In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he (...) is autonomous. In addition this process of identification must itself meet certain procedural constraints. (shrink)

In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he (...) is autonomous. In addition this process of identification must itself meet certain procedural constraints. (shrink)

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, (...) biographical and social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics. (shrink)

The received view in medical contexts is that informed consent is both necessary and sufficient for patient autonomy. This paper argues that informed consent is not sufficient for patient autonomy, at least when autonomy is understood as a "relational" concept. Relational conceptions of autonomy, which have become prominent in the contemporary literature, draw on themes in the thought of Charles Taylor. I first identify four themes in Taylor's work that together constitute a picture of human agency (...) corresponding to the notion of agency implicit in relational accounts of autonomy. Drawing on these themes, I sketch two arguments against the position that informed consent secures autonomy. The first is that informed consent is an "opportunity" concept whereas autonomy is an "exercise" concept; the second is that informed consent requires merely weak evaluation and not strong evaluation. On Taylor's analysis of agency, strong evaluation is required for agency and for autonomy. (shrink)

Governments, producers, and international free tradeorganizations like the World Trade Organization (WTO) areincreasingly confronted with consumers who not only buy (or don'tbuy) goods, but also demand that those goods are producedconforming to certain ethical (often diverse) standards. Not onlysafety and health belong to these ethical ideals, but animalwelfare, environmental concerns, labor circumstances, and fairtrade. However, this phantom haunts the dusty world of social andpolitical philosophy as well. The new concept ``consumersovereignty'' bypasses the conceptual dichotomy of consumer andcitizen.According to the narrow (...) liberal response to this newconstellation, with respect to food one should conceptualizeconsumer sovereignty as the right of the individual consumer toget information on food products and to make his or her ownchoice on the market of food products. In this conception, thereis a very strong emphasis on rules and principles with respect tothe autonomy of individuals.I argue that these narrow liberal concepts are not sufficient forappropriate public policy-making in democratic societies, andthat they only enable us to identify problems; they do not helpnon-experts (and experts, if it comes to that, as well) inweighing the different ethical claims. Besides, not onlyprinciples play a role in the outcome, but all kinds of ideals aswell, like roles, values, and norms. My principal argument isthat analysis or justification of norms or principles is notsufficient to get a synthesis or construction of ethicalsolutions: we need some value orientation to guide us inbalancing the different ethical claims by solving an ethicalproblem. Moreover, this balancing is something that requiressocial space and social time, i.e., public debates. With theconcept of public debates a whole new dimension enters ethicalanalysis, because the attention of ethicists shifts toformulating criteria of successful and rational public debates.However, in the broad liberal view these concepts aresupplemented with values, preferences, practices of care, andinvolvement. I argue firstly for a broadened perspective on foodas an integral part of life styles and not only as something thatpresents risks. That is the reason that food gets such intensiveattention from the public, which is summarized in the concept ofconsumer concerns. Secondly, I defend the argument that not only(rational) public debates, but intensive commitments of bothproducers and consumers in every link of the chain in so calledcare practices or consumer councils can enhance confidence in thefood production system and the way we extract our daily intakefrom nature. (shrink)

Among bioethicists, and perhaps ethicists generally, the idea that we are obliged to respect autonomy is something of a shibboleth. Appeals to autonomy are commonly put to work to support legal and moral claims about the importance of consent, but they also feed a wider discourse in which the patient’s desires are granted a very high importance and medical paternalism is regarded as almost self-evidently indefensible.

This chapter sets out John Rawls’s conception of autonomy and considers the role that it plays in his thought across A Theory of Justice and Political Liberalism. I suggest that one distinctive but overlooked feature of this conception is that it takes seriously the threat to autonomy that arises from how individuals are shaped by their social and political institutions. After setting out this conception and tracing its connections to wider discussions of autonomy, I (...) argue for two main conclusions. First, that despite appearances to the contrary, Rawls’s autonomy-based commitments are broadly speaking consistent across his two main works. Second, that these autonomy-based commitments are not in fact disbarred from playing a grounding role in Political Liberalism. On the contrary, I suggest that Rawls’s conception of autonomy motivates his aim of finding principles of justice that can be stable, and that this in turn illuminates his later commitment to a political liberalism. (shrink)

It is well known that Kant bases morality on the autonomy of the will, which he defines as the "the property of the will by which it is a law to itself" (GMS 4:440). He thus locates the normative basis for all the demands of morality in the capacity of persons to be self-legislating. Many philosophers take this to be an attractive and distinctively modern form of moral theory. It establishes the individual's own reason as the highest authority in (...) the moral realm and grants her the capacity to subject any and all norms to rational scrutiny. However, many of Kant's less sympathetic critics reject this picture of morality because they find the concept of individual autonomy incoherent. In particular, many do not think that self-imposed laws can be binding in any meaningful sense. Laws that one gives oneself cannot really be laws. For this reason, the very idea of self-legislation seems "absurd," as Elizabeth Anscombe so pointedly puts the matter. (shrink)

