Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical (...) aspects of preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductive medicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice — paradoxically — can hamper couples' choice. (shrink)

Choice architecture describes the environment in which choices are presented to decision-makers. In recent years, public and private actors have looked at choice architecture with great interest as they seek to influence human behaviour. These actors are typically called choice architects. Increasingly, however, this role of architecting choice is not performed by a human choice architect, but an algorithm or artificial intelligence, powered by a stream of Big Data and infused with an objective it has (...) been programmed to maximise. We call this entity the autonomous choice architect. In this paper, we present an account of why artificial intelligence can fulfil the role of a choice architect and why this creates problems of transparency, responsibility and accountability for nudges. We argue that choice architects, be them autonomous computational systems or human-beings, at a most basic level select, from a range of designs, the design which is most likely to maximise a pre-determined objective. We then proceed to argue that, given the growing demand for targeted, personalised choice architecture and for faster, dynamic reconfigurations of choice architecture, as well as the ever-expanding pool of data from which feedback can be drawn, the role of the human choice architect is increasingly obscured behind algorithmic, artificially intelligent systems. We provide a discussion of the implications of autonomous choice architects, focusing on the importance of the humans who programme these systems, ultimately arguing that despite technological advances, the responsibility of choice architecture and influence remains firmly one human beings must bear. (shrink)

In “The Ethics of Anonymous Gamete Donation: Is There a Right to Know One's Genetic Origins?,” Inmaculada de Melo‐Martín deconstructs the interests the right is supposed to protect. She argues that these interests are not set back or thwarted when one has no access to one's genetic origins. The basis of her argument is that we lack robust empirical evidence that donor‐conceived individuals suffer certain alleged harms, and that even when such harms are present, they do not provide strong enough (...) justification to ground the right.Indeed, the research on the needs, preferences, and well‐being of donor‐conceived individuals is scant. In fact, we lack robust empirical evidence regarding all aspects of donor conception. I argue, however, that the right to know one's genetic origins does not rest on empirical evidence. Some donor‐conceived individuals who are unable to know their genetic origins may suffer great harms. Others may suffer no harm at all. But all are treated wrongly when they are deprived of the ability to access information about their genetic origins. They are deprived of an important aspect of their autonomy: the liberty to choose what meaning they assign to the genetic components of their identity. (shrink)

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society improve (...) health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

ABSTRACTDiagnostic self‐testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point‐of‐care facilities and at home. Designed to allow earlier detection of diseases, self‐testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society improve (...) health and reduce health costs. However, the full implications of future home‐based diagnostic technology for individuals and society remain unclear due to their novelty.We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home‐based self‐testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation.While the ethical issues are not necessarily new, the development of home‐based self‐testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

In this paper I argue for what I call ‘the inherency thesis’: the thesis that an autonomous choice that succeeds in expressing an agent’s authentic identity is inherently prudentially valuable for the choosing agent. I argue that this is the case because autonomous choice is a vehicle for the expression of authentic identity, the satisfaction of which is intrinsically prudentially valuable. Moreover, I argue that no such inherent relation exists between fulfilled autonomous choice and (...) the exemplification of moral, aesthetic or perfectionist value. These conclusions suggest that accounts of the normativity of personal autonomy should focus on the notion that the demand to respect personal autonomy is grounded on the demand to promote the prudential value – and hence well-being – of others. (shrink)

In this paper I examine some of the significant moral concerns inherent in cases of treatment refusal involving patients with psychotic disorders. In particular, I explore the relevance of the principle of autonomy in such situations. After exploring the concept of autonomy and explaining its current and historical significance in a health care setting, I argue that because autonomous choice depends for its existence upon certain human functions such as the ability to reason, judge, and assess consequences, patients (...) cannot be said to be making free and autonomous decisions if these capacities are compromised. I contend further that because psychotic disorders have the potential to compromise these functions in the future, it is appropriate, in some limited cases, to coerce patients with psychotic disorders to undergo treatment in order to preserve their future decision-making capacities and to protect their ability to recognize and respect the autonomy of others. (shrink)

In this paper I examine some of the significant moral concerns inherent in cases of treatment refusal involving patients with psychotic disorders. In particular, I explore the relevance of the principle of autonomy in such situations. After exploring the concept of autonomy and explaining its current and historical significance in a health care setting, I argue that because autonomous choice depends for its existence upon certain human functions such as the ability to reason, judge, and assess consequences, patients (...) cannot be said to be making free and autonomous decisions if these capacities are compromised. I contend further that because psychotic disorders have the potential to compromise these functions in the future, it is appropriate, in some limited cases, to coerce patients with psychotic disorders to undergo treatment in order to preserve their future decisionmaking capacities and to protect their ability to recognize and respect the autonomy of others. (shrink)

