I defend a neo-Kantian view wherein we are capable of being completely autonomous and impartial and argue that this ability can ground normativity. As this view includes an existentialist conception of the self, I defend radical choice, a primary component of that conception, against arguments many take to be definitive. I call the ability to use radical choice “existentialist voluntarism” and bring it into a current debate in normative philosophy, arguing that it allows that we can be distanced from all (...) ends at once so as to be completely impartial. Finally, I indicate how this can be the source of normativity as it provides a purely impartial reason for being rational. (shrink)

No one has done more than John Martin Fischer and Mark Ravizza to advance our understanding of the important dispute in the theory of responsibility between structuralists and historicists. This makes it all the more important to take the measure of Responsibility and Control, their most recent contribution to the historicist side of the discussion. In this paper I examine some novel features of their most recent version of responsiblity-historicism, especially their new notions of "moderate reasons-responsiveness" and "ownership-of-agency." Fischer and (...) Ravizza intend these new elements to solve two problems untouched by earlier versions of their theory: the "problem of strange preference patterns" and the "reasons-responsiveness problem of induction." I argue that they cannot solve these problems within the theoretical strictures they place upon themselves, namely a minimalist meta-ethics of value and practical reason, and attention only to certain formal features of preference-acquisition. I conclude that historicist compatibilists cannot hope to meet the challenge of structuralist compatibilism, from the one side, and of incompatibilism, from the other, unless they take on the full task of accounting for the difference between the child's acquisition of autonomous substantive preferences and values and her acquisition of heteronomous ones. (shrink)

ZusammenfassungEs ist ein Standard-Verfahren der Medizinethik, auf die Möglichkeit des Missbrauchs solcher Instrumente hinzuweisen, die im lege-artis-Gebrauch legitim sein können. Ein etabliertes Instrument der medizinischen Praxis sind paternalistische Handlungen, die bei geringer Reichweite individueller Entscheidungskompetenz, etwa bei Minderjährigen, verantwortliches Handeln absichern sollen. In der bisherigen Debatte wird Paternalismus als Problem eines ungerechtfertigten oder übermäßigen Gebrauchs diskutiert. Bislang erscheint in der medizinethischen Paternalismus-Debatte das Problem des scheinbaren Paternalismus zu wenig reflektiert. Auch die Thematik der sexualisierten Gewalt gegen Minderjährige im medizinischen Setting (...) ist bisher wenig beachtet worden. Für diese spezifische Form der Gewalt gibt es verschiedene Ermöglichungsbedingungen. Eine wichtige liegt in der Akzeptanz paternalistischer Handlungen im medizinischen Kontext. Denn ein scheinbarer Paternalismus im Zusammenhang mit sexualisierter Gewalt gegen Minderjährige profitiert von der Praxis des passageren Übergehens des aktuellen Willens eines Kindes. Der prominente Fall Larry Nassars, der als Teamarzt der US-Kunstturnerinnen in hunderten Fällen junge Patientinnen sexualisierter Gewalt ausgesetzt hat, macht auf die Möglichkeit sexualisierter Gewalt durch medizinisches Personal aufmerksam. Geht es in der Paternalismus-Debatte um die Frage, in welchen Zusammenhängen Paternalismus problematisch oder unproblematisch ist, so trägt diese Studie den Problemaspekt der Täuschung im Zusammenhang mit sexualisierter Gewalt bei. Sie leistet damit einerseits einen Beitrag zur Thematisierung sexualisierter Gewalt im klinischen Kontext, und sie trägt zum anderen zur medizinethischen Diskussion des Paternalismus bei, die nicht von der Möglichkeit des Schein-Paternalismus absehen sollte. Unter Schein-Paternalismus oder fingiertem Paternalismus wird hier eine Haltung und Praxis verstanden, die in der Gestalt eines Paternalismus eigene Interessen des Agierenden zum Schaden der in Abhängigkeit befindlichen Person verfolgt und Fürsorgepflichten ignoriert. Denn die kindliche Gewöhnung an die Unterordnung des eigenen Willens und Körpers im asymmetrischen klinischen Kontext kann dazu genutzt werden, fingierten Paternalismus zu etablieren. Die Rede vom Schein-Paternalismus soll dabei aber nicht darüber hinwegtäuschen, dass die Grenzziehung zwischen Paternalismus und Nicht-Paternalismus in der Praxis ebenso komplex ist wie diejenige zwischen körperlich-asexueller und körperlich-sexueller Gewalt. Ein präzises und transparentes lege-artis-Modell des Paternalismus soll hier als Basis für die Prävention sexualisierter Gewalt im klinischen Kontext diskutiert werden. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur zur sexualisierten Gewalt im klinischen Kontext und zum Paternalismus. Es folgt dann eine Zusammenfügung der so gewonnenen Erkenntnisse, sodass am Ende eine komplexere Aussage AB über das Verhältnis von sexualisierter Gewalt und Schein-Paternalismus steht. (shrink)