This dissertation examines the conceptual limitations of Kant's ethical theory with the purpose of assessing its suitability as a model of practical philosophy based upon the idea of autonomy. My aim is not only to exhibit the specific weaknesses in Kant's treatment of morality, but also to explore a contrast between two different approaches in ethical theory. This contrast can be characterized in terms of an opposition between a 'formal-individualistic' and a 'social-historical' model for the analysis and derivation of (...) ethical principles. The crucial problem here is whether an ethical theory can be constructed on the exiguous basis of concepts such as the 'rationality' or 'freedom' of the will, or whether it requires an insight into the connection between moral principles and specific conditions of historical and social life that constitute the real foundation of moral judgment. ;The dissertation is composed of four chapters. In Chapter One I consider the deficiencies in Kant's treatment of the historical and temporal dimensions of moral volition. I focus especially upon his neglect of the conditions of historical genesis that underlie the framework of moral concepts he analyzes. In the second and third chapters I examine Kant's failure to attend to the social dimension of morality and distinguish two separate parts to this objection: difficulties resulting from his restriction of the scope of moral freedom to the domain of an agent's inner intentions, so that a consideration of the consequences of action is excluded, and problems arising from his monological interpretation of the universalization procedure. Finally, in Chapter Four I argue that Kant's neglect of the historical and social dimensions of morality is by no means accidental. Rather, it is a function of his reliance upon a two-world metaphysical framework in which moral principles are understood essentially as the laws governing a purely rational, non-natural order. The dependence of Kant's ethical theory upon 'problematic' metaphysical premises--particularly in his justification of the moral law--suggests that the two dimensions he excludes from his analysis--history and society--must be integrated within it in order to yield a more convincing elaboration of the basic concepts of morality. (shrink)

본 연구는 라인홀트(Karl Leonhard Reinhold, 1757∼1823)가 『칸트 철학에 대한 편지들』의 제2권(이하 『편지들 II』)에서 수행한 칸트 자율 개념 비판과 이로부터 촉발된 칸트-라인홀트 논쟁의 의미를 해명함을 주제로 한다. 1792년에 출간된 그의 실천철학적 주저인『편지들 II』에서 라인홀트는 칸트의 도덕이론과 논쟁적인 대결을 벌인다. 총 열 두 개의 편지글로 이루어진 이 저서 중 특히 여섯 번째, 일곱 번째, 그리고 여덟 번째 편지에서 그는 칸트가 개진한 “자율”(Autonomie) 개념이 가지는 내재적인 문제를 집중적으로 파헤치고, 이를 해소할 대안적인 자유 개념을 제시한다. 라인홀트의 칸트 자유 개념 비판에 대한 종래의 연구는 라인홀트와 (...) 칸트 각각의 편을 대변하는 두 입장 간의 대립을 중심으로 이어져 왔다. 첫 번째 입장에 선 연구들은 칸트의 자율 개념에 어떠한 치명적인 모순이 내재해 있는지, 그리고 『편지들 II』에서 라인홀트의 반칸트적 논의는 이러한 문제의 해소에 있어 어떠한 통찰을 제공하는지를 드러내는데 몰두한다. 반면 칸트에 우호적인 입장에서 라인홀트의 칸트 비판은 칸트 자유 이론에 대한 단순한 오해에서 비롯된 일종의 허수아비 때리기에 불과한 것으로 치부된다. 이 두 번째 진영에 선 연구들은 라인홀트의 칸트 비판이 어떠한 오해에서 비롯되었는지를 보임으로써, 칸트 자유 이론의 복권을 시도하는데 급급한다. 이러한 양극단에서의 편파적인 이해는 정작 칸트-라인홀트의 자유 논쟁이 주는 중요한 통찰에 이르는 기회를 가로막는 결과를 초래한다는 것이 본 논문의 입장이다. 라인홀트의 칸트 비판, 그리고 이에 대한 칸트의 반박을 좀 더 냉정한 시선으로 살핌으로써, 본 논문은, 결정론과 무차별론을 넘어서는 참된 자유 이론의 수립을 둘러싼 서양 근대 자유 담론의 성취와 한계를 칸트와 라인홀트 논쟁으로부터 드러내고자 시도한다. (shrink)

This paper undertakes a critical examination of recent philosophical discussions of the concept of individual autonomy. The paper is divided into two parts. Part I focusses on the work of joel feinberg, Gerald dworkin, Harry frankfurt and others, As well as their critics, In the development of the concept of autonomy itself (or its analogues). The suggestion defended is that autonomy is an important complement to freedom when the latter is construed only as the absence of restraints. (...) Also considered is the relation between autonomy and reason or rationality. In part ii, I examine various recent attempts to utilize the property of autonomy in moral and political theory. (shrink)

