Informed consent is considered by many to be a moral imperative in medical research. However, it is increasingly acknowledged that in many actual instances of consent to participation in medical research, participants do not employ the provided information in their decision to consent, but rather consent based on the trust they hold in the researcher or research enterprise. In this article we explore whether trust-based consent is morally inferior to information-based consent. We analyse the moral values essential to valid consent (...) – autonomy, voluntariness, non-manipulation, and non-exploitation – and assess whether these values are less protected and promoted by consent based on trust than they are by consent based on information. We find that this is not the case, and thus conclude that trust-based consent if not morally inferior to information-based consent. (shrink)

Immanuel Kants Metaphysische Anfangsgründe der Rechtslehre, 1797 als erster Teil der Metaphysik der Sitten erschienen, stellen einen Beitrag zur neuzeitlichen Rechts- und Staatsphilosophie dar. Hinsichtlich der normativen Prinzipien von Recht und Staat entwickelt Kant eine erfahrungsunabhängige, insofern metaphysische Theorie. Sie beginnt mit einem angeborenen und unveräußerlichen Menschenrecht und geht dann zu den Institutionen des Eigentums und des Rechtsstaates über. Besonders aktuell ist die Formulierung eines rechts- und friedensfunktionalen Völkerrechts und eines Weltbürgerrechts. Darüber hinaus behandelt Kant auch das Ehe und Familienrecht, (...) das Verhältnis von Staat und Kirche und das Straf- und Begnadigungsrecht. Durch den thematischen Reichtum und die begriffliche Genauigkeit, vor allem jedoch durch die Radikalität seiner Fragen und die Originalität der Antworten ist Kants Rechtsdenken bis heute von hohem systematischem Rang. Die elf Beiträger dieses kooperativen Kommentars, der anlässlich des 300. Kant-Jubiläums in einer 3., überarbeiteten Auflage erscheint, nehmen die bleibend gültigen Provokationen der „Metaphysischen Anfangsgründe" ernst. Mit Beiträgen von Hans Friedrich Fulda, Otfried Höffe, Peter König, Kristian Kühl, Bernd Ludwig, Jean-Christophe Merle, Jörg Paul Müller, Terry Pinkard, Alessandro Pinzani, Robert B. Pippin, Allen W. Wood. (shrink)

Debates on the nature and justifiability of paternalism typically focus only on adults, sometimes presuming without argument that paternalism towards children is a non-issue or obviously justified. Debates on the moral and political status of children, in turn, rarely connect with the rich literature on paternalism. This chapter attempts to bridge this gap by exploring how issues that arise in the general debate on paternalism are relevant also for the benevolent interference with children. I survey and discuss various views and (...) argue for my own: that paternalism towards children is in most respects like paternalism towards adults and stands in the same need of justification, though such justification is more often forthcoming both because children are typically less prudent than adults and so benefit more from interference, and because, in some respects, interference is less harmful to them. (shrink)

This paper discusses the volenti non fit injuria maxim. The volenti maxim states that a person is not wronged by that to which she consents, provided her consent is valid. I will argue, however, that the volenti maxim does not apply to all instances of valid consent. In some cases the consenter is wronged even if his consent is valid. Valid consent can only release others from consent-sensitive duties, not from consent-insensitive duties. If the consentee flouts a consent-insensitive duty the (...) consentee wrongs the consenter and thereby commits a wrong. (shrink)

Contemporary philosophical debates surrounding toleration have revolved around three issues: What is toleration? Should we tolerate and, if so, why? What should be tolerated? These questions are of central importance to social and political thought.

Paternalistic interventions restrict individuals’ liberty or autonomy so as to guide their decisions towards options that are more beneficial for them than the ones they would choose in the absence of such interventions. Although some philosophers have emphasised that there is a case for justifiable paternalism in certain circumstances, much of contemporary moral and political philosophy works from a strong presumption against paternalistic interventions. However, Richard Arneson has argued that there are egalitarian reasons that support the case for paternalism: paternalistic (...) interventions can protect poor decision-makers from making ‘bad’ choices, thus preventing inequalities between them and those with better decision-making skills. This paper seeks to clarify and advance our understanding of the egalitarian argument for paternalism. Arneson’s argument adds an important and often neglected dimension to the debate about paternalism but also raises a number of questions about equality, paternalism and the relationship between the two. (shrink)