To be an autonomous agent is to determine one’s own path in life. However, this cannot plausibly be seen as a one-off affair. An autonomous agent does not merely set herself on a particular course and then lock the steering wheel in place, so to speak, but must maintain some form of ongoing control over her direction in life—must keep her eyes on the road and her hands on the wheel. Circumstances often change in important and unexpected ways, after all, (...) and it is reasonable to think that a crucial part of autonomy consists of the ability and disposition to recognize and properly respond to such changes. This implies, I contend, that a patient whose initial decision to undergo a given treatment satisfied plausible requirements of autonomy, but who is now unable to recognize that available evidence indicates the need to reconsider her medical situation and options has come to lack autonomy with respect to her desire to continue that treatment. However, and despite its importance with respect to both theoretical understandings of autonomy and applications of the concept to clinical ethics, this ongoing aspect of autonomy has received little attention. This paper aims to go some way toward remedying that. I first critically review two of the few theories of autonomy that do address “evidence-responsiveness” so as to identify and elaborate what I take to be the most promising way in which to account for this aspect of autonomy. After considering and responding to a possible objection to the evidence-responsiveness condition I propose, I conclude by discussing its clinical implications. That condition, I argue, is not merely theoretically sound, but can and should be applied to clinical practice. (shrink)

It is plausible to think that part of what it is to be an autonomous agent is to adequately respond to important changes in one’s circumstances. The agent who has set her own course in life, but is unable to recognize and respond appropriately when evidence arises indicating the need to reconsider and perhaps adjust her plan, lacks an important form of personal autonomy. However, this “evidence-responsiveness” aspect of autonomy has not yet been adequately analyzed. Most autonomy theorists ignore it (...) altogether and the few who have addressed it have failed to give a satisfactory account. In this paper, I first examine an evidence-responsiveness condition proposed by Arneson. I argue there that while Arneson’s condition provides a valuable framework in which to examine evidence-responsiveness, there are several crucial issues that it either fails to address at all or else fails to adequately resolve. That condition is therefore in need of further elaboration and refinement. I then examine a recent article in this journal by Blöser, Schöpf, and Willaschek which develops an account of autonomy that I argue can usefully be understood as employing and elaborating upon the general framework offered by Arneson. I argue that while the elaboration Blöser and her co-authors provide Arneson’s condition is instructive, it is inadequate in several important ways which indicate the form a more satisfactory evidence-responsiveness condition will take. I go on to develop such a condition and conclude by highlighting the advantages to be gained by including that condition in a complete theory of autonomy. (shrink)

In this paper, I propose a novel deliberation-based theory of autonomy which grounds an agent’s autonomy in her nature as a rationally-reflective being. I defend that theory against competing approaches to autonomous agency by arguing that the theory I propose is best equipped to handle two of the more troublesome problems that theories of autonomy face: the regress problem and the problem of manipulation. Sarah Buss and Peter Railton have each recently claimed that the regress problem which plagues many prominent (...) accounts of autonomy indicates the need to abandon the notion that autonomous agency is to be understood in terms of deliberation, endorsement, or any other activity on the part of the agent, and adopt instead a “passive” approach to autonomous agency. Against this claim, I argue that despite their shift to the passive mode, the theories offered by Buss and Railton also face a version of the regress problem, and that the general solution to that problem implicit in their passive theories is available also to “active” theories of autonomy, such as the deliberation-based theory I propose. I go on to explain that because the solution to the regress problem I extract from the theories of Buss and Railton requires an “unmoved mover” of autonomy, the history of which is necessarily irrelevant, it invites manipulation objections. I argue that the theory I propose offers the most promising response to such objections, and thus escapes these two prominent problems in better stead than do the competing approaches to autonomous agency. (shrink)