There is robust scientific evidence from meta-analyses in psychotherapy research that common factors such as the alliance between patients and therapists, empathy, goal consensus/collaboration, positive regard/affirmation and genuineness have a much greater effect on the overall psychotherapy outcome than the so-called specific factors like particular treatment methods or ingredients of therapy.1 The current evidence base also suggests that the effects of telepsychiatric treatment are comparable with those of face-to-face treatment, not only regarding clinical outcome parameters but also with respect to (...) patient satisfaction, acceptance and adherence—all common factors of psychotherapy.2 According to a comprehensive review of the main ethical arguments for and against different forms of online psychotherapy, the online setting provides several weighty advantages: for example, increased access, availability, flexibility, convenience, satisfaction, acceptance and increased demand.3 Among the arguments against online psychotherapy, privacy, confidentiality and data security issues, emergency issues, as well as communication issues have been mentioned.3 Frittgen and Haltaufderheide 4 are concerned that telepsychiatry could ‘impact ethically relevant aspects of the therapeutic relationship’. They conclude that ‘there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations’,4 particularly pertaining to ‘respect for autonomy, lucidity, fidelity, justice and humanity towards each other’.4 Indeed, video-based consultations as technically mediated communication ‘do not only transmit but transform what can be perceived, …. (shrink)

In [10] Friedman showed that is a conservative extension of <ε0for-sentences wherei= min, i.e.,i= 2, 3, 4 forn= 0, 1, 2 +m. Feferman [5], [7] and Tait [11], [12] reobtained this result forn= 0, 1 and even with instead of. Feferman and Sieg established in [9] the conservativeness of over <ε0for-sentences for alln. In each paper, different methods of proof have been used. In particular, Feferman and Sieg showed how to apply familiar proof-theoretical techniques by passing through languages with Skolem (...) functionals.In this paper we study the same choice principles in the presence of theBar Rule, which permits one to infer the scheme of transfinite induction on a primitive recursive relation ≺ when it has been proved that ≺ is wellfounded. The main result characterizes + as a conservative extension of a system of the autonomously iterated-comprehension axiom for-sentences. Forn= 0 this has been proved by Feferman in the form that + is a conservative extension of <Γ0; this was first done in [8] by use of the Gödel functional interpretation for the stronger systemZω+μ+ + and then more recently by the simpler methods of [9]. Jäger showed how the latter methods could also be used to obtain the general result of Theorem 1 below. (shrink)

While autonomous vehicles (AVs) are not designed to harm people, harming people is an inevitable by-product of their operation. How are AVs to deal ethically with situations where harming people is inevitable? Rather than focus on the much-discussed question of what choices AVs should make, we can also ask the much less discussed question of who gets to decide what AVs should do in such cases. Here there are two key options: AVs with a personal ethics setting (PES) or (...) an “ethical knob” that end users can control or AVs with a mandatory ethics setting (MES) that end users cannot control. Which option, a PES or an MES, is best and why? This chapter argues, by drawing on the choice architecture literature, in favor of a hybrid view that requires mandated default choice settings while allowing for limited end user control. (shrink)

In this paper, I address the question whether drones, which may soon possess the ability to make autonomous choices, should be allowed to make life-and-death decisions and act on them. To this end, I examine an argument proposed by Rob Sparrow, who dismisses the ethicality of what he calls “killer robots”. If successful, his conclusion would extend to the use of what I call autonomous killer drones, which are special kinds of killer robots. In Sparrow’s reasoning, considerations of (...) responsibility occupy centre stage. Though I reject his argument, I agree both with Sparrow’s conclusion and with his basic contention that the idea of responsibility should play an important role in the investigation of the problem at hand. Therefore, I propose a different argument to show that we should not allow autonomous robots and more specifically autonomous drones to make life-and-death decisions. This argument also invokes the concept of responsibility. But it does so in a way that is different from Sparrow’s use and is congenial to an account of responsibility that I favour. It assumes the simple principle that morally significant choices should only be made by subjects who are capable of responsibility, which can be reconciled both with a deontological and a consequentialist view of morality. Since killer robots, and in particular autonomous killer drones, seem to lack that capability, it follows that they should not be entrusted to make life-and-death decisions and act on them. (shrink)

Autonomous lifelong development and learning are fundamental capabilities of humans, differentiating them from current deep learning systems. However, other branches of artificial intelligence have designed crucial ingredients towards autonomous learning: curiosity and intrinsic motivation, social learning and natural interaction with peers, and embodiment. These mechanisms guide exploration and autonomous choice of goals, and integrating them with deep learning opens stimulating perspectives.

