The capability approach is one of the main contenders in the field of theorizing social justice. Each citizen is entitled to a set of basic capabilities. But which are these? Martha Nussbaum formulated a set of ten central capabilities. Amartya Sen argued they should be selected in a process of public reasoning. Critics object that the Nussbaum-approach is too perfectionist and the Sen-approach is too proceduralist. This paper presents a third alternative: a substantive but non-perfectionist (...) capability theory of justice. It presents a two-level concept of individual agency as connected to social practices. It then argues basic capabilities are those necessary to for the agency necessary to navigate freely and autonomously between different social practices. (shrink)

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

The idea of personalized nutrition is to give tailored dietary advice based on personal health-related data, i.e. phenotoype, genotype, or lifestyle. PN may be seen as part of a general trend towards personalised health care and currently various types of business models are already offering such services in the market. This paper explores ethical issues of PN by examining how PN services within the contextual environment of four future scenarios about health and nutrition in Europe might affect aspects of (...) social justice according to Martha Nussbaum’s capability approach. The scenarios have been created by a mixed group of stakeholders and experts in three consecutive workshops. This resulted in the definition of four future scenarios within a scenario space consisting of two variables: the ‘logic of health care systems’ and ‘conception of health’. Within each scenario, PN is likely to play a more or less important role in improving health by influencing food consumption patterns in society. Nussbaum’s capability approach implies a concept of social justice as a function of a minimum standard of human dignity. This denotes an account for equality in terms of a minimum of entitlements. However, also the ability of achieving individual objectives is essential for social justice. Personalisation advice in health and food consumption patterns, as aimed for by PN, is therefore acceptable provided a minimum of entitlements is guaranteed to all members of a society, and at the same time freedom concerning personal preferences is respected. Potential variation of how different people might benefit from PN should therefore be consistent with the minimum required as defined by the list of capabilities. (shrink)

Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such (...) as the study of modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. In Health Justice, Sridhar Venkatapuram takes up the problem of identifying what claims individuals have in regard to their health in modern societies and the globalized world. Recognizing the social bases of health and longevity, Venkatapuram extends the ‘Capabilities Approach’ of Amartya Sen and Martha Nussbaum into the domain of health and health sciences. In so doing, he formulates an inter-disciplinary argument that draws on the natural and social sciences as well as debates around social justice to argue for every human being’s moral entitlement to a capability to be healthy. An ambitious integration of the health sciences and the Capabilities Approach, Health Justice aims to provide a concrete ethical grounding for the human right to health, while advancing the field of health policy and placing health at the centre of social justice theory. With a foreword by Sir Michael Marmot, chair of the WHO Commission on the Social Determinants of Health. (shrink)

By considering what we identify as a problem inherent in the ‘nature of the firm’—the risk of abuse of authority—we propound the conception of a social contract theory of the firm which is truly Rawlsian in its inspiration. Hence, we link the social contract theory of the firm with the general theory of justice. Through this path, we enter the debate about whether firms can be part of Rawlsian theory of justice showing that corporate governance principles enter the (...) “basic structure.” Finally, we concur with Sen’s aim to broaden the realm of social justice beyond what he calls the ‘transcendental institutional perfectionism’ of Rawls’ theory. We maintain the contractarian approach to justice but introduce Sen’s capability concept as an element of the constitutional and post-constitutional contract model of institutions with special reference to corporate governance. Accordingly, rights over primary goods and capabilities are granted by the basic institutions of society, but many capabilities have to be turned into the functionings of many stakeholders through the operation of firms understood as post-constitutional institutional domains. The constitutional contract on the distribution of primary goods and capabilities should then shape the principles of corporate governance so that at post-constitutional level anyone may achieve her/his functionings in the corporate domain by exercising such capabilities. In the absence of such a condition, post-constitutional contracts would distort the process that descends from constitutional rights and capabilities toward social outcomes. (shrink)

Theories of distributive justice are often criticised for either excluding people with disabilities from the domain of justice altogether, or casting them as deficient in personal attributes. I argue that the capabilities approach to justice is largely immune to these flaws. It has the conceptual resources to locate most of the causes of disadvantage in the interaction between a person and her environment and in doing so can characterise the disadvantages of disability in a way that avoids the (...) imputation of natural deficiency. However, I also argue that the capabilities approach cannot accommodate some of the stronger claims advanced by some disability scholars. No plausible capabilities approach can guarantee that social change will always be the just or fair remedy for disadvantage, and there is a small number of severe cases of disability where capability shortfalls will be attributed to the person’s ‘deficient’ physical and mental impairments. (shrink)

Disparities in socioeconomic status correlate closely with health, so that the lower a person's social position, the worse his health, an effect that the epidemiologist Michael Marmot has labeled the status syndrome. Marmot has argued that differences in autonomy, understood in terms of control, underlie the status syndrome. He has, therefore, recommended that the American medical profession champion policies that improve patient autonomy. In this paper, I clarify the kind of control Marmot sees as connecting differences in socioeconomic status (...) to health disparities. I then discuss his use of Amartya Sen's capabilities approach to justice, arguing that he is unsuccessful in relating autonomy as a descriptive property with a normative framework that can adequately explain why and to what extent we should reduce health disparities. (shrink)