In the contemporary debate on the nature of autonomy, it is generally taken for granted that autonomy is to be understood as rule by the self, with the debate centring on how that self is to be identified. Garnett [2013b] has recently proposed a theory that rejects the dominant understanding of autonomy as rule by the self and views it instead as resistance to rule by others. According to that theory, an autonomous agent is one whose various ‘autonomy traits’ render (...) her sufficiently resistant to subjection to foreign wills. I argue that Garnett has not given us good reason to abandon the understanding of autonomy as rule by the self. His account is plausible only if it is understood to require for autonomy the possession of at least one trait with which the agent can be identified. And the best explanation of the necessity of some such trait is offered, not by Garnett's, but by the dominant understanding of autonomy he rejects. (shrink)

Given the ubiquity and centrality of social and relational influences to the human experience, our conception of self-governance must adequately account for these external influences. The inclusion of socio-historical, externalist considerations into more traditional internalist accounts of autonomy has been an important feature of the debate over personal autonomy in recent years. But the relevant socio-temporal dynamics of autonomy are not only historical in nature. There are also important, and under-examined, future-oriented questions about how we retain autonomy while incorporating new (...) values into the existing set that guides our interaction with the world. In this paper, we examine these questions from two complementary perspectives: philosophy and neuroscience. After contextualizing the philosophical debate, we show the importance to theories of autonomous agency of the capacity to appropriately adapt our values and beliefs, in light of relevant experiences and evidence, to changing circumstances. We present a plausible philosophical account of this process, which we claim is generally applicable to theories about the nature of autonomy, both internalist and externalist alike. We then evaluate this account by providing a model for how the incorporation of values might occur in the brain; one that is inspired by recent theoretical and empirical advances in our understanding of the neural processes by which our beliefs are updated by new information. Finally, we synthesize these two perspectives and discuss how the neurobiology might inform the philosophical discussion. (shrink)

One of the strongest defences of free speech holds that autonomy requires the protection of speech. In this paper I examine five conditions that autonomy must satisfy. I survey recent research in social psychology regarding automatic behaviour, and a challenge to autonomy is articulated. I argue that a plausible strategy for neutralising some of the autonomy-threatening automatic responses consists in avoiding the exposure to the environmental features that trigger them. If this is so, we can good autonomy-based pro tanto reasons (...) for controlling exposure to certain forms of speech. (shrink)

Can Artificial Intelligence be more effective than human instruction for the moral enhancement of people? The author argues that it only would be if the use of this technology were aimed at increasing the individual's capacity to reflectively decide for themselves, rather than at directly influencing behaviour. To support this, it is shown how a disregard for personal autonomy, in particular, invalidates the main proposals for applying new technologies, both biomedical and AI-based, to moral enhancement. As an alternative to these (...) proposals, this article proposes a virtual assistant that, through dialogue, neutrality and virtual reality technologies, can teach users to make better moral decisions on their own. The author concludes that, as long as certain precautions are taken in its design, such an assistant could do this better than a human instructor adopting the same educational methodology. (shrink)

Duties to oneself are allegedly incoherent: if we had duties to ourselves, we would be able to opt out of them. I argue that there is a constraint on one’s ability to release oneself from duties to oneself. The release must be autonomous in order to be normatively transformative. First, I show that the view that combines the division of the self with the second-personal characterization of morality is problematic. Second, I advance a fundamental solution to the problem of the (...) incoherence of duties to oneself, one that does not rely on any division of the self, temporal or otherwise. I build upon the prevalent idea that, in releasing others from duties, we exercise the power of consent. The transformative force of consent partly derives from our autonomy. Invoking a plausible characterization of autonomy, I argue that release from duties requires the right kind of mental state. (shrink)