I first distinguish four types of objection to paternalism and argue that only one – the principled objection – amounts to a substantive and distinct normative doctrine. I then argue that this doctrine should be understood as preventing certain facts from playing the role of reasons they would otherwise play. I explain how this filter approach makes antipaternalism independent of several philosophical controversies: On the role reasons play, on what reasons there are, and on how reasons are related to values. (...) I go on to contrast the filter approach with the competing and dominant action-focused approach, which understands objections to paternalism in terms of paternalistic action, behavior, law, policy and the like. Seana Shiffrin and Peter de Marneffe are singled out as prominent recent proponents of this approach. By engaging with their definitions of paternalism, I explain how the action-focused approach makes antipaternalism dependent on the sorting of actions into paternalistic and nonpaternalistic according to what reasons support them. Because one and the same action can be supported by many different reasons, and by different sorts of reasons, such sorting is very difficult. The upshot is that antipaternalism on the action-focused account fails to provide the precise normative implications of the filter approach that I favor. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

Epistemic paternalism is the thesis that in some circumstances we are justified in interfering with the inquiry of another for their own epistemic good without consulting them on the issue. In this paper, I address the issue of who is rationally entitled to undertake paternalistic interferences, and in virtue of which features one has this entitlement. First, I undermine the view according to which experts are the most apt people to act as paternalist interferers. Then, I argue that epistemic authorities (...) are in a better position to satisfy the requirements of justified epistemic paternalism, when conceived according to the service model of epistemic authority. Finally, I offer a virtue-based account of paternalist interferers and show how it can apply to cases in which the interferer is a group or an institution. (shrink)

Are we being manipulated online? If so, is being manipulated by online technologies and algorithmic systems notably different from human forms of manipulation? And what is under threat exactly when people are manipulated online? This volume provides philosophical and conceptual depth to debates in digital ethics about online manipulation. The contributions explore the ramifications of our increasingly consequential interactions with online technologies such as online recommender systems, social media, user-friendly design, micro-targeting, default-settings, gamification, and real-time profiling. The authors in this (...) volume address four broad and interconnected themes: • What is the conceptual nature of online manipulation? And how, methodologically, should the concept be defined? • Does online manipulation threaten autonomy, freedom, and meaning in life, and if so, how? • What are the epistemic, affective, and political harms and risks associated with online manipulation? • What are legal and regulatory perspectives on online manipulation? The Philosophy of Online Manipulation brings these various considerations together to offer philosophically robust answers to critical questions concerning our online interactions with one another and with autonomous systems. It will be of interest to researchers and advanced students working in moral philosophy, digital ethics, philosophy of technology, and the ethics of manipulation. (shrink)

The books’ goal is to answer the question: Do the weaknesses of value-free economics imply the need for a paradigm shift? The author synthesizes criticisms from different perspectives (descriptive and methodological). Special attention is paid to choices over time, because in this area value-free economics has the most problems. In that context, the enriched concept of multiple self is proposed and investigated. However, it is not enough to present the criticisms towards value-free economics. For scientists, a bad paradigm is better (...) than no paradigm. Therefore, the author considers whether value-based economics with normative approaches such as economics of happiness, capability approach, libertarian paternalism, and the concept of multiple self can be the alternative paradigm for value-free economics. This book is essential reading to everyone interested in the current state of economics as a discipline. (shrink)

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might be suitable (...) as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

Philosophers have talked to each other about moral issues concerning technology, but few of them have talked about issues of technology and the good life, and even fewer have talked about technology and the good life with the public in the form of recommendation. In effect, recommendations for various technologies are often left to technologists and gurus. Given the potential benefits of informing the public on their impacts on the good life, however, this is a curious state of affairs. In (...) the present paper, I will examine why philosophers are seemingly reluctant to offer recommendations to the public. While there are many reasons for philosophers to refrain from offering recommendations, I shall focus on a specific normative reason. More specifically, it appears that, according to a particular definition, offering recommendations can be viewed as paternalistic, and therefore is prima facie wrong to do so. I will provide an argument to show that the worry about paternalism is unfounded, because a form of paternalism engendered by technology is inevitable. Given the inevitability of paternalism, I note that philosophers should accept the duty to offer recommendations to the public. I will then briefly turn to design ethics, which has reconceptualised the role of philosophers and, in my mind, fitted well with the inevitability of paternalism. Finally, I shall argue that design ethics has to be supplemented by the practice of recommendation if it is to sustain its objective. (shrink)