One of the moral questions concerning autonomous vehicles (henceforth AVs) is the choice between types that differ in their built-in algorithms for dealing with rare situations of unavoidable lethal collision. It does not appear to be possible to avoid questions about how these algorithms should be designed. We present the results of our study of moral preferences (N = 2769) with respect to three types of AVs: (1) selfish, which protects the lives of passenger(s) over any number of (...) bystanders; (2) altruistic, which minimizes the number of casualties, even if this leads to death of passenger(s); and (3) conservative, which abstains from interfering in such situations. We differentiate between scenarios in which participants are to make their decisions privately or publicly, and for themselves or for their offspring. We aim to answer two research questions: (1) whether the public visibility of the choice of an AV type choice make this choice more altruistic and (2) which type of situation makes it more difficult to choose altruistically: when choosing for society as a whole, when choosing only for oneself, or when choosing only for one’s offspring. Our results show that respondents exhibit a preference for an altruistic strategy for AVs and that it is reinforced when signaled to others. The altruistic preference is strongest when applies to everybody else, weaker when it reflects a solely personal choice, and weakest when choosing for one’s own child. We conclude that a public choice is considerably more likely to pressure consumers into accepting a more socially beneficial solution. (shrink)

Autonomous vehicles have the potential to save tens of thousands of lives, but legal and social barriers may delay or even deter manufacturers from offering fully automated vehicles and thereby cost lives that otherwise could be saved. Moral philosophers use “thought experiments” to teach us about what ethics might say about the ethical behavior of AVs. If a manufacturer designing an AV decided to make what it believes is an ethical choice to save a large group of lives (...) by steering away from the large group towards a single individual, could the manufacturer be liable to that single individual? I believe the answer is yes. This article discusses famous “trolley problem” thought experiments in moral philosophy, which news articles have recently applied to AVs. After establishing a hypothetical case, applying product liability law to AV behavior may show a way, in some jurisdictions, that will permit a manufacturer to implement an ethical choice without triggering liability, but liability risk remains. I then turn to possible traditional defenses to see if they prevent liability for a manufacturer making what it believes is an ethical design choice—necessity, defense of self, and the sudden emergency doctrine. None of them provides an effective defense. Under current law, maximizing collision avoidance appears to minimize legal risk. I conclude that the only way to provide effective protection to a manufacturer seeking to implement ethical choices about AV behavior is through special legislation or regulation. (shrink)

Gendered socialization has prompted numerous attempts to redefine what counts as an autonomous choice. However, there is strong disagreement among feminist theorists over the criteria to identify cases of autonomy impairment _vis-à-vis_ the embeddedness of individuals in patriarchal cultures. I argue that this focus on choice and autonomy has often neglected the costs of non-compliance to social norms and the trade-offs that women make to flourish within their community. Even if we were to find an effective way (...) to determine whether a self-regarding choice calls for state interference because of its socialized nature, we would still lack a sufficient justification for interfering with women’s choices. To justify political action, my claim is that we should also look at the effects that preference interference would have on women within their societal context. Consequently, I develop a non-ideal feminist account aimed chiefly at analysing the costs of proposed feminist change. I shall focus in particular on women’s engagement with practices of body modification for the sake of conforming to gendered standards of appearance, such as cosmetic surgery and hymen restoration. In both cases, I argue that blanket bans risk backfiring into a form of double-jeopardy for those who are already the most vulnerable to gendered oppression, hence they are not justified. However, this does not imply passively accepting the status quo but urges us to reconsider new ways to offset transition costs, making resistance to social norms a collectively shared endeavour rather than a burden that exclusively befalls the most vulnerable. (shrink)

Gendered socialization has prompted numerous attempts to redefine what counts as an autonomous choice. However, there is strong disagreement among feminist theorists over the criteria to identify cases of autonomy impairment _vis-à-vis_ the embeddedness of individuals in patriarchal cultures. I argue that this focus on choice and autonomy has often neglected the costs of non-compliance to social norms and the trade-offs that women make to flourish within their community. Even if we were to find an effective way (...) to determine whether a self-regarding choice calls for state interference because of its socialized nature, we would still lack a sufficient justification for interfering with women’s choices. To justify political action, my claim is that we should also look at the effects that preference interference would have on women within their societal context. Consequently, I develop a non-ideal feminist account aimed chiefly at analysing the costs of proposed feminist change. I shall focus in particular on women’s engagement with practices of body modification for the sake of conforming to gendered standards of appearance, such as cosmetic surgery and hymen restoration. In both cases, I argue that blanket bans risk backfiring into a form of double-jeopardy for those who are already the most vulnerable to gendered oppression, hence they are not justified. However, this does not imply passively accepting the status quo but urges us to reconsider new ways to offset transition costs, making resistance to social norms a collectively shared endeavour rather than a burden that exclusively befalls the most vulnerable. (shrink)