Paternalism is the restriction of a person's autonomy for the good of that person. It embodies a familiar conflict of intuitions: while we cherish individual freedom, we also want to protect/promote what we know to be good. So, every paternalist must meet two challenges: paternalism must be justifiable as a restriction of autonomy as well as effective in terms of well-being. In this essay, I argue that the ‘autonomy’ restricted by paternalism is a Razian brand of free self-authorship and that (...) the ‘good’ protected is captured by Martha Nussbaum's account of personal well-being. I then defend a mild welfare paternalism based on a dichotomy implicit in any defensible description of well-being. I argue that some aspects of the good life do not require endorsement and, therefore, can be justifiably and effectively promoted by autonomy-restricting means. Finally, I discuss why paternalism need not be hostile to ethical independence. (shrink)

The term “political” egalitarianism is used here, not to refer to equality within the political sphere, but rather in John Rawls’s sense, to refer to a conception of egalitarian distributive justice that is capable of serving as the object of an overlapping consensus in a pluralistic society.1 Thus “political” egalitarianism is political in the same way that Rawls’s “political” liberalism is political. The central task when it comes to developing such a conception of equality is to determine what constraints a (...) principle of equality must satisfy in order to qualify as “freestanding,” or to be justifiable in a way that does not presuppose the correctness of any one member of the set of reasonable yet incompatible “religious, philosophical and moral” doctrines that attract large numbers of adherents in our world.2 (Rawls uses the analogy of a “module” in order to describe the way that a properly political conception of justice “fits into and can be supported by various reasonable comprehensive doctrines that endure in the society regulated by it.”3 Political egalitarianism would be “modular” in this sense.) Rather than getting embroiled in the controversies that have arisen over Rawls’s formulation of this idea, I would like simply to accept the intuition, widespread among political philosophers, that equality is the sort of principle that – if given a proper formulation – could satisfy the requirements of a political conception of justice. After all, regardless of what peoples’ projects, values, or conceptions of the good life may be, it should be possible to design a set of arrangements that would provide equal opportunity to pursue these goals, or that would treat each conception of the good with equal respect, etc. From this perspective, the principle of equality resembles the principle of Pareto-efficiency, or certain formulations of the principle of liberty – it is one that everyone should be able to endorse, insofar as it does not privilege, or presuppose the correctness of, any particular set of projects, values.. (shrink)

Literature on the ethics of researching refugees, both as participants and partners, presents strong arguments for why anonymity is the safer option in the event of questionable consent. However, blanket anonymity, without asking refugee interviewees if they wish to be anonymous, may cause more harm than good in certain contexts. One such context which this article will explore is the context of Israel, where a working Refugee Status Determination (RSD) system has yet to be established. This case study highlights that, (...) even in extreme circumstances where identity exposure can create risks, there may be a case for allowing identity exposure and perhaps an obligation on the part of the researcher to publish a name if this is the strong wish of the interviewee. This article builds on literature addressing confidentiality of identities (Duvell et al., 2010; Giordano et al., 2007; Kelly, 2009; Lahman et al., 2011; Lee, 1993; Mackenzie et al., 2007; Pittaway et al., 2010) and literature addressing informed consent (Hugman et al., 2011; Mackenzie et al., 2007; Pittaway et al., 2010; Zion et al., 2010). Primary sources demonstrating the use of waiving anonymity were collected between 2007 and 2012. Data were collected from refugee and activist civil society publications, television and newspaper media reports, participatory observation in the Israeli Knesset, and in-depth interviews with refugees and asylum seekers from South Sudan, Sudan, DR Congo, Liberia and Eritrea living in Tel Aviv, Jerusalem and Eilat. (shrink)