What is the foundation of consent in the criminal law? Classically liberal commentators have offered at least three distinct theories. J.S. Mill contends we value consent because individuals are the best judges of their own interests. Joel Feinberg argues an individual’s consent matters because she has a right to autonomy based on her intrinsic sovereignty over her own life. Joseph Raz also focuses on autonomy, but argues that society values autonomy as a constituent element of individual well-being, which it is (...) the state’s duty to promote. The criminal law’s approach to the problem of non-contemporaneous consent—prospective consent and retrospective consent—casts a unique light on the differences among these three justifications. Peter Westen claims neither Mill’s nor Feinberg’s justifications for consent fully explains how non-contemporaneous consent is treated in the criminal law. Specifically, Mill’s “self-interest” conception explains the criminal law’s limited recognition of prospective consent, but cannot explain its total rejection of retrospective consent. Conversely, Feinberg’s “sovereign autonomy” conception explains why the criminal law rejects retrospective consent, but cannot explain why the law recognizes irrevocable prospective consent only in limited circumstances. I resolve this dilemma by explaining that Raz’s “autonomy is good” conception is consistent with both the criminal law’s limited recognition of irrevocable prospective consent and its total rejection of retrospective consent. This suggests the existing criminal law embodies Raz’s theory that it is the duty of the state to promote morality, in particular the moral good of individual well-being through living autonomously. In contrast, the criminal law’s treatment of consent would have to be modified if it were to reflect Mill’s “self-interest” conception, or Feinberg’s “sovereign autonomy” conception. (shrink)

John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)

Je défends ici une conception interpersonnelle des menaces et des offres coercitives, centrée sur les intentions de ceux qui font de telles menaces ou de tellesoffres. Je critique, ce faisant, un groupe de conceptions fort influentes, appelées «baseline accounts». Robert Nozick, qui adopte une approche de ce genre, incorpore à son analyse des menaces coercitives des éléments non moraux aussi bien que des éléments moraux. Les approches de Daniel Lyons et de David Zimmerman peuvent être vues, à certains égards, comme (...) des améliorations par rapport à celle de Nozick. On essaiera de montrer, cependant, qu'aucune de ces approches ne fournit une analyse adéquate des menaces et des offres coercitives. (shrink)

Phase 1 healthy volunteer clinical trials—which financially compensate subjects in tests of drug toxicity levels and side effects—appear to place pressure on each joint of the moral framework justifying research. In this article, we review concerns about phase 1 trials as they have been framed in the bioethics literature, including undue inducement and coercion, unjust exploitation, and worries about compromised data validity. We then revisit these concerns in light of the lived experiences of serial participants who are income-dependent on phase (...) 1 trials. We show how participant experiences shift attention from discrete exchanges, behaviors, and events in the research enterprise to the ongoing and dynamic patterns of serial participation in which individual decision-making is embedded in collective social and economic conditions and shaped by institutional policies. We argue in particular for the ethical significance of structurally diminished voluntariness, routine powerlessness in setting the terms of exchange, and incentive structures that may promote pharmaceutical interests but encourage phase 1 healthy volunteers to skirt important rules. (shrink)

The article tries to inquire a third way in normative ethics between consequentialism or utilitarianism and deontology or Kantianism. To find such a third way in normative ethics, one has to analyze the elements of these classical theories and to look if they are justified. In this article it is argued that an adequate normative ethics has to contain the following five elements: (1) normative individualism, i. e., the view that in the last instance moral norms and values can only (...) be justified by reference to the individuals concerned, as its basis; (2) consideration of the individuals' concerns and interests—aims, desires, needs, strivings—insofar as they have a justificatory function; (3) a pluralism of references of these concerns and hence of moral norms and values to all possible elements of actions; (4) the necessity of a principle of aggregation and weighing with regard to these concerns; (5) finally, as a central principle of aggregation and weighing, the principle of relative reference to self and others, operating as a generalizing meta-principle that guides the application of concrete principles and decisions. (shrink)

When are we morally obligated as a society to help the homeless, and is coercive interference justified when help is not asked for, even refused? To answer this question, we propose a comprehensive taxonomy of different types of homelessness and argue that different levels of autonomy allow for interventions with varying degrees of pressure to accept help. There are only two categories, however, where paternalism proper is allowed, be it heavily qualified. The first case is the homeless person with severely (...) diminished autonomy as a result of mental illness, and the second case is the homeless person who runs a risk of serious and imminent harm to self. In the first case, namely, that of soft paternalism, we argue that coercive intervention in the case of a refusal to accept help should be focused on the provision of housing that meets basic needs—needs that we outline in the article. In the case of imminent and severe harm to self, the case of hard paternalism, we argue that forced intervention can only be allowed if it is temporary and local, namely focused on getting someone out of harm’s way. (shrink)

Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to take care (...) of their patient’s best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas. (shrink)