Marxism as a normative position is critical of liberalism. However, the problems of justice and alienation that Marxism draws attention to can be solved by liberalism without the implementation of a Marxist political project. The purpose of the article is to substantiate the thesis that Martha Nussbaum's capabilities approach (one of the versions of political liberalism) is a more inclusive and rational method of theorizing about the basic principles of justice than Marxism. By analyzing Elizabeth Anderson's theory of liberal (...) egalitarianism "democratic equality", I show that some of Marxist approaches that (1) do not deny the existence of justice and (2) are concerned with the problem of alienation, can apply the arsenal of the moral theory of political liberalism to solve these problems. I also criticize Rawls's and Nussbaum's theories of political liberalism for their procedural vagueness and non-inclusive theory of justice. I present an outline of my position, which I propose to call «extended political liberalism» (hereafter EPL). EPL is currently represented by two arguments: 1) the paideia argument and 2) the argument of the interdependence of the good and the right. The first allows talking about the actual implementation of basic rights and freedoms only when citizens are aware of them and have the opportunity to change their views regarding the personal conception of the good. This is impossible without qualitative basic education. Also, one of the central concepts of EPL is presented within the framework of Paideia's argument - the interpretation of the political conception of justice. Because of this concept, it makes sense to talk about the possibility of citizens' reflection on the reconciliation of the current political conception with the personal conception of the good. This can also be done through the analysis of other conceptions of the good. The second argument is a continuation of the first, appearing as a theoretical mechanism that allows supplementing the existing political conception in case of serious social changes. In conclusion, if we take into account the advantages of the capabilities approach and my criticism of its weaknesses, then a theoretical position will emerge that is quite acceptable to some representatives of Marxism. Moreover, the latter will not have to give up their basic beliefs. The peculiarity of my concept presented in this text is that it is not so much a critique of Marxism as an analysis of the basic normative judgments of political liberalism, with which some Marxists can agree. With this article, I also want to illustrate the strengths of such a concept and point to its prospects for further attempts to interpret the political conception by other normative positions. (shrink)

The capabilities approach of Amartya Sen and Martha Nussbaum has become an influential viewpoint for addressing issues of social justice and human de- velopment. It has not yet, however, given adequate theoretical consideration to the requirements of environmental sustainability. Sen has focussed on the instrumental importance of human development for achieving sustainability, but has failed to consider the limits of this account, especially with respect to consumption-reduction. Nussbaum has criticised constraining material consumption for its paternalistic prescription of one (...) particular conception of the good life, without considering it as an imperative of justice. We discuss two possible extensions of the capabilities approach. First, the concept of ca- pability ceilings contains several attractive elements, but it also suffers from some shortcomings. Therefore, second, we advocate constraining people’s combinations of functionings in accordance with a personal budget which con- sists of a fair share of environmental resources. (shrink)

For almost the past three decades the model of autonomy which has dominated philosophical discussion of this concept has been the "hierarchical" model, which has been independently developed and defended by Harry Frankfurt, Gerald Dworkin and John Christman, and which is primarily concerned with what makes a person autonomous with respect to her first-order desires. It is argued that all versions of the hierarchical model of personal autonomy are based upon a theoretical mistake, and so should be rejected. This (...) mistake is to focus upon the person's attitude towards the desire in question. Such attitude-based approaches will be mistaken because it is always possible to raise the question as to whether the person is autonomous with respect to this attitude itself. With this rejection of the hierarchical analyses of autonomy in hand it is argued that a person is autonomous with respect to her first-order desires to the extent that she has critically reflected upon the beliefs which lead her to have them. This belief-based approach to autonomy enjoys several advantages over its attitudebased rivals. It avoids all of the problems that are faced by the attitude-based models offered by Frankfurt et al., and it is also able to recognize a richer taxonomy of desire than they are. Moreover, this account of autonomy is not committed to either a Humean or an anti-Humean model of motivation. ;With the defense of the belief-based model of autonomy in hand, it is then applied to three distinct debates within applied ethics; social ethics , business ethics , and medical ethics' focus on the Principle of Respect for Autonomy. This part of the dissertation concludes by observing that in all three of these particular debates it is not autonomy that is of primary concern, but well-being, subjectively understood. (shrink)

What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a (...) valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it. (shrink)

I argue against the strategy recently proposed by Ben Colburn for reconciling two apparently conflicting theses, the “Autonomy Claim” and “Anti-Perfectionism.” The strategy turns on demonstrating that the conception of Anti-Perfectionism that captures the intuitions of most anti-perfectionists is not opposed to state promotion of what Colburn calls “second-order values,” and that autonomy is just such a value. I object that Anti-Perfectionism should be understood as opposed to some second-order values, and that autonomy is just such (...) a value. (shrink)

The capability approach aims to ensure all individuals are able to form and pursue their own conception of the good, whilst the state remains neutral between them, and has done much to include oppressed and marginalised groups. Liberal neutrality and social inclusivity are worthy goals, yet I argue that Martha Nussbaum’s influential formulation of the capability approach, at least, cannot meet them. Conceptualising capabilities as opportunities to perform specific, valuable functionings fails to accommodate those who (...) do not value, or cannot perform, these functionings. I therefore propose that the capability approach be modified, such that capabilities are conceptualised, instead, as opportunities to exercise control in certain central domains of our life. (shrink)

