La sous-spécification peut être, et est généralement, appréhendée à l’heure actuelle comme relevant d’une classe d’emplois de certains noms. On peut également aborder la sous-spécification, non plus comme fondant un type d’emploi, mais comme une propriété sémantique intrinsèque de certains noms ou types de noms et éprouver, d’une part, que cette sous-spécification est présente quels que soient les emplois du nom qui la manifeste, et d’autre part, qu’elle a partie liée avec d’autres propriétés sémantiques comme la généralité, l’abstraction et la (...) non-autonomie référentielle notamment. Cet article vise à traiter la sous-spécification dans cette dernière perspective avec pour illustration le comportement du nom général élément. (shrink)

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

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

The Non-Identity Problem is the problem of explaining the apparent wrongness of a decision that does not harm people, especially since some of the people affected by the decision would not exist at all were it not for the decision. One approach to this problem, in the context of reproductive decisions, is to focus on wronging, rather than harming, one's offspring. But a Non-Person Problem emerges for any view that claims (1) that only persons can be wronged and (2) that (...) the person-making properties allow for there to be human non-persons. Consider an individual human organism that is prevented from ever possessing the person-making properties. On person-only accounts of the victims of wronging, this organism cannot be wronged by anyone. Hence even individuals whose decisions prevent it from ever possessing the person-making properties cannot wrong it. But this is counter-intuitive. We can think of examples where a human organism is wronged by precisely those decisions that prevent it from possessing the person-making properties. The best solution to this problem, in the case where the person-making property is rational self-governance in pursuit of a meaningful life, is to adjust the concept of a person so that it refers, not merely to those with the immediate capacity for rational self-governance in pursuit of a meaningful life, but also to those with a higher-order capacity for such self-governance. Any solution to the Non-Identity Problem that focuses on wronging rather than harming should incorporate this sort of solution to the Non-Person Problem. (shrink)

The Kurdish-led autonomous entity called Autonomous Administration of North and East Syria - also known as Rojava - considers women?s liberation an imperative condition for shaping a democratic society. The practice of autonomy in NES shares strong resemblances with Non- Territorial Autonomy models; however, it introduces a novelty in the role of women as active agents in building a plurinational democracy. This paper examines the intellectual and political origins of the political role ascribed to women in autonomous administrations (...) and how the practice of autonomy in Rojava has advanced women?s rights by shedding light on both institutional implementation of women?s rights, as well as the creation of -territorial spaces of women?s emancipation within the autonomous model. The argument made is that the conceptual framework of the Rojava model goes beyond the Kurdish question and can be considered an attempt to resolve a democratic deficit of liberal democratic nation-states through bringing together solutions that address the intertwined subordination of minorities and women. nema. (shrink)

The notion of a non-renounceable right is an integral part of recent liberal reconciliatory attempts to justify apparently paternalistic policies, such as compulsory insurance or providing people with certain goods irrespective of their subjective preferences, non-paternalistically. However, non-renounceable rights cannot be justified non-paternalistically. A critical scrutiny of the liberal reconciliatory arguments in question reveals this and points towards a plausible paternalist justification of the policies in question.

It was something of a dogma for much of the twentieth century that one cannot validly derive an ought from an is. More generally, it was held that non-normative propositions do not entail normative propositions. Call this thesis about the relation between the natural and the normative Natural-Normative Autonomy. The denial of Autonomy involves the entanglement of the natural with the normative. Naturalism entails entanglement—in fact it entails the most extreme form of entanglement—but entanglement does not entail naturalism. (...) In a ground-breaking paper “The autonomy of ethics” Arthur Prior constructed some intriguing counterexamples to Autonomy. While his counterexamples have convinced few, there is little agreement on what is wrong with them. I present a new analysis of Autonomy, one which is grounded in a general and independently plausible account of subject matters. While Prior’s arguments do establish shallow natural-normative entanglement, this is a consequence of simple logical relationships that hold between just about any two subject matters. It has nothing special to do with the logical structure of normativity or its relation to the natural. Prior’s arguments leave the fundamental idea behind natural-normative Autonomy intact. I offer a new argument for deep entanglement. I show that in any framework adequate for dealing with the natural and the normative spheres, a purely natural proposition entails a purely normative proposition, and vice-versa. But this is no threat to non-naturalist moral realism. In fact it helps ameliorate the excesses of an extreme non-naturalism, delivering a more palatable and plausible position. (shrink)