John Martin Fischer’s most recent collection of essays, Deep Control: Essays on Free Will and Value, is both incredibly wide-ranging and impressively detailed. Fischer manages to cover a staggering amount of ground in the free will debate, while also providing insightful and articulate analyses of many of the positions defended in the field. In this collection, Fischer focuses on the relationship between free will and moral responsibility. In the first section of his book, Fischer defends Frankfurt cases as an important (...) and useful tool in rejecting the necessity of regulative control for moral responsibility. In the second section, Fischer turns his attention to his own account of guidance control. In this essay, I first focus on Fischer’s defense of Frankfurt cases, specifically his response to the argument that the assumption of determinism in such cases is question-begging. I then analyze two objections to Fischer’s account of guidance control. Finally, I conclude with a brief discussion of the metaphor of the pilgrimage, which Fischer introduces in the opening essay of his collection. (shrink)

The 2015 UK Supreme Court judgment in Montgomery v Lanarkshire reinforces the importance of informed consent to medical treatment. This paper suggests that Montgomery recognises the challenge faced by vulnerable individuals in choosing between treatment options and making decisions with appreciation of information about material risks. The judgment endorses a form of weak paternalism to safeguard such persons, which is not disrespectful of the aggregate principles of the Mental Capacity Act 2005. But ethical practice requires professionals to tread carefully between (...) weak and hard paternalism in the context of therapeutic interactions with vulnerable patients, while ensuring their awareness of material risks. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

In their excellent monograph, Crimes, Harms and Wrongs, Andrew Simester and Andreas von Hirsch argue for an account of legitimate criminalisation based on wrongfulness, the Harm Principle and the Offence Principle, while they reject an independent anti-paternalism principle. To put it at its simplest my aim in the present paper is to examine the relationship between ‘the harms’ and ‘the wrongs’ of the authors’ title. I begin by comparing the authors’ version of the Harm and Offence Principle with some other (...) influential accounts. After examining the role wrongfulness plays in their work, I ask what there is left for their Harm and Offence Principles to do. In the light of the understanding and foundations of the Harm and Offence Principles proposed by the authors, I suggest that the answer is little or nothing. The wrongfulness constraint the authors place on their Offence Principle comes close to swallowing it up entirely. Furthermore the part of their Offence Principle that is not thus swallowed by wrongfulness leaves the account with a commitment that is probably best dropped. As far as their Harm Principle is concerned I suggest that the authors’ account of ‘harm’ is so broad that it lacks the resources to distinguish harm-based reasons from wrongfulness- or immorality-based reasons in any principled way. Among other things, I ask in this context, first, whether one can be harmed as one’s character deteriorates and, secondly, whether one is harmed by virtue of the serious wrong one does to another. What really drives the authors’ account of legitimate criminalisation, I believe, is wrongfulness together with an important, amorphous set of potential defeating conditions. They themselves accept such a picture so far as paternalism is concerned. I conclude that their account, which I think has considerable force, would lose little of any significance were their Harm and Offence Principles simply excised. More generally I suspect that a strong role for wrongfulness in an account of legitimate criminalisation is likely to put into serious question the plausibility of an independent principled role for harm and offence. (shrink)

Social robots are designed to perform intelligent, emotional, and autonomous behavior in order to establish intimate relationships with humans, for instance, in the context of elderly care. However, the imitation of qualities usually assumed to be necessary for human reciprocal interaction may impact our understanding of social interaction. Against this background, we compare the technical operations based on which social robots imitate human-like behavior with the concepts of emotionality, intelligence, and autonomy as usually attached to humans. In doing so, we (...) aim at making a conceptual contribution to the intuition that the technical imitation of emotional, intelligent, and autonomous behavior differs qualitatively from human forms of emotionality, intelligence, and autonomy. We conclude that the increasing tendency of social robots to imitate human characteristics and the thus increased human tendency of anthropomorphizing technical systems put forth new forms of human–machine interactions (HMI) that call for a critical examination. Thus, the emerging forms of interaction may lead, for instance, to false, reinforced, and perplexing assumptions regarding reciprocity. Therefore, studies are needed that critically examine the potential consequences and psychological effects that may be associated with the use of social robots, especially with regard to vulnerable groups such as children or the elderly. (shrink)

In this paper I argue that Joel Feinberg was wrong to suppose that liberals must oppose any criminalization of “harmless immorality”. The problem with a theory that permits criminalization only on the basis of his harm and offense principles is that it is underinclusive, ruling out laws that most liberals believe are justified. One objection (Arthur Ripstein’s) is that Feinberg’s theory is unable to account for the criminalization of harmless personal grievances. Another (Larry Alexander’s and Robert George’s) is that it (...) cannot account for public decency laws. I shall reject both of these underinclusiveness objections in favor of one that focuses on the “free floating evil” of corpse desecration. Liberals need “pure” legal moralism (PLM) to explain their support for a criminal ban on mistreatment of the dead. I also argue that while deterrence is plausibly regarded as the primary rationale for criminalizing and punishing wrongs like murder or rape, it is not plausibly regarded as any part of the rationale for criminalizing free floating evils. The point of punishing corpse desecrators has to be either retribution or the promotion of virtue/discouraging of vice. Finally, I consider Feinberg’s reason for rejecting all PLM, namely, that competent adults have a right to personal sovereignty or autonomy, and the state’s duty to respect that right trumps the desirability of punishing or reducing the vice associated with harmless immorality. I argue that Feinberg’s argument here fails because it exaggerates the right’s strength and scope. (shrink)