The recent progress in the development of autonomous cars has seen ethical questions come to the forefront. In particular, life and death decisions regarding the behavior of self-driving cars in trolley dilemma situations are attracting widespread interest in the recent debate. In this essay we want to ask whether we should implement a mandatory ethics setting for the whole of society or, whether every driver should have the choice to select his own personal ethics setting. While the consensus (...) view seems to be that people would not be willing to use an automated car that might sacrifice themselves in a dilemma situation, we will defend the somewhat contra-intuitive claim that this would be nevertheless in their best interest. The reason is, simply put, that a PES regime would most likely result in a prisoner’s dilemma. (shrink)

"A runaway trolley is speeding down a track" So begins what is perhaps the most fecund thought experiment of the past several decades since its invention by Philippa Foot. Since then, moral philosophers have applied the "trolley problem" as a thought experiment to study many different ethical conflicts - and chief among them is the programming of autonomous vehicles. Nowadays, however, very few philosophers accept that the trolley problem is a perfect analogy for driverless cars or that the situations (...) autonomous vehicles face will resemble the forced choice of the unlucky bystander in the original thought experiment. This book represents a substantial and purposeful effort to move the academic discussion beyond the trolley problem to the broader ethical, legal, and social implications that autonomous vehicles present. There are still urgent questions waiting to be addressed, for example: how AVs might interact with human drivers in mixed or "hybrid" traffic environments; how AVs might reshape our urban landscapes; what unique security or privacy concerns are raised by AVs as connected devices in the "Internet of Things"; how the benefits and burdens of this new technology, including mobility, traffic congestion, and pollution, will be distributed throughout society; and more. An attempt to map the landscape of these next-generation questions and to suggest preliminary answers, this volume draws on the disciplines of philosophy, sociology, economics, urban planning and transportation engineering, business ethics and more, and represents a global range of perspectives. (shrink)

There is a concern that the widespread deployment of autonomous machines will open up a number of ‘responsibility gaps’ throughout society. Various articulations of such techno-responsibility gaps have been proposed over the years, along with several potential solutions. Most of these solutions focus on ‘plugging’ or ‘dissolving’ the gaps. This paper offers an alternative perspective. It argues that techno-responsibility gaps are, sometimes, to be welcomed and that one of the advantages of autonomous machines is that they enable us (...) to embrace certain kinds of responsibility gap. The argument is based on the idea that human morality is often tragic. We frequently confront situations in which competing moral considerations pull in different directions and it is impossible to perfectly balance these considerations. This heightens the burden of responsibility associated with our choices. We cope with the tragedy of moral choice in different ways. Sometimes we delude ourselves into thinking the choices we make were not tragic ; sometimes we delegate the tragic choice to others ; sometimes we make the choice ourselves and bear the psychological consequences. Each of these strategies has its benefits and costs. One potential advantage of autonomous machines is that they enable a reduced cost form of delegation. However, we only gain the advantage of this reduced cost if we accept that some techno-responsibility gaps are virtuous. (shrink)

It is commonly held that, given multiple medically permissible ways of proceeding, each with a different impact on the patient’s future, it is extremely important, and part of respecting patient autonomy, that patients not be under substantial pressure to defer to their physicians’ presumed authority. Some, however, worry that the focus on patient autonomy can be detrimental and that, at least in cases where it is hard to grasp what it is really like to live with certain outcomes without any (...) first‐hand or second‐hand experience, it is best if patient choice is firmly directed, or at least effectively nudged, by the recommendation of an experienced medical professional. The idea seems to be that, since physicians cannot get their patients to promptly assimilate a large amount of information and experience, physicians must, if they are to really help their patients make good decisions in hard cases, exert non‐argumentative influence on them. But this neglects an interesting possibility, namely the possibility of influencing patients by providing them with evidence regarding what decisions have proved most satisfactory for patients with their profile. Approximations of patient profile tests are already employed in medical practice. But the potential of the profile‐test approach in medical practice (and research) has been obscured by ongoing debate that neglects the significance of the approach with respect to the apparent dilemma faced by patients who need to make informed, autonomous decisions but cannot be expected to fully assimilate, in short order, the knowledge and experience of their physicians. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary (...) medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

The truth of the matter is that our deficiency does not lie in the want of well-verified "facts." What we lack is our bearings. The contemporary experience of things technological has repeatedly confounded our vision, our expectations, and our capacity to make intelligent judgments. Categories, arguments, conclusions, and choices that would have been entirely obvious in earlier times are obvious no longer. Patterns of perceptive thinking that were entirely reliable in the past now lead us systematically astray. Many of our (...) standard conceptions of technology reveal a disorientation that borders on dissociation from reality. And as long as we lack the ability to make our situation intelligible, all of the "data" in the world will make no difference.;From the Introduction. (shrink)

