In recent times, informed consent has been adopted worldwide as a cornerstone to ensure autonomy during HIV testing. However, there are still ongoing debates on whether the edifice on which informed consent requirements are grounded, that is, personal autonomy, is philosophically, morally, and practically sound, especially in countries where HIV is an epidemic and/or may have a different ontological perspective or lived reality. This study explores the views of participants from Zambia. In-depth and focus group discussions were conducted at various (...) locations in Lusaka and Chongwe, Zambia. Participants came from various demographics, including people living with HIV, healthcare professionals and workers, policymakers, pregnant women, churchgoers, teachers, rural-based persons, and police officers. Data were manually analysed by conducting inductive and deductive thematic analyses. Results show that participants were not in favour of HIV policies that promote personal autonomy at the expense of pursuit of the common good. Participants viewed interdependence, not autonomy, as an essential characteristic of being human. The participants’ views have a realistic potential to provide a contextual and appropriate ethical, respectful, and realistic foundation for HIV testing policies. (shrink)

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal (...) autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

Certain forms of practical deference seem to be incompatible with personal autonomy. I argue that such deference undermines autonomy not by compromising the governance of an authentic self, nor by constituting a failure to track objective reasons, but by constituting a particular social relation: one of interpersonal rule. I analyse this social relation and distinguish it from others, including ordinary relations of love and care. Finally, I argue that the particular form of interpersonal rule constituted by dispositions of practical deference (...) in itself entails a partial, though not total, disconnection from the good of a self-authored life. (shrink)

In this dissertation, I respond to the feminist critique of traditional theories of autonomy, which revolves around the charge that such theories are too individualistic. Feminists argue against the liberal atomism that they see at the center of traditional autonomy theories. Their resulting theory of relational autonomy is meant to remedy that traditional theories of autonomy posit an individualistic conception of both the self and autonomy. Instead, feminists have argued for a theory of autonomy that takes account of the ways (...) in which persons are irreducibly social, and the ways in which autonomy itself is only possible within certain types of social relationships. I separate the feminist charges against liberalism from the feminist charges against traditional autonomy, since it is at least prima facie possible to consider personal autonomy separately from political autonomy. I thus isolate the feminist critique of liberal atomism from the feminist critique of individualistic autonomy. The first chapter examines the feminist critique of liberalism to determine why it is that the charge of liberal atomism continues to stick, even though it has been clearly established by both feminist and mainstream liberals that liberalism is not guilty of such a charge. While I do not provide a full defense of liberalism, I do argue that such a defense is possible, and possible in a way that upholds feminist goals. Having separated the critiques of liberalism from the critiques of traditional autonomy, the rest of the dissertation focuses exclusively on the autonomy debate. I present an argument against the most robustly relational feminist accounts of autonomy those which accept a relational account of both the self and autonomy. I argue that, although such theories are explicitly designed to vindicate the normative commitments of feminism, their implications yield unwelcome results from this very same feminist perspective. I then present my own procedural account of autonomy. Because it is not constitutively social, it is unlikely to be characterized as a relational account at all. I argue, however, that it is this very feature which allows my account to vindicate the feminist normative commitments espoused by constitutively relational accounts. (shrink)