Es wurde für die These argumentiert, dass der Begriff der Würde in der Medizinethik nutzlos sei und in den Fällen, in denen er verständlich verwendet wird, nichts anderes meint als den Respekt vor der Autonomie von Personen. In diesem Aufsatz soll gezeigt werden, dass diese These falsch ist. Es wird ein Begriff von Würde vorgestellt, der sich nicht auf den Begriff des Respekts vor der Autonomie von Personen reduzieren lässt. Anhand der Diskussion um ein Sterben in Würde soll auch deutlich (...) werden, dass auf den Begriff der Würde auch in der Medizinethik nicht verzichtet werden kann. (shrink)

Der libertäre Paternalismus befürwortet Eingriffe in die Entscheidungsfindung von Bürgern, ohne ihnen Optionen völlig nehmen zu wollen. Vielmehr soll die Lenkung des Willens durch Schubser geschehen. Im folgenden Beitrag möchte ich zeigen, dass der libertäre Paternalismus auf tönernen Füßen steht. Ich bediene mich dabei des polemischen Bilds von Quacksalbern. Dieses Bild passt zu meinem argumentativen Vorgehen, da ich erstens zeigen will, dass der libertäre Paternalismus falsche Diagnosen über vermeintliche Krankheiten der Willensbildung stellt, und zweitens, dass er die falsche Therapie empfiehlt. (...) Im ersten Teil des Artikels kritisiere ich die Diagnose des libertären Paternalismus, wonach Menschen in ihrer Entscheidungsfindung systematisch fehlschlagen. Die Auswirkungen der zugrundeliegenden psychologischen Forschung werden missinterpretiert und damit vielen menschlichen Entscheidungen eine Art Defekt zugeschrieben. Der zweite Teil des Beitrags hinterfragt die Therapie des libertären Paternalismus. Für entsprechende Interventionen in die Wahlarchitektonik muss Wissen erlangt werden über die Richtung, in welche die Menschen jeweils geschubst werden sollten. Die hier genannte epistemische Aufgabe kann mit den theoretischen Mitteln des libertären Paternalismus nicht gelöst werden. (shrink)

Hospize verstehen sich als Orte einer ganzheitlichen Sterbebegleitung, welche nicht allein die Behandlung körperlicher und psychischer Symptome, sondern auch die soziale und spirituelle Betreuung der Sterbenden beinhaltet. Eine zentrale Bedeutung innerhalb dieser umfassenden Begleitung am Lebensende hat die Idee der Selbstbestimmung. Dem Hospizgast soll ermöglicht werden, im Sinne einer größtmöglichen Autonomie über die eigenen Belange bis zuletzt selbst entscheiden zu können. Diese zentrale Zielsetzung der Hospizarbeit wurde in der Literatur bisher überwiegend in theoretisch-programmatischer Weise thematisiert, es liegen jedoch kaum Untersuchungen (...) zu der Frage vor, wie die Idee der „Selbstbestimmung bis zuletzt“ im Alltag der Hospize praktisch umgesetzt wird. Über die besonderen Umstände der Pflege in stationären Hospizen hinaus ist der hier zugrunde gelegte Begriff von Autonomie auch von grundsätzlichem medizinethischen Interesse. Das ganzheitlich-palliative Konzept von Behandlung und Pflege, welches bereits im Hospiz als Institution fest verankert ist, legt nahe, dass die Idee der Selbstbestimmung in diesem Umfeld anders konzeptualisiert wird als im Bereich der „klassischen“, zumeist kurativ orientierten Medizin. Die qualitative Interviewstudie mit haupt- und ehrenamtlichen Mitarbeiterinnen und Mitarbeitern konnte zeigen, dass in stationären Hospizen ein Konzept von Selbstbestimmung vertreten wird, welches über rein medizinische Entscheidungen weit hinausgeht. Zugleich konnte aber auch herausgearbeitet werden, wo nach Ansicht der Mitarbeiterinnen und Mitarbeiter mögliche Grenzen der Selbstbestimmung des Gastes im Hospiz liegen. (shrink)