I argue that capabilities approaches are useful in formulating a political theory that takes seriously the needs of persons with severe cognitive disabilities (PSCD). I establish three adequacy criteria for theories of justice that take seriously the needs of PSCD: A) understanding PSCD as oppressed, B) positing a single standard of what is owed to PSCD abled individuals, and C) concern with flourishing as well as political liberty. I claim that conceiving valued capabilities as the end of social distribution (...) may help a political theory to meet these criteria.I posit three further adequacy criteria: D) refusing to see PSCD as less than human, E) valuing moral powers other than practical reason, and F) securing space for care and dependency relationships. I show that how well Elizabeth Anderson and Martha Nussbaum’s capabilities approaches meet these criteria depends on their divergent conceptions of what capabilities are for. I sketch another capabilities approach that might better meet the three latter criteria (inspired by Lawrence Becker and Eva Kittay’s work), that conceives capabilities as for agency and relationship. (shrink)

This article addresses two questions: How should a ‘practical political theory’ approach the ideological struggle between advocates of critical social justice and defenders of free speech? And, what does this conflict tell us about the deficits of one particular tradition of practical political theory — namely, agonistic democracy? The paper’s purpose, then, is to illuminate a concrete contemporary phenomenon through the lens of agonistic theory and, conversely, to use this struggle as an impetus to carve out and address (...) weaknesses in the theory of agonism.I defend an ‘agonistic approach’ to the struggle against two alternatives — first, the claim that there is, conceptually, no ‘real’ conflict between social justice and free speech, and second, the strategy to ‘take sides’ in the conflict. By taking seriously the agonistic core idea that struggle and conflict can be valuable and productive expressions of plurality and inclusivity, I argue that this struggle should be approached as an agonistic conflict — as the welcome and important expression of a diversity of views on central social, moral and political questions.I also show, however, how retaining the focus on the real-life struggle between advocates of critical social justice and free-speech sheds light on the inconsistencies of much agonistic thought. In particular, I will criticize those agonists who limit their conception of the ‘agon’ to respectful struggles, and those who see the agon merely as a tool of emancipation for oppressed groups. Against these visions of agonism, I develop an anti-perfectionist, yet radical, account of agonism with the potential to serve as a guide in complex social and political conflicts. (shrink)

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

The article argues for an alliance of the capability approach developed by Amartya Sen with ideas from critical pedagogy for undergraduate university education which develops student agency and well being on the one hand, and social change towards greater justice on the other. The purposes of a university education in this article are taken to include both intrinsic and instrumental purposes and to therefore include personal development, economic opportunities and becoming educated citizens. Core ideas from the (...) capability approach are outlined, with examples, before possible articulations of capability and Sen's notion of process freedom with critical pedagogy are investigated. It is argued that each approach has something to offer when brought alongside as ‘critical capability pedagogies’, which seek to enhance and expand student experiences of learning and their ‘valuable beings and doings’. Finally core capabilities in a university education are considered and some of the problems of domesticating the capability approach addressed. (shrink)

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

The main goal of critical social justice is to ensure the agency of citizens, which enables them to take part, not only in public discussions about how resources are distributed, but also about matters such as what should be produced, how to do it and through what kind of production, among others. Critical social justice can be best formulated within the foundation programme of discursive ethics, in particular within Apel's version specified in his principle of co-responsibility. This principle (...) establishes a telos that operates as a normative guide to formulate the constructive question about which the necessary conditions are for someone to be able to become a subject of dialogue. Answering this question leads, on the one hand, to the development of some constitutive elements of critical social justice and, on the other hand, to the identification of the social relations and structures that undermine the possibilities of a person to effectively participate in the discussion of the topics they consider relevant. As its constitutive elements, I propose reciprocal recognition autonomy, the metric of capabilities and a sufficientarian principle of justice, which work together with the well-known difference principle. These elements constitute a normative net that allows contemporary societies to be criticized from the perspective of justice. (shrink)