Since the late 1960s, the legal doctrine of consent has occasionally been subject to severe criticism from within the bioethical discourse. The criticism was often based on observations indicating that consents and refusals, which had been considered valid from legal or institutional points of view, had frequently failed to reflect genuinely autonomous decision making, hence genuinely autonomous choices.This has led several critics to conclude that informed consent is a legal fiction. To clarify the concept, a legal fiction is (...) a supposition of fact taken to be true by the courts of law, irrespective of whether it is true or not, and even though it might not be true .1 What these critics probably meant to say was that the law deems any person who has given a legally valid consent to be genuinely task specifically autonomous, regardless of whether this is true or not and even though it might not be true. In other words, informed consent is a legal fiction, since it presupposes—that is, claims to reflect—genuine task specific autonomy, however baselessly.It was precisely this potentially embarrassing conclusion that prompted Faden and Beauchamp to develop a brilliant and remarkably effective argument in defence of the legal doctrine of consent. In their seminal work, AHistory and Theory of Informed Consent, they indeed acknowledged that effective consent often fails to be compatible with autonomous authorisation . Indeed, they recognised that effective consent does not necessarily entail autonomous authorisation. They argued, however, that the former is not a legal fiction, since it does not presuppose the …. (shrink)

In recent educational reforms in New Zealand, a central assumption has been the existence of a free and autonomous chooser acting as a consumer of education. The present paper examines and critiques this notion of autonomy, as developed within liberal theory. Both Foucault and Lyotard provide materials for this critique of such a self, a self independent of the laws and principles of a community.

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen (...) autonomy and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

Recently, we have seen various proposed laws that would require that women considering abortions be given ultrasounds along with explanations of these ultrasounds. Proponents of these laws could argue that they are assisting with autonomous abortion choices by providing needed information, especially about the ontological status of the fetus. Arguing against these proposed laws, I first claim that their supporters fail to appreciate how personalized an abortion choice must be. Second, I argue that these laws would provide the (...) pregnant woman no control over when and to what extent emotion is inserted into her deliberation. This unjustly inhibits her autonomy, making these ultrasound laws unjustified. (shrink)

Substantive accounts of autonomy place value constraints on the objects of autonomous choice. According to such views, not all sober and competent choices can be autonomous: some things simply cannot be autonomously chosen. Such an account is developed and appealed to, by Thomas Hill Jr, in order to explain the intuitively troubling nature of choices for deferential roles. Such choices are not consistent with the value of self-respect, it is claimed. In this paper I argue that Hill's (...) attempt to explain the problem with such a choice, and Marcia Baron's interpretation and defence of his view, fail in this task. The troubling nature of some choices for deference cannot be explained in terms of a substantive self-respect condition for autonomy. (shrink)

In most areas of our lives, legal protections are in place to ensure that we have autonomous control over what happens in and to our bodies. However, there are fewer protections in place for autonomous choice when it comes to the food we purchase and consume. In fact, the current trend in US legislation is pushing us away from autonomous food choice. In this paper, I discuss two examples of this trend: corporate resistance to GM (...) labeling laws and farm protection laws. These examples are quite different from a legislative point of view. In one case, laws that would promote autonomous choice are actively resisted, whereas in the other case, laws that undermine autonomy are enacted. The common core of the two examples is the effect: in both cases, we are unable to determine whether the food we purchase and consume is consistent with our values. In both cases, then, autonomous choice about the food we purchase and put into our bodies is undermined. (shrink)

How should autonomous vehicles be programmed to behave in the event of an unavoidable accident in which the only choice open is one between causing different damages or losses to different objects or persons? This paper addresses this ethical question starting from the normative principles elaborated in the law to regulate difficult choices in other emergency scenarios. In particular, the paper offers a rational reconstruction of some major principles and norms embedded in the Anglo-American jurisprudence and case law (...) on the “doctrine of necessity”; and assesses which, if any, of these principles and norms can be utilized to find reasonable guidelines for solving the ethical issue of the regulation of the programming of autonomous vehicles in emergency situations. The paper covers the following topics: the distinction between “justification” and “excuse”, the legal prohibition of intentional killing outside self-defence, the incommensurability of goods, and the legal constrains to the use of lethal force set by normative positions: obligations, responsibility, rights, and authority. For each of these principles and constrains the possible application to the programming of autonomous vehicles is discussed. Based on the analysis, some practical suggestions are offered. (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be (...) respected. (shrink)