Hospize verstehen sich als Orte einer ganzheitlichen Sterbebegleitung, welche nicht allein die Behandlung körperlicher und psychischer Symptome, sondern auch die soziale und spirituelle Betreuung der Sterbenden beinhaltet. Eine zentrale Bedeutung innerhalb dieser umfassenden Begleitung am Lebensende hat die Idee der Selbstbestimmung. Dem Hospizgast soll ermöglicht werden, im Sinne einer größtmöglichen Autonomie über die eigenen Belange bis zuletzt selbst entscheiden zu können. Diese zentrale Zielsetzung der Hospizarbeit wurde in der Literatur bisher überwiegend in theoretisch-programmatischer Weise thematisiert, es liegen jedoch kaum Untersuchungen (...) zu der Frage vor, wie die Idee der „Selbstbestimmung bis zuletzt“ im Alltag der Hospize praktisch umgesetzt wird. Über die besonderen Umstände der Pflege in stationären Hospizen hinaus ist der hier zugrunde gelegte Begriff von Autonomie auch von grundsätzlichem medizinethischen Interesse. Das ganzheitlich-palliative Konzept von Behandlung und Pflege, welches bereits im Hospiz als Institution fest verankert ist, legt nahe, dass die Idee der Selbstbestimmung in diesem Umfeld anders konzeptualisiert wird als im Bereich der „klassischen“, zumeist kurativ orientierten Medizin. Die qualitative Interviewstudie mit haupt- und ehrenamtlichen Mitarbeiterinnen und Mitarbeitern konnte zeigen, dass in stationären Hospizen ein Konzept von Selbstbestimmung vertreten wird, welches über rein medizinische Entscheidungen weit hinausgeht. Zugleich konnte aber auch herausgearbeitet werden, wo nach Ansicht der Mitarbeiterinnen und Mitarbeiter mögliche Grenzen der Selbstbestimmung des Gastes im Hospiz liegen. (shrink)

The popularity and profitability of American gridiron football is beyond dispute. Recent polls put football as the overwhelming favorite of people who follow at least one sport and huge revenues are reported at both the professional and the university level. We know, however, that what is the case tells us little about what ought to be the case, and it is to the latter question that this paper is directed. I offer a three-pronged attack on the ethical acceptability of American (...) football, both amateur and professional, based on harm to the players, objectification of the players, and harm to others done by the players, leading to the conclusion that the sport, as currently constituted, is morally unacceptable. (shrink)

It is usually thought that wrongful acts of threat-involving coercion are wrong because they involve a violation of the freedom or autonomy of the targets of those acts. I argue here that this cannot possibly be right, and that in fact the wrongness of wrongful coercion has nothing at all to do with the effect such actions have on their targets. This negative thesis is supported by pointing out that what we say about the ethics of threatening (and thus the (...) ethics of coercion) constrains what we can say about the ethics of warning and offering. Importantly, our favoured explanation of the wrongness of certain kinds of threatening should not commit us to condemning as wrong parallel cases of warning and offering. My positive project is to show how this can be done. I defend the claim that wrongful coercion is nothing more than the issuing of a conditional threat to do wrong, and that an agent's issuing of a conditional threat to do wrong is wrong because it constitutes motivation for that agent to adopt the announced intention to do wrong. The idea of explaining the wrongness of wrongful coercion in this way has gone unnoticed because we have thus far been mistaken about what a threat is. In this essay I present my moral analysis of coercion only after presenting a careful descriptive analysis of threats. On my view, it is essential to a threat that the announced intention is one that the agent does not possess before announcing it. This analysis makes it possible to elucidate the descriptive differences between threats, warnings and offers, which sets up the later project of elucidating the moral differences between them. (shrink)

I argue that libertarian paternalism is in fact paternalism, or hard paternalism, rather than a form of soft paternalism. I do so on the basis of an analysis of the paternalist act according to which the paternalist act needn’t violate the will of the agent who is the target of that act and the paternalist actor need only suspect that her action may improve the welfare of that target. The paper considers and rejects interpretations of libertarian paternalism as soft paternalism. (...) I then provide an outline as to how libertarian paternalism may be reformed in light of the finding that current libertarian paternalism is hard paternalism. The proposal is to require that the enactment of libertarian paternalist policies be conditional on opinion polling indicating support for those policies from the agents they target. (shrink)