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

Does respect for autonomy imply respect for precedent autonomy? The principle of respect for autonomy requires us to respect a competent patient’s treatment preference, but not everyone agrees that it requires us to respect preferences formed earlier by a now‐incapacitated patient, such as those expressed in an advance directive. The concept of precedent autonomy, which concerns just such preferences, is problematic because it is not clear that we can still attribute to a now‐incapacitated patient a preference (...) which that patient never disaffirmed but can no longer understand. If we cannot make that attribution, then perhaps we should not respect precedent autonomy – after all, how can you respect patient autonomy by giving patients what they no longer want, even if they never disaffirmed those wants? I argue that whether an earlier preference can still be attributed to a now‐incapacitated patient depends on the reasons behind the preference, for a preference includes (and is not merely supported by) the reasons behind it. When the considerations that served as reasons no longer exist, neither does the preference which included those reasons. In particular, if the considerations that served as reasons for the patient exist only under conditions where the patient retains full mental capacity, then once that capacity is lost, so are those reasons and the preference based upon them. I use this analysis of precedent autonomy to ascertain the merits of various approaches to advance medical decisionmaking, including Nancy Rhoden’s approach, approaches based on a Parfitian personal identity analysis, approaches based on soft paternalism, and approaches based on the stability and longevity of preferences. Despite the apparent absurdity of respecting patient autonomy by giving patients what they no longer prefer but have never disaffirmed, I conclude with some programmatic remarks on when and why respect for (precedent) autonomy nonetheless requires us to respect former preferences. (shrink)

Amongst traditionally-available frameworks within which end-of-life decisions in Intensive Care Units are situated, we favour Ordinary versus Extra-ordinary care distinctions as the most helpful. Predicated on this framework, we revisit the concepts of personhood and autonomy. We argue that a full account of personhood locates its foundation in relationships with others, rather than merely in “rationality”. A full account of autonomy also recognises relationships with others, as well as the actual reality of the patient’s situation-in-the-world. The fact that, (...) when critically ill, the patient may no longer be able to take an active role in decision-making does not bring about the end of their personhood, or of their autonomy. Because the patient’s autonomy is intimately linked to their relationships with others, once critical illness supervenes, respect for their autonomy devolves to those others with whom the patient is in relationship. In practical application, this means that there must be a dialogue, as the end-of-life of the critically-ill patient in ICU comes into view. Such dialogue should be grounded on this understanding in order to conform best to moral philosophical principles. Ideally the dialogue will involve all those with whom the patient is in relationship and, practical difficulties within an ICU notwithstanding, will aim to be inclusive, non-coercive and reflective as it seeks to maximise the good of the patient in their unique context. (shrink)

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three (...) cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors. (shrink)

The ‘Introduction’ to Naturrecht Feyerabend is the transcript of a lecture Kant held at the very time he began writing the Groundwork. It contains the first securely dated occurrence of the term ‘autonomy’ (and its first occurrence in the context of moral philosophy) in Kant’s work. It argues that moral imperatives are categorical and asks how they are possible. Kant’s attempts to answer this question circle around the idea that freedom must be ‘a law to itself’ and lead him (...) to the claim that the form of universal lawfulness, independently of any inclination, can determine the will. Thus various central elements of the Groundwork conception of autonomy are already present in this text. Other elements, most notably the universal law formulation of the categorical imperative and the emphasis on reason as both source and addressee of moral commands, are conspicuously absent. Following a reconstruction of Kant’s overall argument for autonomy of the will in the notes, the paper offers a detailed interpretation of central passages concerning autonomy in order to identify both similarities and differences between the conceptions of autonomy in the ‘Introduction’ and in the Groundwork. (shrink)

In the jurisprudence of constitutional courts around the world, there is an emerging trend towards an autonomy-based understanding of constitutional rights: increasingly, rights are interpreted as being about enabling people to live autonomous lives, rather than disabling the state in certain ways. This article investigates the conception of autonomy employed by courts by presenting two candidates and examining which of them explains the current practice of constitutional rights law better. The first, labelled the excluded reasons conception (...) of autonomy, claims that a person’s autonomy is violated if he is treated on the basis of certain impermissible—in particular, moralistic or paternalistic—reasons. It is concluded that, while this is a coherent understanding of autonomy, it cannot explain many of the rights that are widely accepted today. The second, the protected interests conception, argues that a person has autonomy interests in controlling certain domains of her life, and offers a scale on which the importance of the various autonomy interests can be assessed. The article demonstrates that this conception is coherent and adequately explains the current practice. The final section briefly explores some implications of this result for a comprehensive reconstructive theory of constitutional rights. (shrink)