Autonomy operates as a key term in debates about the rights of families to choose distinct approaches to education. Yet, what autonomy means is often complicated by the actual circumstances and contexts of schools, families, and children. In this essay, Terri S. Wilson and Matthew A. Ryg focus on the challenges involved in translating an ideal of educational autonomy into the “nonideal” contexts and circumstances that surround families' choices. Drawing on the methodological insights of Elizabeth Anderson and John Dewey, they (...) sketch out a nonideal approach for exploring autonomy. Wilson and Ryg particularly focus on Dewey's notion of an ideal, his treatment of autonomy as a concept, and his view of the self. Such a nonideal approach draws attention toward the specific circumstances, habits, and environments that make autonomy possible. Wilson and Ryg illustrate the salience of this nonideal approach by exploring one example of an empirically engaged study of autonomy. (shrink)

Although autonomy is clearly still the paradigm in bioethics, there is increasing concern over its value and feasibility. In agreeing with those concerns, I argue that autonomy is not just a status, but a skill, one that must be developed and maintained. I also argue that nearly all healthcare interactions do anything but promote such decisional skills, since they rely upon assent, rather than upon genuinely autonomous consent. Thus, throughout most of their medical lives, patients are socialised to be (...) heteronomous, rather than autonomous. Yet, at the worst possible time – critical care decision-making – when life and death consequences are attached to the choices, the paradigm shifts and real consent is sought, even demanded, thereby making an often traumatic situation even harder.I go on, though, to also reject paternalistic models of beneficence as an alternative. Rather, I conclude that the problem is so fundamental in healthcare that a genuine solution would require a radical restructuring. I recommend steps that can be taken in the interim to improve the situation and to move toward such a restructuring. (shrink)

This paper presents a comparison of social kinship (patrilineage) and biological kinship (genetic relatedness) in predicting cooperative relationships in two different economic contexts in the fishing and whaling village of Lamalera, Indonesia. A previous analysis (Alvard, Human Nature 14:129–163, 2003) of boat crew affiliation data collected in the village in 1999 found that social kinship (patrilineage) was a better predictor of crew affiliation than was genetic kinship. A replication of this analysis using similar data collected in 2006 finds the same (...) pattern: lineage is a better predictor than genetic kinship of crew affiliation, and the two together explain little additional variance over that explained by lineage alone. However, an analogous test on food-sharing relationships finds the opposite pattern: biological kinship is a better predictor of food-sharing relationships than is social kinship. The difference between these two cooperative contexts is interpreted in terms of kin preferences that shape partner choice, and the relative autonomy with which individuals can seek to satisfy those preferences. Drawing on stable matching theory, it is suggested that unilineal descent may serve as a stable compromise among multiple individuals’ incongruent partner preferences, with patriliny favored over matriliny in the crew-formation context because it leads to higher mean degrees of relatedness among male cooperators. In the context of food-sharing, kin preferences can be pursued relatively autonomously, without the necessity of coordinating preferences with those of other households through the institution of lineage. (shrink)

Adaptive preferences give rise to puzzles in ethics, political philosophy, decision theory, and the theory of action. Like our other preferences, adaptive preferences lead us to make choices, take action, and give consent. In 'False Consciousness for Liberals', recently published in The Philosophical Review, David Enoch (2020) proposes a criterion by which to identify when these choices, actions, and acts of consent are less than fully autonomous; that is, when they suffer from what Natalie Stoljar (2014) calls an 'autonomy (...) deficit'. According to Enoch, such actions are not protected in the usual way against interference by others; there is not the same prohibition against trying to prevent someone from acting in a particular way when that action is motivated by such adaptive preferences and is an attempt to satisfy them. In this note, I raise two concerns about Enoch's criterion. (shrink)

This article attempts to assess Jon Elster's contribution to rational choice in Ulysses and the Sirens and Sour Grapes. After reviewing Elster's analysis of functional versus intentional explanations, the essay moves on to the crucial distinction between the thin and broad theories of rationality. The former elabo rates on the traditional economist's preference / feasible set apparatus; the latter is the more demanding theory which inquires into the rationality of beliefs and preferences. Elster's approach to the broad theory normally (...) consists in using the thin theory as a reference point and in making purposefully limited departures from it. The essay illustrates the method while commenting on Elster's discus sion of autonomous preferences in Sour Grapes. It goes on to stress some impor tant analogies between Elster's use of the thin and broad theories, on one hand, and Weber's ideal-typical method, on the other. The final assessment is phrased in terms of these analogies; it is suggested that Elster is at his best when the ideal-typical method and his own separate from each other, that is, when he comes to grips with the broad theory in its own terms. (shrink)