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon (...) demonstration of competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to acquire knowledge, use instrumental rationality, and form and revise a life plan. (shrink)

The work of Herbert Marcuse, unlike that of certain of his colleagues at the Institut für Sozialforschung, is most often maligned as being excessively positive and identitarian. His work on Freud, for example, is criticized for being grounded in a crude biological determinism which points towards an ultimate reconciliation of both psychic and social conflict. This essay will attempt to counter such readings by critically juxtaposing Marcuse’s concept of non-repressive sublimation with Cornelius Castoriadis’s understanding of psychic socialization. It will be (...) suggested that the affinities between Marcuse and Castoriadis’s appropriations of Freudian metapsychology reveals the degree to which the former can be read as a radical democratic thinker affirming the values of autonomy and creativity. This reading demonstrates that Marcuse has much to contribute to contemporary debates on the role of the aesthetic and the sensuous in democratic theory. (shrink)

Accounts of autonomy which acknowledge the importance of non-domination – that is, of being structurally protected against arbitrary interference with one's life – face an apparent problem with regards to intimate relationships. By their very nature, such relations open us up to psychological and material suffering that would not be possible absent the particular relationship; even worse, from the non-domination point of view, is that this vulnerability seems to be structural in a way exactly analogous to workplace or social (...) domination. If being powerless to prevent an employer causing me harm constitutes domination at work, then what relevant differences can support the intuition that being powerless to prevent my partner causing me comparable pain is not autonomy-hostile? I argue for the reassuring view that the obligations and possibility of pain arising from such relations aren't necessarily dominating; they would be so only if we believed that any obligation we have not explicitly agreed to is a restriction on our autonomy, and that is false. I conclude with a note of caution: even though intimate relations aren't necessarily dominating, they will often be contingently so if they take place in a wider social context of domination – such as that which we currently inhabit. (shrink)

This essays provides a critical overview of the the significance of sexual activity and the important role consent as a necessary condition for its permissibility.

Recently, the Israel National Bioethics Council (INBC) issued recommendations permitting egg freezing to prevent both disease- and age-related fertility decline. The INBC report forms the basis of Israel's new policy, being one of the first countries to regulate and authorise egg freezing for what it considers to be non-medical (ie, social) uses. The ethical discussion in the INBC report is reviewed and compared with the scant ethical discourse in the academic literature on egg freezing as a means of preventing age-related (...) loss of fertility. We argue that both the INBC recommendations and the bioethical academic discourse on egg freezing are grounded in liberal ideology, which views technology as primarily enabling. Accordingly, they promote ‘individual autonomy’ as exercised through informed consent. Our study suggests that a relational approach to autonomy may be a more suitable model for considering women's choices about egg freezing. (shrink)

The reasons for judgment by the Supreme Court of Canada on the appeal in Mabior (2012 SCC 47) fail to address or resolve a number of significant questions. The reasons acknowledge the fundamental role of sexual consent in protecting sexual autonomy, equality, and human dignity, but do not use the law of consent as a tool to assist the Court in crafting a fresh approach to the issue on appeal. Instead the Court adopts the same general approach to analysis (...) of the elements of aggravated sexual assault committed by fraud it used in 1998 in Cuerrier. Fifteen years later, it should be possible to re-conceptualize the problem in a more straightforward manner that reflects Charter values, fundamental common law principles, recent developments in sexual assault law, and the limitations and uncertainties of current HIV treatment and diagnosis. -/- Ironically, the two pronged legal test ultimately proposed by the Court -- non-disclosure of HIV-positive status and a “realistic possibility of transmission,” is likely to give false confidence to individuals who adhere to a regime of anti-retroviral treatment, use good quality latex condoms, and routinely conceal their HIV-positive status from their sexual partners. Research shows that HIV viral loads fluctuate widely in response to a myriad of factors. An inevitable consequence of reliance on the Mabior test will be accused who are shocked to find themselves charged under s. 273, charges that would not apply had they disclosed their HIV-positive status to their sexual partner(s). There are further practical consequences. Non-disclosure will tend to increase the risk of transmission because non-HIV-positive sexual partner(s) will not fully appreciate the actual hazards of improper condom use. As a direct result, careless sexual practices will be more common. And finally, the decision will not contribute to reducing the social stigma that haunts the lives of those who are HIV-positive -- even those who are skilled at deceit. That stigma will not be reduced or eliminated by a ruling that can be seen as tacitly validating stigmatization and fear by appearing to permit infected individuals to pretend they are not HIV-positive when they know or suspect this to be false. Deceit harms the human dignity of the deceived and deceiver alike, and does nothing to build authentic social trust and cohesion. For all these reasons, the problem on appeal in Mabior requires a different approach. This article proposes one. (shrink)