De Proost & Grey criticize Nickel et al.’s article “Justice and empowerment through digital health: ethical challenges and opportunities,” arguing that it should have embraced relational autonomy and capability approaches. We distinguish two variants of this critique, one saying that a view of digital health empowerment should welcome these approaches, and one saying that a view of digital health empowerment should essentially be defined in terms of these approaches. We are somewhat open to the first variant: relational autonomy and (...) the capability approach are promising ways of spelling out the ethical values behind digital health empowerment, even if they are not completely unproblematic and uncontroversial. However, there are reasons to reject the second variant. A view that leaves the exact normative commitments of digital health empowerment open is persuasive to a wider audience, and more amenable to different constructs of autonomy, capability, and empowerment across disciplines. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Egalitarian Liberalism Revisited: On the Meaning and Justification of Social Justice by Per SundmanBharat RanganathanEgalitarian Liberalism Revisited: On the Meaning and Justification of Social Justice Per Sundman uppsala, sweden: uppsala universitet, 2016. 242 pp. $72.50Across a range of contemporary disciplines, discussions about justice abound. Despite the prevalence of these discussions, however, there is little consensus about what justice is and whether (and, if so, how) appeals (...) to it should be made. Moreover, if the interconnectedness and pluralism that obtain in our rapidly globalizing world are taken seriously, concerns about the content, meaning, and use of justice are amplified. Against this backdrop, Per Sundman aims to explicate and evaluate one particular form of justice: egalitarian liberalism. On his definition, egalitarian liberalism is "best understood as a triune conjunction of equality of opportunity, desert and self-ownership" (10). Over the course of eight substantive chapters, Sundman labors to show how these criteria both reinforce and don't contradict each other, aiming to clarify the meaning of social justice while considering known alternatives.To develop this argument, Sundman covers a truly impressive range of topics in contemporary debates about justice, including consequentialism and deontology, equality of opportunity and equality of resources, capabilities and rights, corrective and distributive policies, the natural and social lotteries, status in moral and political communities, and the politics of recognition and misrecognition. On the whole, covering such a range of topics proves to be a strength. Sundman introduces the reader to a number of important topics and how several important thinkers have treated those topics, and his discussion of these topics and thinkers is evenhanded and insightful. If you're familiar with (and interested in) one or more of these debates, you will be delighted to find a theological ethicist engaging in them. There's also a further reason for delight: Sundman enters and engages in these debates without bringing the all-too-frequent (and oftentimes empty) charge that liberalism is "impoverished"—a point to which I'll return. But depending on your level of familiarity with recent debates in moral and political philosophy, you may be left unsatisfied with some aspects of Sundman's discussion. Specifically, some of these topics and thinkers deserve further attention and scrutiny than Sundman provides, especially important given Sundman's stated desire to navigate alternative understandings. [End Page 189]I do want to draw the reader's attention to the penultimate chapter of Sundman's book, "Save Us from Liberalism." But first I want to make a larger point. I mentioned what I think is an all-too-frequent charge made in theological ethics: namely, that liberalism is impoverished. Sometimes, this charge is entirely warranted. But oftentimes, at least in my experience, it is empty: the person bringing the charge neither distinguishes among the diversity that obtains within liberalism nor charitably reads and represents the thinker with whom they are trying to engage. Given this disciplinary shortcoming, Sundman is to be commended for turning to Christian critiques of liberalism only after he's carefully worked (and guided the reader) through the myriad topics and thinkers that constitute egalitarian liberalism writ large.So what about this chapter in particular? Focusing on Christian communitarians—for example, Stanley Hauerwas and John Milbank—Sundman explores whether authentic Christian ethics contradicts and is superior to egalitarian liberalism. In the first half of the chapter, he examines the different ways in which Christian communitarians understand obedience to God's commands and have criticized the putative liberal obsession with "autonomy." Following an important discussion where he contrasts Christian and liberal understandings of the circumstances of justice, the second half of Sundman's chapter argues briefly but persuasively against Christian exclusivity (e.g., the recently popular Benedict Option) and for Christians to act out of love, for justice, and in the world.There is much to recommend about this book. Both substantively and structurally, it is admirable and instructive.Bharat RanganathanUniversity of Notre DameCopyright © 2018 Society of Christian Ethics... (shrink)

Genes are functional cell segments of DNA within an organism, as well as basic physical units of biological inheritance, which have consequences for human dignity and public interest. Genes and genetic material (DNA strands of nucleotides, genetically altered plants and animals e.g., see Appendix B) are patentable. In the US and around the globe, governments grant genetic patents for new, non-obvious, and useful gene inventions. A wide range of interest groups such as religious leaders, scientists, biotech pharmaceuticals, medical practitioners, health (...) care providers, venture capitalists, medical patients and persons have interests in defining what is subject to patents. Yet, it is at least questionable that genetic inventions, and the ownership of discoveries of gene mutations leading to possible diseases, should be subject to influence by interest groups. Although some genes (cDNA) are currently legally patentable, the question in this examination is whether gene patents should be legally and morally justified. In this work I examine whether gene patents should legally and morally be justified, given the principles of biomedical ethics such as human Beneficence /Autonomy and Justice. I argue that gene patenting is not justifiable, and I consider what can be done to create a system that delivers access to genetic information in the current genetic Intellectual Patent system. This interdisciplinary work is more complex than whether bio-science researchers and corporate entities should hold gene patents, or differentiating the legal question of whether genes are an invention or a discovery in the human genome. Mere responses to these questions would not ultimately solve the genetic justice problem. The justification for genetic appropriation is more complexity, since it is grounded in axiological claims about human dignity and public interest set in an ever changing biomedical/biogenetic technology. To address this complexity, I will draw upon the ideas of “the capability approach” to genetic justice found in the work of Nussbaum and Sen. This work is an interdisciplinary examination of the proper appropriation of natural genetic material and its impact on human dignity. It is argued that genetic material and information should be accessible to all, via heath care, for example. We must look to new ways to achieve genetic justice that promote human flourishing as a public good. (shrink)

John Christman has recently objected to substantive conceptions of autonomy on the grounds that they introduce unwanted perfectionism into political thinking. I defend substantive conceptions of autonomy against Christman’s critique on two fronts. First, I defend substantive conceptions of autonomy against the charge that their utilisation in political theory would result in the inappropriate exclusion from democratic respect of individuals in oppressive relations. Second, I defend substantive conceptions of autonomy from the charge that they fail the ‘endorsement constraint’, i.e. that (...) incorporating a substantive conception of autonomy into the concept of the person at the heart of a political theory would be alienating for citizens. (shrink)