While there is much literature on autonomy and the conditions for its attainment, there is less on how those conditions reflect on agents’ ordinary careers. Most people’s careers involve a great deal of subservient activity that would prevent the kind of control over agents’ actions that autonomy would seem to require. Yet, it would seem strange to deny autonomy to every agent who regularly follows orders at work—to do so would make autonomy a futile ideal. Most contemporary autonomy accounts provide (...) purely theoretical analysis without reference to any practical goal that autonomy could serve. These accounts are likely to resolve this issue in one direction: either almost entirely including or excluding subservient workers from autonomy. Either solution would fail to distinguish agents who sufficiently control their lives, in spite of limited subservience, according to their own standards, from agents for whom subservience precludes a fulfilling life. I suggest the solution lies in a return to goal-oriented autonomy accounts, which can use the goal to distinguish when subservience overwhelms autonomy from when subservience and autonomy can coexist. I present an account that anchors autonomy in the happiness that it provides for agents who sufficiently control their lives as determined by their more important prudential standards. On this account, agents in subservient careers can be autonomous if they determine how to make their careers consistent with their happiness. (shrink)

The US federal research regulations prohibit informed consent, whether written or oral, from including provisions in which human subjects waive or appear to waive legal rights. We argue that policies that prevent human subjects from waiving legal rights in research can be ethically justified under the rationale of group, soft paternalism. These policies protect competent adults from making adverse decisions about health and legal matters that they may not understand fully. However, this rationale is less defensible if there is a (...) comprehensive compensation for injury programme available in which subjects are asked to waive some legal rights in order to participate in the programme. In this situation, subjects should be allowed to waive some legal rights to obtain the benefits of the programme. (shrink)

Sarah Conly defends paternalistic public health policies, such as New York City’s soft drink ban, on the grounds that they promote values that people accept but have difficulty realizing, owing to their cognitive biases. In this commentary, I criticize Conly’s defense of the soft drink ban and offer my own view of the justification for paternalistic food and beverage policies. I propose that paternalistic government restrictions on food and beverage choices should address a significant health problem pertaining to a specific (...) type or class of food or beverage. There should also be substantial evidence that the restrictions are likely to be effective at dealing with the problem and that alternative ways of dealing with it, which do not involve coercion, are likely to be ineffective. (shrink)

In this article I defend a rule utilitarian approach to paternalistic policies in research with human participants. Some rules that restrict individual autonomy can be justified on the grounds that they help to maximize the overall balance of benefits over risks in research. The consequences that should be considered when formulating policy include not only likely impacts on research participants, but also impacts on investigators, institutions, sponsors, and the scientific community. The public reaction to adverse events in research (such as (...) significant injury to participants or death) is a crucial concern that must be taken into account when assessing the consequences of different policy options, because public backlash can lead to outcomes that have a negative impact on science, such as cuts in funding, overly restrictive regulation and oversight, and reduced willingness of individuals to participate in research. I argue that concern about the public reaction to adverse events justifies some restrictions on the risks that competent, adult volunteers can face in research that offers them no significant benefits. The paternalism defended here is not pure, because it involves restrictions on the rights of investigators in order to protect participants. It also has a mixed rationale, because individual autonomy may be restricted not only to protect participants from harm but also to protect other stakeholders. Utility is not the sole justification for paternalistic research policies, since other considerations, such as justice and respect for individual rights/autonomy, must also be taken into account. (shrink)

El propósito central de este ensayo consiste en contextualizar el debate contemporáneo entre la abolición de la prostitución o la regulación el trabajo sexual en la dinámica de un humanitarismo sexual altamente sentimentalizado. El texto muestra, en primer lugar, que la compasión —como fuerza central que mueve al humanitarismo sexual a “rescatar” a las víctimas de explotación sexual— no es necesariamente, como sostienen algunos, una fuerza que silencia a quien la recibe. Las diferencias de contexto y de dinámicas políticas, pueden (...) determinar que, en ciertas ocasiones, la compasión efectivamente silencie, mientras que en otras puede dar lugar a dinámicas sociales verdaderamente emancipatorias. El artículo propone, así, que, en cada caso concreto en que aparece la compasión como fuerza movilizadora, se haga un análisis pragmático de los costos y beneficios de este uso. En segundo lugar, el ensayo traslada el marco conceptual anterior a la discusión constitucional sobre la prostitución y el trabajo sexual en Colombia y muestra cómo ésta ocurre en un terreno dominado por un humanitarismo sexual compasivo que ha determinado la “sentimentalización” de los valores de dignidad, autonomía e igualdad. Un análisis pragmático de la jurisprudencia de la Corte Constitucional colombiana sobre prostitución, trabajo sexual y tráfico de personas permite concluir, al menos provisionalmente, que la señalada sentimentalización constitucional sustenta, de manera simultánea, el proyecto político de la regulación del trabajo sexual y el de la abolición de la prostitución. (shrink)