L’anthropologie philosophique est l’un des fronts sur lesquels s’est développée, ces dernières années, la critique du libéralisme politique : à la figure d’un sujet rationnel et souverain, déjà autonome, certains courants de la théorie politique ont tenté d’opposer une conception alternative du sujet et c’est dans ce contexte qu’a émergé la thématique de la vulnérabilité dont le développement est apparu comme le fondement éventuel d’un dépassement de la problématique libérale. On ne s’étonnera pas de voir la référence à la vulnérabilité (...) figurer en bonne place dans la réflexion néorépublicaine et en particulier dans la théorie de liberté comme non-domination élaborée par Philip Pettit. Comment les néorépublicains définissent-ils la vulnérabilité et quel statut lui accordent-ils ? Quel rôle la vulnérabilité joue-t-elle dans la définition d’une perspective républicaine originale et dans l’élaboration d’une conception non libérale de l’autonomie ? Que nous apprend-elle enfin sur les limites éventuelles du projet néorépublicain ? C’est à ces questions que tentent de répondre les deux articles rassemblés ici. Ces deux textes correspondent aux deux volets d’une étude sur le statut de la catégorie de la vulnérabilité dans la théorie néorépublicaine. Le premier article (« Vulnérabilité, non-domination et autonomie : l’apport du républicanisme ») correspond au volet proprement analytique de notre étude : il propose un état des lieux du statut de la vulnérabilité dans le cadre des théories néorépublicaines, de Pettit à Iseult Honohan, en passant par John Maynor... L’examen de l’articulation entre vulnérabilité et non-domination met en lumière les ressources du néorépublicanisme et son potentiel d’élargissement (via l’intégration des problématiques socialistes, multiculturalistes, écologistes et féministes). Le second article (« Vulnérabilité, non-domination et autonomie : vers une critique du néorépublicanisme ») part de la manière dont les néorépublicains ont souligné la convergence entre l’autonomie telle qu’elle est pensée à l’aune de la non-domination et les approches relationnelles de l’autonomie. Il s’agit pour nous d’interroger ce rapprochement et par là de dégager certaines limites de l’approche néorépublicaine de la vulnérabilité en la confrontant de façon systématique à d’autres conceptions mises en avant dans la théorie des capabilités, dans les théories de la reconnaissance et dans les éthiques du care. (shrink)

How to interpret autonomy plays a crucial role that leads to different readings in Kant’s moral metaphysics, philosophy of religion and moral psychology. In this paper I argue for a two-layered conception of autonomy with varying degrees of justification for each: autonomy as a capacity and autonomy as a paragon-like paradigm. I argue that all healthy rational humans possess the inalienable capacity of autonomy, i. e. share the universal ground for the communicability of objective basic (...) moral principles. This initial understanding stands for autonomy as a capacity about which we can talk of universal validity and justification. Nevertheless, the way a person fully actualizes herself, her freedom, namely autonomy, is shaped by her initial conception of autonomy and moral view of the world. Autonomy as an organic experience of real moral agents, which means an ongoing, non-static, irreducible and inexplicable judgmental process concerning one’s actualization of oneself gives way to consider autonomy as a godlike state of the soul even though one cannot provide objective validity for this. (shrink)

Children’s age and developmental capacity leave them incapable of making medical decisions for themselves. Decisions for children are traditionally made under the best interest standard. Ross calls into question whether the best interest standard can function as both a guidance and intervention principle, able to be applied across the spectrum of pediatric decision making. Ross describes constrained parental autonomy as an alternative model, arguing that it affords parents the ability to make decisions within the context of their family while (...) upholding a child’s current and future interests. Although the model provides a robust framework for intrafamilial decision making, I question whether it can be broadly applied to children living in non-intimate families. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 143-165, June 2022.