Liberal institutions should respect citizens as autonomous agents. But what does this mandate require and how should it shape the demands of liberal legitimacy? I trace the contemporary disagreement between liberal perfectionist and anti-perfectionist accounts of legitimacy back to this requirement to respect the autonomy of citizens in order to weigh up how well each approach fulfils this mandate. I argue that further reflection over the nature of respect for the value of personal autonomy gives liberals reason (...) to favour moderate forms of perfectionism and be sceptical of criticisms of perfectionism grounded in concerns over respect. (shrink)

In his book Liberalism Without Perfection, Jonathan Quong challenges liberal perfectionists to show whether their favoured doctrine is capable of generating distinctive distributive principles whilst retaining a valid conception of personal responsibility. In this article I develop this challenge into a dilemma and show that liberal perfectionists can escape by illustrating how arguments for the value of personal autonomy may entail a specific and distinct treatment of choice and responsibility. I develop this claim into a sufficientarian approach (...) to the promotion of autonomy as self-authorship. In doing so I show how differing conceptions of both autonomy and the person employed by liberal perfectionists and political liberals entail different distributive outcomes. (shrink)

Amartya Sen has made a major contribution to the theory of social justice, and of gender justice, by arguing that capabilities are the relevant space of comparison when justice-related issues are considered. This article supports Sen's idea, arguing that capabilities supply guidance superior to that of utility and resources (the view's familiar opponents), but also to that of the social contract tradition, and at least some accounts of human rights. But I argue that capabilities can help us to (...) construct a normative conception of social justice, with critical potential for gender issues, only if we specify a definite set of capabilities as the most important ones to protect. Sen's "perspective of freedom" is too vague. Some freedoms limit others; some freedoms are important, some trivial, some good, and some positively bad. Before the approach can offer a valuable normative gender perspective, we must make commitments about substance. (shrink)

This article critically re-examines the application of the principle of patient autonomy within bioethics. In complex societies such as those found in North America and Europe health care professionals are increasingly confronted by patients from diverse ethnic, cultural, and religious backgrounds. This affects the relationship between clinicians and patients to the extent that patients' deliberations upon the proposed courses of treatment can, in various ways and to varying extents, be influenced by their ethnic, cultural, and religious commitments. The principle of (...) patient autonomy is the main normative constraint imposed upon medical treatment. Bioethicists typically appeal to the principle of patient autonomy as a means for generally attempting to resolve conflict between patients and clinicians. In recent years a number of bioethicists have responded to the condition of multiculturalism by arguing that the autonomy principle provides the basis for a common moral discourse capable of regulating the relationship between clinicians and patients in those situations where patients' beliefs and commitments do or may contradict the ethos of biomedicine. This article challenges that claim. I argue that the precise manner in which the autonomy principle is philosophically formulated within such accounts prohibits bioethicists' deployment of autonomy as a core ideal for a common moral discourse within multicultural societies. The formulation of autonomy underlying such accounts cannot be extended to simply assimilate individuals' most fundamental religious and cultural commitments and affiliations per se. I challenge the assumption that respecting prospective patients' fundamental religious and cultural commitments is necessarily always compatible with respecting their autonomy. I argue that the character of some peoples' relationship with their cultural or religious community acts to significantly constrain the possibilities for acting autonomously. The implication is clear. The autonomy principle may be presently invalidly applied in certain circumstances because the conditions for the exercise of autonomy have not been fully or even adequately satisfied. This is a controversial claim. The precise terms of my argument, while addressing the specific application of the autonomy principle within bioethics, will resonate beyond this sphere and raises questions for attempts to establish a common moral discourse upon the ideal of personal autonomy within multicultural societies generally. (shrink)

In The Idea of Justice , Amartya Sen argues for an approach to justice that is comparative and realization-based rather than transcendental and institutional. While Sen’s arguments for such an approach may not be as convincing as he thought, there are additional arguments for it, and one is that it provides a unique and valuable platform on which an account of justice as a virtue of social and political actors (including institutions and social movements) can be (...) built. Hence new dimensions of comparison are opened up: some actors are better disposed and more successful than others at leading social change in the direction of greater justice. The main objective of this article is to use the capability approach to construct such an account. Six dimensions of acting justly are identified: (1) reducing capability shortfalls; (2) expanding capabilities for all; (3) saving the worst-off as a first step towards their full participation in economy and society, (4) which is also to be promoted by a system of entitlements protecting all from social exclusion; while (5) supporting the empowerment of those whose capabilities are to expand; and (6) respecting ethical values and legitimate procedures. I conclude by sketching some underlying moral psychology. (shrink)