The idea that research with human participants should benefit society has become firmly entrenched in various regulations, policies, and guidelines, but there has been little in-depth analysis of this ethical principle in the bioethics literature. In this paper, I distinguish between strong and weak versions and the social benefits principle and examine six arguments for it. I argue that while it is always ethically desirable for research with human subjects to offer important benefits to society, the reasonable expectation of substantial (...) public benefit should be a necessary condition for regarding research as ethical only when it imposes more than minimal risks on non-consenting subjects; or it is supported by public resources. (shrink)

This article considers and criticizes criminal law‘s assumption of the moral autonomy of individuals, showing how that view rests on questionable and obscure Kantian commitments about the self, and proposes a naturalistic alternative developed through a synthetic reading of Adorno‘s and Bhaskar‘s account of the subject in relation to nature and society. As an embodied, emergent, changing subject whose practically rational powers are emergent, polymorphous, and contingent, the subject‘s moral autonomy is dependent on the conditions for experiences of solidarity in (...) four-planar nature. This view makes criminal theory‘s Autonomy Assumption look deeply questionable; autonomy must be a complex, nuanced open question, not an abstract, a priori default assumption. (shrink)

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this (...) article I focus on claims of coercion, examining nudges within two of the main approaches to coercion—the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature. (shrink)

In a recent paper, Schaefer et al. proposed to enhance autonomy via improving reasoning abilities through cognitive enhancement [1]. While initially their idea additionally seems to elegantly avoid objections against genetic enhancements based on the value of autonomy, we want to draw attention to several problems their approach poses. First, we will show that it is not at all clear that safe and meaningful methods to genetically or pharmaceutically enhance cognition will be feasible any time soon. Second, we want to (...) provide a deeper discussion of the role of cognition and reasoning abilities in philosophical concepts of autonomy, as discussed in the mentioned paper. In doing so, we wish to demonstrate that using reasoning abilities as the common denominator in different accounts of autonomy in the context of enhancement does not do justice to the highly complex interrelations between cognition, reasoning abilities and autonomy. Neither should this way of arguing be accepted as a basis to call for practical outcomes, such as funding research into e. g. genetic cognitive enhancements, if the examined concepts of autonomy are taken seriously. (shrink)

This essay first discusses the three major arguments in favor of euthanasia and physician-assisted-suicide in contemporary Western society, viz ., the arguments of mercy, preventing indignity, and individual autonomy. It then articulates both Confucian consonance and dissonance to them. The first two arguments make use of Confucian discussions on suicide whereas the last argument appeals to Confucian social-political thought. It concludes that from the Confucian moral perspectives, none of the three arguments is fully convincing.

A primary goal of clinical practice is to respect patient autonomy. To promote this goal for patients who have lost the ability to make their own decisions, commentators recommend that surrogates make their treatment decisions based on the substituted judgment standard. This standard is commonly interpreted as directing surrogates to make the decision the patient would have made in the circumstances, if the patient were competent. However, recent commentators have argued that this approach—attempting to make the decision the patient would (...) have made if competent—is theoretically problematic, practically infeasible, and ignores the interests of the patient9s family and loved ones. These commentators conclude that the substituted judgment standard should be revised significantly, or abandoned altogether. While this response would avoid the cited problems, it also would require substantial changes to clinical practice and would raise significant problems of its own. The present paper thus considers the possibility that the criticisms do not point to problems with the substituted judgment standard itself; instead, they point to problems with the way it is most commonly interpreted. This analysis suggests that the substituted judgment standard need not be dramatically revised or abandoned. Instead, it should be interpreted in a way that effectively promotes respect for the autonomy of incompetent patients. The ‘endorsed life’ interpretation described here helps clinicians and surrogates to achieve this important goal. To clarify this approach, we explain how it differs from three other recently proposed alternatives to the standard interpretation of the substituted judgment standard. (shrink)

The article tries to inquire a third way in normative ethics between consequentialism or utilitarianism and deontology or Kantianism. To find such a third way in normative ethics, one has to analyze the elements of these classical theories and to look if they are justified. In this article it is argued that an adequate normative ethics has to contain the following five elements: (1) normative individualism, i. e., the view that in the last instance moral norms and values can only (...) be justified by reference to the individuals concerned, as its basis; (2) consideration of the individuals’ concerns and interests—aims, desires, needs, strivings—insofar as they have a justificatory function; (3) a pluralism of references of these concerns and hence of moral norms and values to all possible elements of actions; (4) the necessity of a principle of aggregation and weighing with regard to these concerns; (5) finally, as a central principle of aggregation and weighing, the principle of relative reference to self and others, operating as a generalizing meta-principle that guides the application of concrete principles and decisions. (shrink)