The introduction of non-invasive prenatal testing in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: to prevent increased uptake of NIPT and to promote informed choice. First, given the aim of prenatal screening, high or low uptake rates are not intrinsically desirable (...) or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women’s choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external influences on women’s personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair. (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)

The mathematical developments of the 19th century seemed to undermine Kant’s philosophy. Non-Euclidean geometries challenged Kant’s view that there is a spatial intuition rich enough to yield the truth of Euclidean geometry. Similarly, advancements in algebra challenged the view that temporal intuition provides a foundation for both it and arithmetic. Mathematics seemed increasingly detached from experience as well as its form; moreover, with advances in symbolic logic, mathematical inference also seemed independent of intuition. This paper considers various philosophical responses to (...) these changes, focusing on the idea of modifying Kant’s conception of intuition in order to accommodate the increasing abstractness of mathematics. It is argued that far from clinging to an outdated paradigm, programs based on new conceptions of intuition should be seen as motivated by important philosophical desiderata, such as the truth, apriority, distinctiveness and autonomy of mathematics. (shrink)

It has been often claimed that physicalism challenges the explanatory autonomy of psychological sciences. Most who advocate for such explanatory autonomy and do not want to renounce to physicalism, presuppose a causalist account of explanatoriness and try to demonstrate that, adequately construed, (causal) psychological explanations are compatible with (some sufficient version of) physicalism. In Sect. 1 we summarize the different theses and assumptions involved in the seeming conflict between explanatory autonomy and physicalism. In Sect. 2 we review (...) the main attempts to make them compatible assuming a causalist account of explanation and argue that none succeeds. In Sect. 3 we introduce a recent, non-causalist account of scientific explanation as ampliative, specialized embedding (ASE) that has been successfully applied to other fields. In Sect. 4 we apply ASE to elucidate two paradigmatic cognitive explanations of psychological phenomena: déjà vu and action production. We conclude that ASE elucidates well the autonomy of the cognitive explanations of these phenomena independently of what finally happens with the causal exclusion problem and that it may be generalized to other psychological explanations. (shrink)

ZusammenfassungOnora O’Neill hat 1984 den Zusammenhang zwischen grundsätzlichen Bedenken gegenüber dem ethischen Autonomiebegriff und der Kritik an der paternalistisch geprägten medizinethischen Praxis hergestellt, nicht die tatsächliche Einwilligung des konkreten Patienten zu berücksichtigen, sondern die angenommene, hypothetische Einwilligung, die ein idealisierter, völlig rationaler Patient geben würde. Im Anschluss an experimentalpsychologische Studien zur subliminalen Wahrnehmung, zu Volition und Handlungskontrolle erfahren kompatibilistische Theorien menschlicher Freiheit innerhalb der theoretischen Philosophie neue Popularität. Eine Handlung ist demnach frei, wenn sie das Resultat bestimmter Fähigkeiten einer Person (...) ist. Der Artikel setzt sich mit zwei dieser Theorien, Henrik Walters Konzept „natürlicher Freiheit“ und Michael Pauens „Minimalkonzeption personaler Freiheit“ näher auseinander—und zwar vorderhand im Hinblick auf den Entwurf eines nichtidealisierten ethischen Autonomiekonzeptes. Als solches ist es an der aktualen bzw. faktischen Fähigkeit einer Person ausgerichtet, rekurrierend auf die spezifische Determiniertheit autonomer Entscheidungen und Handlungen sowie auf ein relativiertes Konzept menschlicher Vernunft. (shrink)

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy (...) as a phenomenon, and a moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it. (shrink)