Justice for children and during childhood and the particular political, social and moral status of children has long been a neglected issue in ethics, and in social and political philosophy. The application of general, adult-oriented theories of justice to children can be regarded as particularly problematic. Philosophers have only recently begun to explore what it means to consider children as equals, what goods are especially valuable to them, and what are the obligations of justice different agents have toward (...) children. In addition, while philosophers have extensively written about global poverty and inequality, the issue of disadvantages during childhood, especially child poverty, has only been superficially addressed. This also applies to the Capability Approach (CA) as a normative theory. Although the socio-scientific and economic literature on how to conceptualize capabilities and functionings of children and how to measure them in the context of poverty and wellbeing is steadily growing, the normative aspects of these issues are still under-theorized. The CA offers a unique framework to engage with both the topic of justice for children and questions concerning what justice implies and demands with regard to children living and growing up in disadvantaged circumstances. Furthermore, justice and disadvantage during childhood is a compellingly interdisciplinary topic that invites the combination of ethical and philosophical reasoning together with socio-scientific theories and empirical knowledge. In this special issue of Ethical Perspectives we bring together theoretical and empirically informed discussions that explore the CA in relation to children and the many disadvantages they can face in their lives. (shrink)

This paper develops a framework for conceptualising social justice in education, drawing particularly on Martha Nussbaum's (2000) capabilities approach. The practical case for consideration is that of widening participation and pedagogical implications in higher (university) education in England. While the paper supports the value and usefulness of Nussbaum's list of ten capabilities for developing a more radical and challenging language and practice for higher education pedagogies, it also argues that her approach is limited. Other ways of conceptualising (...) social justice are also required in order to develop adjudicating theories which enable us to judge which practices take us closer to social justice. An argument is made for ‘bivalent’ theorising which integrates individual and institutional development and agents and social structures. (shrink)

Artificial Intelligence (AI) is predicted to have a deep impact on the future of work and employment. The paper outlines a normative framework to understand and protect human freedom and justice in this transition. The proposed framework is based on four main ideas: going beyond the idea of a Basic Income to compensate the losers in the transition towards AI-driven work, towards a Responsible Innovation approach, in which the development of AI technologies is governed by an inclusive and deliberate (...) societal judgment; going beyond a philosophical conceptualisation of social justice only focused on the distribution of ‘primary goods’, towards one focused on the different goals, values, and virtues of various social practices (Walzer’s ‘spheres of justice’) and the different individual capabilities of persons (Sen’s ‘capabilities’); going beyond a classical understanding of capital, towards one explicitly including mental capacities as a source of value for AI-driven activities. In an effort to promote an interdisciplinary approach, the paper combines political and economic theories of freedom, justice and capital with recent approaches in applied ethics of technology, and starts applying its normative framework to some concrete example of AI-based systems: healthcare robotics, ‘citizen science’, social media and platform economy. (shrink)

Drawing on Courtney Jung’s structural theory of obligation, this article proposes a novel interpretation of the relationship between liberal democratic justice and identity politics. This interpretation, in turn, justifies an anti-racist curriculum in the context of liberal democratic education. According to Jung’s theory, the liberal state has an obligation to improve the status of oppressed identity groups in society in so far as the state itself has participated in the formation of their identities through historical and continuing structural injustices. (...) Based on this theory, the article argues that anti-racist education should be understood as receiving its justification not from the recognition of particularistic identities as such, but from the state’s obligation to compensate for the structural injustices, which have contributed to the formation of the identities in question, and which are incompatible with liberal democratic justice. Furthermore, the article elaborates on a form of anti-racist curriculum broadly compatible with the liberal democratic aim of fostering political and personal autonomy of students. (shrink)

Whatever ethical stance one takes in the debate regarding the ethics of human enhancement, one or more reference points are required to assess its morality. Some have suggested looking at the bioethical notions of safety, justice, and/or autonomy to find such reference points. Others, arguing that those notions are limited with respect to assessing the morality of human enhancement, have turned to human nature, human authenticity, or human dignity as reference points, thereby introducing some perfectionist assumptions into the debate. In (...) this article, we ask which perfectionist assumptions should be used in this debate. After a critique of views that are problematic, we take a positive approach, suggesting some perfectionist elements that can lend guidance to the practice of human enhancement, based on the work of Martha Nussbaum's Capability Approach. We suggest that the central capabilities can be used to define the human aspect of human enhancement and thereby allow a moral evaluation of enhancement interventions. These central capabilities can be maximized harmoniously to postulate what an ideal human would look like. Ultimately, the aim of this article is twofold. First, it seeks to make explicit the perfectionist assumptions found in the debate and eliminate those that are problematic. Second, the paper clarifies an element that is often neglected in the debate about human enhancement, the view of the ideal human towards which human enhancement should strive. Here, we suggest that some central capabilities that are essential for an ideal human being can be maximized harmoniously and can therefore serve as possible reference points to guide human enhancement. (shrink)

Thomas Pogge answers the question if the capability approach can be justified with a firm ‘no’. Amongst others, he ridicules capability theorists for demanding compensation for each and every possible natural difference between people, including hair types. Not only does Pogge, so this paper argues, misconstrue the difference between the capability approach and Rawlsian resourcism. Even worse: he is actually implicitly relying on the idea of capabilities in his defence of the latter. According to him (...) the resourcist holds that the institutional order should not be biased towards the average person or the needs of some. Yet, as his own case of blind people and traffic lights can illustrate, whether or not this is the case is impossible to assess without resorting to some concept like people’s capabilities. Secondly, it is argued that the real issue at stake is not at all the best metric of justice—primary goods or capabilities—but rather the scope of theories of justice. On the surface the difference of opinion seems to be how to deal with so-called “personal heterogeneities”, yet the discussed case of interpersonal differences in metabolism and communal land-use choices hints at something else; Whereas Pogge insists that questions of justice only concern the institutional structure of society, many capability theorists support the inclusion of culture and social practices as possible sources of injustice. Unfortunately Pogge does not properly acknowledge this, as right from the start of his paper he frames the debate between both approaches in terms of institutions only. (shrink)

