On narrative self-constitution and self-understanding In spite of what Galen Strawson defends, it is claimed that a narrative attitude – as a psychological fact – is of great use for self-reflective beings in making their experiences understandable and managing their lives. Secondly, there is doubt about the existence of what Marya Schechtman called a ‘narrative self’, i.e. a self that is constituted by the stories people tell about themselves. It is proposed to leave the constitution (...) question aside and to choose, like Peter Goldie did before, for the ‘narrative sense of self’ as an anchor point when we want to understand how people think about their lives and themselves in narrative terms. Finally, it is disputed that narrative self-understanding would be impossible or should be banished to the world of fiction, as anti-narrativists contend. Although the life stories of people are inevitably perspectival and in essence contestable, they are always factual stories that can be true and false and thus play a significant role in better understanding ourselves and others. (shrink)

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Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.