Advances in psychology and neuroscience have elucidated the social aspects of human agency, leading to a broad shift in our thinking about fundamental concepts such as autonomy and responsibility. Here, we address a critical aspect of this inquiry by investigating how people consider the socio-relational nature of their own agency, particularly the influence of others on their perceived control over their decisions and actions. Specifically, in a series of studies using contrastive vignettes, we examine public attitudes about when external (...) influences on everyday decisions are perceived as " undue " – that is, as undermining the control conditions for these decisions to be considered autonomous – vs. when they are perceived as appropriate and even supportive of autonomous decision-making. We found that the influence of preauthorized agents – individuals and institutions with whom we share a worldview – was judged to be less undue than non-preauthorized agents, even after controlling for the familiarity of the agent. These effects persisted irrespective of the extent to which respondents identified as communitarian or individualistic, and were consistent across two distinct scenarios. We also found that external influences that were rational were perceived as less undue than those that were arational. Our study opens new avenues of inquiry into the " folk conception " of autonomy, and we discuss the implications of our findings for the ethics of public policies designed to influence decisions and for information sharing in social networks. (shrink)

It is commonly held that respect for autonomy is one of the most important principles in medical ethics. However, there are a number of interpretations as to what that respect actually entails in practice and a number of constraints have been suggested even on our self-regarding choices. These limits are often justified in the name of autonomy. In this paper, it is argued that these different interpretations can be explained and understood by looking at the discussion from the (...) viewpoints of positive and negative liberty and the various notions of a “person” that lay beneath. It will be shown how all the appeals to positive liberty presuppose a particular value system and are therefore problematic in multicultural societies. (shrink)

The East Asian family-oriented principle is defensible in theory as a shared decision making model and thus a viable alternative to individual-oriented decision making in bioethics. There are two crucial problems with the family-oriented principle, i.e., family-oriented paternalism and conflicts of interests between a patient and his family. These obstacles may appear formidable but they are not insurmountable in practice.

Consent governs innumerable everyday social interactions, including sex, medical exams, the use of property, and economic transactions. Yet little is known about how ordinary people reason about the validity of consent. Across the domains of sex, medicine, and police entry, Study 1 showed that when agents lack autonomous decision-making capacities, participants are less likely to view their consent as valid; however, failing to exercise this capacity and deciding in a nonautonomous way did not reduce consent judgments. Study 2 found that (...) specific and concrete incapacities reduced judgments of valid consent, but failing to exercise these specific capacities did not, even when the consenter makes an irrational and inauthentic decision. Finally, Study 3 showed that the effect of autonomy on judgments of valid consent carries important downstream consequences for moral reasoning about the rights and obligations of third parties, even when the consented-to action is morally wrong. Overall, these findings suggest that laypeople embrace a normative, domain-general concept of valid consent that depends consistently on the possession of autonomous capacities, but not on the exercise of these capacities. Autonomous decisions and autonomous capacities thus play divergent roles in moral reasoning about consent interactions: while the former appears relevant for assessing the wrongfulness of consented-to acts, the latter plays a role in whether consent is regarded as authoritative and therefore as transforming moral rights. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy (...) in this paper is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

Through the World Health Organization’s definition of midwifery, midwives are frequently heard to describe themselves as autonomous practitioners. In this article this notion is refuted. An overview of individual and collective autonomy is first presented to contextualize the subsequent discussion. Then the notion of autonomy in relation to midwifery practice in Scotland and New Zealand is critiqued through tracing the history of midwives and midwifery in these two countries. Issues relating to midwifery registration, medicalization of birth and consumerism (...) are discussed. Each of these categories is suggested as limiting to autonomous practice within midwifery. (shrink)

Through the World Health Organization’s definition of midwifery, midwives are frequently heard to describe themselves as autonomous practitioners. In this article this notion is refuted. An overview of individual and collective autonomy is first presented to contextualize the subsequent discussion. Then the notion of autonomy in relation to midwifery practice in Scotland and New Zealand is critiqued through tracing the history of midwives and midwifery in these two countries. Issues relating to midwifery registration, medicalization of birth and consumerism (...) are discussed. Each of these categories is suggested as limiting to autonomous practice within midwifery. (shrink)

Grounded in newer French socio-political philosophy, this text deals with the paradoxical situation in which the interpretation of society as well as the relation between the individual and the social remains ambiguous even though autonomy and interrogation of the social emerges: Autonomy remains trapped between transcendence and immanence. Modernity is when society claims to know that it has to produce its own myths. Traditional societies did not relate to their myths as if they were their own products. Nevertheless, (...) as soon as the traditional religious points of reference are disclosed and disappear, the community gives itself new points of reference in order to put the social at a distance. Thus the social creates a distance to itself and a mirror for itself in order to perceive itself and work upon itself. The article explores the questions of why this is so and the difference between heteronomous and autonomous autotranscendence. (shrink)