Informed choice is increasingly recognised as important in supporting patient autonomy and ensuring that people are neither deceived nor coerced. In cancer screening the emphasis has shifted away from just promoting the benefits of screening to providing comprehensive information to enable people to make an informed choice. Cancer screening programmes in the UK now have policies in place which state that it is their responsibility to ensure that individuals are making an individual informed choice. There is a (...) need to evaluate whether such policies mean that those people invited for screening are making informed choices, and how comprehensive information affects other variables such as uptake, cost effectiveness, and satisfaction. At the present time, there is no validated measure of informed choice in cancer screening. Such a measure could be used to evaluate the effectiveness of interventions to increase informed choice and levels of informed choice in a population invited for screening. It could encourage health professionals to be accountable. Factors important when measuring informed choice in cancer screening include an individual’s understanding of the limitations of screening, the ability to make an autonomous choice, and the difference between choice and behaviour. (shrink)

Consequential historical decisions that shaped transportation systems and their influence on society have many valuable lessons. The decisions we learn from and choose to make going forward will play a key role in shaping the mobility landscape of the future. This is especially pertinent as artificial intelligence (AI) becomes more prevalent in the form of autonomous vehicles (AVs). Throughout urban history, there have been cyclical transport oppressions of previous-generation transportation methods to make way for novel transport methods. These cyclical (...) oppressions can be identified in the baroque and modernist periods, and a third oppression may occur in the contemporary period. To explore the idea of a third oppression, we focus on the bicycle and outline the history of cycling to understand how historical mode oppression unfolded. We then present several social and political factors that contributed to the oppression of cycling and share recommendations for how to avoid future oppressions including political, social, and design actions for researchers and policymakers to take. This paper argues that priorities for AI-enabled mobility and cyclist needs be advanced in proportion to the extent that they contribute to societal goals of urban containment, public realm, and proximal cities. Additionally, future mobility evolutions should prioritise mobility justice and mode choice over inducing a singular transportation method. (shrink)

Autonomy is fundamental to liberalism. But autonomous individuals often choose to do things that harm themselves or undermine their equality. In particular, women often choose to participate in practices of sexual inequality—cosmetic surgery, gendered patterns of work and childcare, makeup, restrictive clothing, or the sexual subordination required by membership in certain religious groups. In this book, Clare Chambers argues that this predicament poses a fundamental challenge to many existing liberal and multicultural theories that dominate contemporary political philosophy. Chambers argues (...) that a theory of justice cannot ignore the influence of culture and the role it plays in shaping choices. If cultures shape choices, it is problematic to use those choices as the measure of the justice of the culture. Drawing upon feminist critiques of gender inequality and poststructuralist theories of social construction, she argues that we should accept some of the multicultural claims about the importance of culture in shaping our actions and identities, but that we should reach the opposite normative conclusion to that of multiculturalists and many liberals. Rather than using the idea of social construction to justify cultural respect or protection, we should use it to ground a critical stance toward cultural norms. The book presents radical proposals for state action to promote sexual and cultural justice. (shrink)

:To what extent, if any, should minors have a say about whether they participate in research that offers them no prospect of direct benefit? This article addresses this question as it pertains to minors who cannot understand enough about what their participation would involve to make an autonomous choice, but can comprehend enough to have and express opinions about participating. The first aim is to defend David Wendler and Seema Shah’s claim that minors who meet this description should (...) not be offered a choice about whether they participate. The second aim is to show, contra Wendler and Shah, that the principle of nonmaleficence requires more with respect to giving these minors a say than merely respecting their dissent. Additionally, it requires that investigators obtain affirmation of their non-dissent. This addresses intuitive concerns about denying children a choice, while steering clear of the problems that arise with allowing them one. (shrink)