From an ethical point of view, there is an important distinction between two types of prenatal screening. The first of these targets maternal or foetal conditions (e.g., infectious diseases, blood group sensitization) where early detection allows for interventions that improve the chances of a healthy pregnancy outcome. The second screens for foetal conditions such as Down syndrome, where a timely diagnosis in most cases only allows for a choice between preparation for a child with special needs or termination of the (...) pregnancy. Whereas the former makes an easy fit with the prevention aim of most other population screening programmes, the latter does not. In order to steer clear from a possible eugenic reading of its aim, a wide international consensus has emerged for the view that prenatal screening of this type should have the atypical aim of helping women (couples) to make autonomous reproductive choices, rather than reducing the birth prevalence of the relevant disorders. However, keeping these types of prenatal screening apart may become increasingly difficult given the development of tests, such as the Non‐Invasive Prenatal Test, which cannot only be used for both types of screening but may also lead to interconnected findings on both sides of the divide. This makes it an urgent question: What the aim or aims of this new hybrid screening should be? As neither ‘prevention’ nor ‘autonomy’ will do, we argue for a normative framework that gives both aims their due, while recognizing the tensions between them. (shrink)

Traditionally, philosophers have focused on whether and how emotions threaten autonomy, insofar as they lie outside the sphere of rational agency. That is, they have conceptualized emotional vulnerability as passivity. Second, they have considered how emotions are insensitive to rational judgment, focusing on cases in which emotions are dissonant or recalcitrant. Third, in recognizing the motivational force of emotions, philosophers have tracked their negative impact on rational deliberation. Indeed, emotions are often contrastive elements in rational deliberation. They appear to (...) defeat deliberative judgments about what to do, survive rational deliberation or preempt the very possibility of rational deliberation. But there are more interesting cases in which it is apparent that emotions bear a rather complicated relation to autonomy. Love and shame provide powerful examples of the ambivalences and complexities of such a relation. In analyzing such complexities, my aim is to present a case for appreciating various dimensions of vulnerability and, correspondingly, for exposing the importance of emotional vulnerability for agential autonomy. This view is rooted in a general account of agential autonomy marked by mutual respect and recognition of others, as a normative response to constitutive vulnerability, understood as the capacity to affect and be affected by others as well as by external agentive and non-agentive causes. (shrink)

Higher education institutions are increasingly relying on learning analytics to collect voluminous amounts of data ostensibly to inform student learning interventions. The use of learning analytics, however, can result in a tension between the Council for the Advancement of Standards in Higher Education (CAS) principles of autonomy and non-malfeasance on the one hand, and the principle of beneficence on the other. Given the complications around student privacy, informed consent, and data justice in addition to the potential to do harm, (...) many current practices around learning analytics within higher education can be considered to be in violation of CAS standards. This paper aims to explore this tension in greater detail and argues that the student voice offers a promising way to ensure that students’ autonomy is respected, harm is reduced, and that higher education institutions can still fulfil the principle of beneficence. (shrink)

Individuals’ food choices are intimately connected to their self-images and world views. Some dietary choices adopted by consumers pose restrictions on their use of genetically modified food (GMF). It is quite generally agreed that some kind of labeling is necessary for respecting consumers’ autonomy of choice regarding GMF. In this paper, we ask whether the current practice of mandatory labeling of GMF products in the European Union is a sufficient administrative procedure for respecting consumers’ autonomy. Three issues concerning (...) this question are discussed. First, we argue that labeling needs to be accompanied by relevant and understandable information on genetic modification, genetically modified food, and the European practice of GMF labeling. Second, we claim that this type of informing makes it less likely that consumers start to avoid GMF products just because labels make them suspicious of the products. It is further noted that even though some consumers may react to labels this way, labels do not restrict their autonomy of choice. Third, a need for more precise labels indicating the source of the transferred gene is considered. It is found out that such labels are not morally necessary when also non-GMF products are available and no relevant differences (such as differences in price and healthiness) exist between them and GMF products. However, in some other cases more precise labels may be needed for respecting consumers’ autonomy of choice. (shrink)