There are instances where the provider of an intervention, such as surgery, has failed to obtain necessary informed consent from the recipient of the intervention. Perhaps the surgeon has failed to warn the patient that she may go into a coma, or even be killed, from the surgery. Sometimes, as a result of this intervention, the recipient cannot give informed consent to researchers for the release of their personal data precisely because of the intervention. If they are in a coma, (...) they cannot be reached. Sometimes, this personal data itself can prove that the provider of the intervention failed to obtain informed consent for the intervention. For example, a personal file may include a consent form that does not include warnings about the risk of falling into a coma from the surgery. Paradoxically, those who cannot give informed consent for the disclosure of their personal data on an intervention may have been especially ill-informed about the repercussions of the intervention. In such instances, should researchers ever use the data and disclose the data in their research? In an attempt to demonstrate when this dilemma may be relevant, and how it may be solved, I will present a real-world case of this dilemma in my own empirical research on refugees who agreed to repatriate to their countries of origin from Israel. I will consider what theories on consent, if any, can help us resolve this dilemma. (shrink)

Some claim that liberalism’s neutrality toward the Good encourages anomie, thereby disallowing social confirmation of beliefs, leaving the individual with an uncertainty about judgments that is opposed to confidence and self-respect. This is the “anomie challenge.” I begin by discussing toleration and neutrality and motivating the problem. I then look at responses to the challenge by liberal pluralists and liberalism’s critics. After dismissing both, I argue that the right to choose is the good to be advocated and that it allows (...) for supportive, but voluntary, social structures. I conclude that liberalism better supports self-respect than the alternatives. (shrink)

Many anti-obesity policies face a variety of ethical objections. We consider one kind of anti-obesity policy — modifications to food assistance programs meant to improve participants' diet — and one kind of criticism of these policies, that they are inequitable. We take as our example the recent, unsuccessful effort by New York State to exclude sweetened beverages from the items eligible for purchase in New York City with Supplemental Nutrition Support Program assistance. We distinguish two equity-based ethical objections that were (...) made to the sweetened beverage exclusion, and analyze these objections in terms of the theoretical notions of distributive equality and social equality. First, the sweetened beverage exclusion is unfair or violates distributive equality because it restricts the consumer choice of SNAP participants relative to non-participants. Second, it is disrespectful or violates social equality to prohibit SNAP participants from purchasing sweetened beverages with food stamps. We conclude that neither equity-based ethical objection is decisive, and that the proposed exclusion of sugar-sweetened beverages is not a violation of either distributive or social equality. (shrink)

As concerns about the negative health effects of unhealthy eating and overweight/obesity increase, so too do efforts to combat obesity. Both the federal government, as well as state and local governments, have proposed and implemented a variety of healthy eating and obesity prevention policies. Many of these policies are controversial, facing objections that range from the practical to the ethical. In this paper, we consider one such policy — restrictions on food assistance programs that are meant to improve participants’ diet (...) — and one criticism of these policies, that they are inequitable. We take as our primary example the recent, unsuccessful effort by New York State to exclude sweetened beverages from the items eligible for purchase in New York City with Supplemental Nutrition Assistance Program. (shrink)

A well-known objection to prioritarianism, famously levelled by Mike Otsuka and Alex Voorhoeve, is that it wrongly ignores the unity of the individual in treating intra-personal cases like inter-personal cases. In this paper we accept that there should be a moral shift between these cases, but argue that this is because autonomy is a relevant consideration in intra-personal but not inter-personal cases, and one to which pluralist prioritarians ought to attend. To avoid this response, Otsuka and Voorhoeve must assume we (...) know nothing about the subjective information of the person being chosen for. But we show that this commits them to two controversial assumptions: that welfare consists in an objective list of goods, and – if one accepts an unorthodox but plausible account of the relationship between risk aversion and rationality – that there is only a narrow range of rational risk aversions. Only prioritarians who accept both these assumptions are on the hook of Otsuka and Voorhoeve’s objection; for all others, the examples have insufficient information, and so lose their sting. (shrink)

Mental capacity and autonomy are often understood to be normatively neutral? the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and functional tests requiring consistency, expression of identity, (...) reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty. (shrink)