Causal Determinism (CD) entails that all of a person’s choices and actions are nomically related to events in the distant past, the approximate, but lawful, consequences of those occurrences. Assuming that history cannot be undone nor those (natural) relations altered, that whatever results from what is inescapable is itself inescapable, and the contrariety of inevitability and freedom, it follows that we are completely devoid of liberty: our choices are not freely made; our actions are not freely performed. Instead of disputing (...) the soundness of this reasoning, some philosophers prefer to maintain that we could yet have a small measure of freedom were CD true of our world: although being unable to choose or act differently, one could at least under normal circumstances truly claim to be acting ‘on one’s own’, beyond the control of ‘outside forces’, in a word, autonomous. They further argue that being free in this sense suffices for moral responsibility. Call their philosophy ‘Autonomy Compatibilism’ (AC). -/- In adopting here reactive attitudes towards an agent, one is choosing to highlight the fact that the individual in question is of sound mind, reasoning and acting free from the interference of others. These facts alone, the adherent of AC claims, justify his stance, despite the necessity of the agent’s choices. Why would we not regard a sane individual who is not being coerced, intimidated, deceived or unduly put upon as in charge of his life so as to be responsible for his activities? -/- The Manipulation Argument (MA) is supposed to cut off this line of retreat. Its authors hold that, were CD true of our world, we would be no more autonomous than a victim of “covert, non-constraining control” (CNC): manipulation whereby one person causes another, through the use of methods such as brainwashing or circumspect operant conditioning, to ‘do his bidding’ without the latter being aware of his subjugation or feeling in any way coerced. Since a CNC victim obviously lacks autonomy, then so must “persons” living in a deterministic universe. Defenders of AC have, then, the following argument with which to contend: -/- 1. Victims of CNC (obviously) lack autonomy. 2. Thus, AC would be true only if some definition of autonomy succeeds in specifying a freedom relevant difference between victims of CNC and agents whose choices/actions are necessary consequences of prior events. 3. There could be no such definition. 4. Therefore, AC must be false. -/- The challenge issued here is clear: find a way to refute the claim that being subject to natural laws would be tantamount to being a victim of CNC, to show that Nature is no manipulator. Moreover, this challenge cannot be met by responding with a Frankfurt case: a situation in which things have been surreptitiously arranged so that an agent is unable to avoid doing something that he manages to do ‘on his own’, thus, being autonomous despite his inability to act otherwise. For, even if CD is not inconsistent with autonomy because it eliminates the ability to do otherwise per se, it may yet entail that no human agent ever does act of his own accord, an implication of which would be a lack of alternatives on anyone’s part. In other words, the fact that causally determined beings could never act differently than they do does is perhaps only symptomatic of the reason why such beings would lack autonomy: forces beyond their control would have dominion over their psychological development. Thus, AC advocates must show that the way that an agent’s character would be shaped, were she (merely) subject to natural laws, would leave unimpaired an ability that CNC would destroy. What follows is a definition of this ability, which I also use to solve the Problem of Freedom and Foreknowledge. (shrink)

Suppose that an autonomous vehicle encounters a situation where (i) imposing a risk of harm on at least one person is unavoidable; and (ii) a choice about how to allocate risks of harm between different persons is required. What does morality require in these cases? Derek Leben defends a Rawlsian answer to this question. I argue that we have reason to reject Leben’s answer.

Suppose that an autonomous vehicle encounters a situation where imposing a risk of harm on at least one person is unavoidable; and a choice about how to allocate risks of harm between different persons is required. What does morality require in these cases? Derek Leben defends a Rawlsian answer to this question. I argue that we have reason to reject Leben’s answer.

Recently, many AI researchers and practitioners have embarked on research visions that involve doing AI for “Good”. This is part of a general drive towards infusing AI research and practice with ethical thinking. One frequent theme in current ethical guidelines is the requirement that AI be good for all, or: contribute to the Common Good. But what is the Common Good, and is it enough to want to be good? Via four lead questions, the concept of Ethics Pen-Testing identifies challenges (...) and pitfalls when determining, from an AI point of view, what the Common Good is and how it can be enhanced by AI. The current paper reports on a first evaluation of EPT. EPT is applicable to various artefacts that have ethical impact, including designs for or implementations of specific AI technology, and requirements engineering methods for eliciting which ethical settings to build into AI. The current study focused on the latter type of artefact. In four independent sessions, participants with close but varying involvements in “AI and ethics” were asked to deconstruct a method that has been proposed for eliciting ethical values and choices in autonomous car technology, an online experiment modelled on the Trolley Problem. The results suggest that EPT is well-suited to this task: the remarks made by participants lent themselves well to being structured by the four lead questions of EPT, in particular, regarding the question what the problem is and about which stakeholders define it. As part of the problem definition, the need became apparent for thorough technical domain knowledge in discussions of AI and ethics. Thus, participants questioned the framing and the presuppositions inherent in the experiment and the discourse on autonomous cars that underlies the experiment. They transitioned from discussing a specific AI artefact to discussing its role in wider socio-technical systems. Results also illustrate to what extent and how the requirements engineering method forces us to not only have a discussion about which values to “build into” AI systems, the substantive building blocks of the Common Good, but also about how we want to have this discussion at all. Thus, it forces us to become explicit about how we conceive of democracy and the constitutional state and the procedural building blocks of the Common Good. (shrink)

The often‐posed dichotomy between the interest and choice theory of rights can obfuscate a proper understanding of children's rights. We need a gradualist model in which the grounds for attributing rights to a being change in response to the development of autonomy. Rights for children initially function to protect their interests but, as they develop into full‐fledged autonomous choosers, rights function to ensure that their choices, even those that do not serve their welfare, are respected.