Beauchamp and Childress’ definition of autonomous decision‐making includes the conditions of intentionality, understanding, and non‐control. In genetics, however, a relational conception of autonomy has been increasingly recognized. This article aims to empirically assess aspects of social influence in genetic testing decision‐making and to connect these with principlist and relational theories of autonomy. We interviewed 18 adult genetic counsellees without capacity issues considering predictive genetic testing for cancer predisposition for themselves and two counselling physicians in Switzerland. We conducted a (...) qualitative analysis, building on a grounded theory study about predictive genetic testing decision‐making. We found that some participants agreed to predictive genetic testing predominantly because relatives wanted them to do it, with some even acting contrary to their own convictions. Others, in contrast, based their decision on purely individualistic reasons but expressed difficulties in explaining their decision to their social environment. Healthcare professionals had a critical influence on decision‐making in many cases without being manipulative, as perceived by counsellees. Still, cases of coercion and social pressure occurred within social relationships. In conclusion, predictive genetic testing decision‐making includes relational and individualistic aspects, and both are compatible with autonomous decision‐making. While the principlist and relational notions of autonomy compete on a theoretical level, they are two sides of the same coin when used as analytical lenses for genetic testing decision‐making. Social acceptance of refusal of testing should be improved to mitigate social pressure. Individuals should be encouraged to decide for themselves how much their social environment influences their decision regarding predictive genetic testing. (shrink)

Natalie Stoljar posits that purely procedural theories of autonomy are unable to explain the ‘feminist intuition’, which is the idea that the internalization of false and oppressive norms are incompatible with autonomy. She claims instead that an account based on ‘normative competence’ – which requires true beliefs and critical reflection – can explain why oppressive norms should be excluded as legitimate decision-making inputs. On my view, however, the normative competence approach is subject to a worrying problem. While Stoljar's (...) view successfully problematizes the internalization of oppression, her view misattributes non-autonomy also to those who perpetrate the oppression. I suggest that this is implausible, arguing instead that we can establish an asymmetry of autonomy between those who oppress others and those who are made target of oppression. (shrink)

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of (...) ‘structural arbitrariness’ in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)

Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis (...) or otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of testing. However, we also claim that the definitive nature of the information received, and the fact that the information can lead to decisions of great significance, makes NIPD an important choice. This choice should only be made by means of a rigorous and appropriately supported decision-making process (assuming that this is what the pregnant woman wants). We conclude that, on balance, consent procedures for NIPD should mirror those for invasive testing, albeit without the need to emphasise procedure-related risk. (shrink)

A popular view among autonomy theorists is that facts about the history of a person's desires, and specifically facts about how they were formed or acquired, matter crucially to her autonomy. I argue that while there is an important relationship between a person's autonomy and the history of her desires, a person's autonomy does not depend on how her desires were formed or acquired. I argue that a desire's autonomy lies not in its origins but (...) in whether its bearer has a history of having engaged with it in the right sort of way. I argue that this view has important advantages, and no obvious disadvantages, over its historical and its non-historical rivals. (shrink)

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

Re-consent in research, the asking for a new consent if there is a change in protocol or to confirm the expectations of participants in case of change, is an under-explored issue. There is little clarity as to what changes should trigger re-consent and what impact a re-consent exercise has on participants and the research project. This article examines applicable policy statements and literature for the prevailing arguments for and against re-consent in relation to longitudinal cohort studies, tissue banks and biobanks. (...) Examples of re-consent exercises are presented, triggers and non-triggers for re-consent discussed and the conflicting attitudes of commentators, participants and researchers highlighted. We acknowledge current practice and argue for a greater emphasis on ‘responsive autonomy,’ that goes beyond a one-time consent and encourages greater communication between the parties involved. A balance is needed between respecting participants' wishes on how they want their data and samples used and enabling effective research to proceed. (shrink)

The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly (...) speaking compel people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

Within now prolific debates surrounding the compatibility of feminism and multiculturalism in liberal societies, the need arises for a normative conception of women’s self-determination that does not violate the self-understandings or values of women of different backgrounds and forms of life. With reference to the recent British debate about forced marriage, this article proposes an innovative approach to this problem in terms of the idea of ‘plural autonomy’. While the capacity for autonomy is plural, in the sense of (...) varying across cultures, autonomy in any world-view involves a capacity to ‘endorse’ one’s decisions in certain crucial spheres of life. Non-endorsement, coercion or force occurs if one risks being alienated from the (cultural) goods and relationships that structure one’s capacity to act in the world. This approach counsels more caution than prominent liberal approaches with respect to negotiating the contested boundary between freedom and force in a diverse society. (shrink)