Both articles in the November‐December 2021 issue of the Hastings Center Report reflect bioethics’ growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement—an approach that replaces personal autonomy with group benefit as the (...) primary criterion for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance. (shrink)

In this paper, an attempt is made to give patient autonomy added conceptual clarity. A concept of patient autonomy grounded in both negative and positive freedoms is defended. Amartya Sen's capabilities approach is used as a conceptual framework in which patient autonomy and fairness are defined compatibly. It is argued that in a socially fair healthcare system, everyone should have at least the degree of patient autonomy that affords access to those healthcare services necessary for survival and a minimally (...) adequate level of quality of life, consistent with each person's naturally endowed health characteristics. (shrink)

One of the defining features of the capability approach to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal (...) accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability. (shrink)

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to date. I (...) critically review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates. (shrink)

The capability approach described by Amartya Sen illustrates the multiple aspects of injustice in such fields as racially motivated sexual harassment or segregation in urban space. In response to Sen’s pointing out that we should focus not simply on institutions but also on the social realizations they engender, the article illustrates the function of the natural and social environments for racial groups in affecting the distribution of resources necessary to secure justice.

This first part of this article critiques Sridhar Venkatapuram's conception of health as a capability. It argues that Venkatapuram relies on the problematic concept of dignity, implies that those who are unhealthy lack lives worthy of dignity, sets a low bar for health, appeals to metaphysically problematic thresholds, fails to draw clear connections between appealed-to capabilities and health, and downplays the importance/relevance of health functioning. It concludes by questioning whether justice entitlements should pertain to the capability for health (...) versus health achievements, challenging Venkatapuram's claims about the strength of health entitlements, and demonstrating that the capabilities approach is unnecessary to address social determinants of health. (shrink)

This article argues that political liberalism, of the type formulated by John Rawls and Charles Larmore and further developed in Amartya Sen and Martha Nussbaum's capabilities approach, is superior to more comprehensive political views both in domestic and in global affairs. Perfectionist liberalism as advocated by John Stuart Mill and Joseph Raz attempts to erase existing religions and replace them with the religion of utility or autonomy. This is wrong, because in the ethico-religious environment of reasonable disagreement that we (...) inhabit all comprehensive forms of political morality pose a threat to people's liberty and equality. Only thin and narrow conceptions of value like the ones suggested by Rawls, Larmore, Sen, and Nussbaum can guarantee the respect for diversity that is needed in a pluralistic world. Although Rawls famously failed to extend this idea from domestic to transnational matters, the argument of the article is that not only do the principles of political liberalism apply to global mat.. (shrink)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

What is the best standard of interpersonal comparison for a broadly egalitarian theory of social justice?1 A broadly egalitarian theory is one that holds that justice requires that institutions and individual actions should be arranged to improve, to some degree, the quality of life of those who are worse off than others, or very badly off, or both.2 I shall add the specification that to qualify as broadly egalitarian, the theory must in some circumstances require action to aid the (...) worse off or very badly off even when such action would not maximize the aggregate sum of utility, welfare, or well-being. Any such view needs a standard of interpersonal comparison that allows us to distinguish better off from worse off persons. Recently two types of standard have attracted adherents. One is the resource-oriented approach developed by John Rawls and others, and the other is the capability approach associated with the work of Amartya Sen and Martha Nussbaum.3 Rawls has affirmed that the proper measure is an index of primary social goods, flexible, multi-purpose resources such that any rational person wants more rather than fewer of them. (shrink)

Historically, philosophers have had little to say about justice and disability. However, in recent years and in response to disability rights movements, philosophers have started to consider the claims to justice of persons with mental and physical impairments. Importantly, some have charged that without extensive revision, social contract accounts of justice – which enjoy immense popularity among political philosophers – cannot address the needs and interests of persons with disabilities. In this article, I explain why social contract accounts (...) are thought to flounder when it comes to justice for persons with disabilities. Then I assess the merits of recent attempts to construct theories of justice inclusive of persons with disabilities. In particular, I consider Nussbaum’s capabilities approach, Kittay’s justice as caring, and various restatements of the social contract. (shrink)

Over the last decade, humans have produced each year as much data as were produced throughout the entire history of humankind. These data, in quantities that exceed current analytical capabilities, have been described as “the new oil,” an incomparable source of value. This is true for healthcare, as well. Conducting analyses of large, diverse, medical datasets promises the detection of previously unnoticed clinical correlations and new diagnostic or even therapeutic possibilities. However, using Big Data poses several problems, especially in terms (...) of representing the uniqueness of each patient and expressing the differences between individuals, primarily gender and sex differences. The first two sections of the paper provide a definition of “Big Data” and illustrate the uses of Big Data in medicine. Subsequently, the paper explores the struggle to represent exhaustively the uniqueness of the patient through Big Data is highlighted prior to a deeper investigation of the digital representation of gender in personalized medicine. The final part of the paper put forward a series of recommendations for better approaching the complexity of gender in medical and clinical research involving Big Data for the creation or enhancement of personalized medicine services. (shrink)

Książka proponuje interpretację filozofii politycznej jednej z bardziej wpływowych współczesnych amerykańskich autorek – Marthy Craven Nussbaum. Praca skupia się na rozwijanej przez filozofkę wersji koncepcji zdolności (capability approach), która jest rozpatrywana w kontekście po- Rawlsowskiego egalitarnego liberalizmu. Biorąc pod uwagę takie zaplecze, książka ma na celu zbadanie warunków możliwości zrealizowania jego podstawowych założeń normatywnych, a więc wartości: wolności, równości i szacunku dla pluralizmu. Zgodnie z proponowaną interpretacją koncepcja Nussbaum ukazuje podstawy egalitarnego liberalizmu w nowym świetle, w tej mierze, (...) w jakiej zwraca uwagę na konieczność uzupełnienia instytucji o odpowiedni model rozumowania praktycznego. Książka wykazuje estetyczność takiej koncepcji, która przejawia się zarówno na poziomie pojęć (podobieństwa między doświadczeniem estetycznym a rozumowaniem praktycznym), jak i na poziomie przykładów (zastosowania sztuki dla kształcenia postaw obywatelskich). W ten sposób zaprezentowane ujęcie wpisuje się w ramy szeroko pojętej estetyki politycznej. Zagadnienia podejmowane w pracy obejmują między innymi następujące kwestie: dyskusja na temat tzw. waluty sprawiedliwości, liberalizm polityczny, psychologia moralna, emocje polityczne, władza sądzenia, związki między etyką a literaturą oraz kształcenie obywatelskie. Oprócz Marthy Nussbaum szczególne znaczenie dla argumentacji mają tacy autorzy, jak Amartya Sen, John Rawls, Charles Larmore, Immanuel Kant, Hannah Arendt, Crispin Sartwell. (shrink)

A strong distinction is often made between personal autonomy and moral autonomy. Personal autonomy involves governing yourself in the pursuit of your own conception of the good. Moral autonomy involves legislating the moral law for yourself. Viewed in this way personal autonomy seems at best marginal and at worst a positive hindrance to moral autonomy, since personal autonomy can conflict with moral autonomy. Given that Kantian approaches to morality are closely aligned with moral autonomy, does that (...) mean that the Kantian must view personal autonomy as a moral hindrance? Can there be a legitimate role for personal autonomy within Kant’s ethical framework? This paper will seek to argue: that personal and moral autonomy need not be seen as in tension or at odds with one another; that Kant defends an attractive weak substantive theory of personal autonomy; that socialisation plays an important role (both positive and negative) in the development of autonomy competences in Kant’s theory; and that personal autonomy (properly understood) has an essential role to play in Kant’s ethical framework. (shrink)

I argue in this paper that the development and convergence of information and communication technologies (ICT) is creating a global network of surveillance capabilities which affect the traveler. These surveillance capabilities are reminiscent of 18th century philosopher Jeremy Bentham’s panopticon, and as such the emerging global surveillance network has been referred to as the travel panopticon. I argue that the travel panopticon is corrosive of personal autonomy, and in doing so I describe and analyse various philosophical approaches to (...) class='Hi'>personal autonomy. (shrink)

Vulnerability and empowerment are central concepts of contemporary development theory and ethics. Vulnerability associated with human interdependence is a wellspring of values in care ethics, while vulnerability arising from social problems demands remedy, of which empowerment is frequently the just form. Development planners and aid providers focus upon improving the wellbeing of the most vulnerable – especially women – by empowering them economically, socially and politically. -/- Both vulnerability and empowerment are considered in this volume. Jay Drydyk argues that (...) empowerment is necessarily relational, not simply a matter of expanding choices. Christine Koggel reviews Drydyk’s discussion through the lens of feminist relational theory, considering how norms, structures and institutions shape, delimit, and promote empowerment. Gail Presbey examines empowerment in East African women’s lives through the writings and biography of Wangari Maathai. Stacy Kosko considers indigenous self-governance and participation in shared governance. Serene Khader reflects upon postcolonial feminist criticism of the concept of adaptive preference. Vida Panitch discusses the economic vulnerability that surrounds the global market in surrogate birth. Anupam Pandey provides a review of third world eco-feminist activism and literature. Ann Cudd envisions international humanitarian intervention to support female autonomy against oppressive state and social institutions. (shrink)

Readers of Sex and Social Justice will find in its essays fresh insights and powerful arguments on such varied topics as pornography, prostitution, gay rights, the tensions between feminist imperatives and respect for cultural and religious differences, the importance to feminism of considering how desires adjust to socially formed expectations, the relationship between narrative, mercy and justice, Kenneth Dover’s memoirs, and Richard Posner’s economic and evolutionary account of sexual behaviour. In her discussions of these highly charged topics, Nussbaum never (...) gives in to the temptation of uncomprehending moral condemnation, but instead approaches the issues with an enviable command of the facts, a sympathetic understanding, and a will to uncover and reason through the best arguments on all sides. Women and Human Development: The Capabilities Approach is an ambitious work of political philosophy that aims to guide constitutional design and social policy. Its four chapters present the capabilities approach in detail, argue for its universal status, and apply it to issues in religion and the family. (shrink)