ABSTRACT In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision‐making competence and 2) the practice of surrogate decision‐making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because (...) of ‘structural arbitrariness’ in the whole process of how we assess decision‐making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision‐ making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision‐making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non‐competent others. (shrink)

Medical paternalism has long been a common medical practice. However, patient autonomy in healthcare has been recently adopted by doctors and patients alike. This study explored whether doctors and patients in a tertiary care hospital in Saudi Arabia preferred autonomy or paternalism in shared decision‐making. A total of 118 participants (51 patients requiring total knee replacement, owing to stages 3–4 of osteoarthritis, and 67 doctors) from the Eastern province, Saudi Arabia. responded to a 17‐question category‐based questionnaire involving four (...) scales of autonomy. Descriptive statistics and chi‐square test results revealed that in this hospital, patients preferred a paternalistic approach toward their medical care along with a full disclosure of the risks related to surgical procedures. We recommend health education regarding the specific autonomy subscales (doctor knows best, patient should decide, right to non‐participation, and obligatory risk information), and the implementation of protocols that protect patients' rights and enhance personal autonomy. (shrink)

Respecting the autonomy of agents grounds various obligations to others such as non-interference, deference to her authority over self-regarding decisions, limitations on paternalism, and so on. According to a broadly liberal moral sensibility, respecting others in this way implies accepting the valuesValue they autonomously hold even if they are judged problematic, immoral, self-destructive, or otherwise non-ideal. In discussions of such respect, it is generally assumed that persons expressing that respect have no direct bearing on whether the subject of that (...) respect is herself autonomous. However, in many situations, persons interact in a way that helps establish or re-establish the autonomy of one or both of these agents themselves.For example, the would-be paternalist may be a therapist whose professional obligationObligations is to facilitate the process of re-establishing autonomy for vulnerable victims of traumaTrauma. In such scenarios, the usual lines between hardPaternalismhard and softPaternalismsoft paternalism, as well as the standard liberal rejection of the former, do not apply. Still, it would be wrong for the aid workerAid workers to simply impose her views of a decent life on the struggling person. How, then, do we reformulate restrictions on paternalism and other such normative strictures grounded in respect forAutonomyrespect for autonomy in scenarios where the relationshipRelationships between client and aid workerAid workers is itself a crucial part of the process that results in the self-governingSelf-governing agency of the client?This paper explores these issues and argues that such scenarios indicate that conceptions of autonomy must view the self as diachronic as well as socially constituted but also must be sensitive to the ways that autonomy can sometimes be established only with others’ help. In particular, the obligationObligations to remain relatively neutralNeutral toward the content of others’ values in showing respect forPersonsrespect for their autonomy must be reformulated to take into account the way interpersonal dynamics themselves help establish the autonomy with which persons hold the values that they hold. These observations are applied to certain cases of aid and care where such questions are central. (shrink)

The practice of medicine—and especially the patient-doctor relationship—has seen exceptional shifts in ethical standards of care over the past few years, which by and large originate in occidental countries and are then extrapolated worldwide. However, this phenomenon is blind to the fact that an ethical practice of medicine remains hugely dependent on prevailing cultural and societal expectations of the community in which it serves. One model aiming to conceptualise the dichotomous efforts for global standardisation of medical care against differing sociocultural (...) expectations is the individualism-collectivism model, with the ‘West’ being seen as individualistic and the ‘East’ being seen as collectivistic. This has been used by many academics to explain differences in approach towards ethical practice on key concepts such as informed consent and patient autonomy. However, I argue that this characterisation is incomplete and lacks nuance into the complexities surrounding cross-cultural ethics in practice, and I propose an alternative model based on the ethics of clinical care in Hong Kong, China. Core ethical principles need not be culture-bound—indeed, their very existence mandates for them to be universal and non-derogable—but instead cultural alignment occurs in the particular implementation of these principles, insofar as they respect the general spirit of contemporary ethical standards. (shrink)