. Books Received. Ethics, Place & Environment: Vol. 5, No. 3, pp. 295-297.

A new ethics of human finitude developed through three experimental essays. As ethical beings, we strive for lives that are meaningful and praiseworthy. But we are finite. We do not know, so we hope. We need, so we trust. We err, so we forgive. In this book, philosopher John T. Lysaker draws our attention to the ways in which these three capacities—hope, trust, and forgiveness—contend with human limits. Each experience is vital to human flourishing, yet each also poses significant personal (...) and institutional challenges as well as opportunities for growth. Hope, Trust, and Forgiveness explores these challenges and opportunities and proposes ways to best meet them. In so doing, Lysaker experiments with the essay as a form and advances an improvisational perfectionism to deepen and expand our ethical horizons. (shrink)

Engineers are traditionally regarded as trustworthy professionals who meet exacting standards. In this chapter I begin by explicating our trust relationship towards engineers, arguing that it is a linear but indirect relationship in which engineers “stand behind” the artifacts and technological systems that we rely on directly. The chapter goes on to explain how this relationship has become more complex as engineers have taken on two additional aims: the aim of social engineering to create and steer trust between people, and (...) the aim of creating automated systems that take over human tasks and are meant to invite the trust of those who rely on and interact with them. (shrink)

From the perspective of philosophy and political science it is often pointed out that trust is of central value for democracy. The paper critically examines this claim and argues that we should not overestimate the role of trust in democracy. In order to do that, I argue for a specific understanding of the notion of trust that appropriately accounts for the distinction between trust and mere reliance. In a second step, I argue that we have no reason to put this (...) kind of trust in our elected officials and representatives, but should instead focus on legislative and institutional ways to make sure that they are reliable in particular respects. After contrasting my suggestion with the position of Hardin, I point to two advantages of my account: The avoidance of political analysis through the lens of trust allows us to react more flexibly to unforeseen circumstances and resist populist attempts to emotionalize public debates; at the same time, diffusing the tension between trust and civic vigil... (shrink)

A summary of the philosophical literature on trust.

The status quo on parental licensing in most Western jurisdictions is that licensing is required in the case of adoption but not in the case of assisted or unassisted biological reproduction. To have a child via adoption, one must fulfill licensing requirements, which, beyond the usual home study, can include mandatory participation in parenting classes. One is exempt from these requirements, however, if one has a child via biological reproduction, including assisted reproduction involving donor gametes or a contract pregnancy. In (...) an earlier paper, we challenged this system of parental licensing by showing that arguments in favour of it do not succeed. One argument we failed to consider, however, is that prospective biological parents have a right to reproduce that protects them against the sort of state interference that is involved in parental licensing. According to this argument, because prospective adoptive parents do not exercise a similar right when attempting to become parents, they are not similarly protected. In this paper, we argue that this reproductive rights argument, like other arguments in favour of the status quo on parental licensing, is flawed. We also question whether people in fact have a right to reproduce, and in doing so distinguish this right from others that we think are legitimate, including a right to become a parent and a right to bodily autonomy. (shrink)

Nossa seleção de verbetes parte do interesse de cada pesquisador e os dispomos de maneira histórico-cronológica e, ao mesmo tempo, temática. O verbete de Melissa Lane, “Filosofia Política Antiga” vai da abrangência da política entre os gregos até a república e o império, às portas da cristianização. A “Filosofia Política Medieval”, de John Kilcullen e Jonathan Robinson, é o tópico que mais demanda espaço na nossa seleção em virtude das disputas intrínsecas ao período, da recepção de Aristóteles pelo medievo e (...) da tensão entre poder Papal e Civil. No verbete “Liberalismo”, de Gerald Gaus, Shane Courtland e David Schmidtz, vemos as fontes fundantes da Filosofia Política da modernidade. As ideias de liberdade negativa e positiva se coadunam com a Ética Liberal e sua influência sobre a abrangência do valor fundamental da liberdade individual diante das políticas públicas. O texto de Ian Carter, “Liberdade Positiva e Liberdade Negativa”, expõe o paradoxo da liberdade em suas concepções valorativas e neutra, muito úteis para compreender os problemas políticos que enfrentamos hoje. Por fim, Bas Van Der Vossen no texto “Libertarianismo” trata das noções tensas entre Estado e indivíduos. A concepção de “liberdade de si”, genuinamente negativa, ganha destaque justificatório. Jackie Scully, no verbete Bioética Feminista, exemplifica o valor da influência dessas correntes no âmago de todos os contemporâneos. Sua escrita homenageia postumamente Anne Donchin com um apanhado histórico da luta de inserção de políticas feministas na pesquisa acadêmica global. No verbete “Democracia”, os professores brasileiros Gustavo Dalaqua e Alberto Ribeiro Barros acrescentaram tópicos importantes ao tema geral, respectivamente: “Construtivismo Representativo vs. Representação Descritiva” e “Democracia Contestatória de Philip Pettit”. O texto de Thomas Christiano perpassa os principais argumentos de justificação política contra e a favor da democracia ocidental, com foco central nas concepções de liberdade e igualdade. Os verbetes dispostos nessa seleção de textos são tendenciosos na medida que expressam o interesse genuíno de cada pesquisador com os assuntos relevantes em suas pesquisas. Em virtude disso, a escolha “adota um lado” em detrimento de outros – mais especificamente: de outro que poderia ser mais “progressista”. Por si só, o livro já nasce reclamando um segundo volume, que será providenciado. Colocamos de lado qualquer exigência de “imparcialidade”, algo que não existe na Filosofia, muito menos na Filosofia Política. Sobressai, nesse aspecto, o caráter reflexivo que o assunto exige e a importância do assunto, sem o qual não teríamos a modernas concepções de representatividade, as teorias da justiça ou mesmo as ciências sociais. Um outro volume, portanto, se faz imperativo, por conta da abrangência da própria SEP e do respeito a seu projeto inicial, genuinamente um plano plural. (shrink)

This paper aims to provide autonomy-based reasons in favour of limitarianism. Limitarianism affirms it is of primary moral importance that no one gets too much. The paper challenges the standard assumption that having more material resources always increases autonomy. It expounds five mechanisms through which having too much material wealth might undermine autonomy. If these hypotheses are true, a theory of justice guided by a concern for autonomy will support a limitarian distribution of wealth. Finally, the paper discusses two issues (...) autonomy-based limitarianism would raise. First, insofar as coercion invades autonomy, do autonomy-based reasons legitimate coercive measures to secure a limitarian distribution of wealth? Second, is a limitarian ethos consistent with the incentive to produce enough wealth to secure distributive justice? (shrink)

It is common in popular depictions to portray the attitude of trusting and the norms associated with rationality as standing in some kind of tension. In this article, we suggest a way of capturing this tension, and explore some recent attempts at resolving it.

The adoption of web-based telecare services has raised multifarious ethical concerns, but a traditional principle-based approach provides limited insight into how these concerns might be addressed and what, if anything, makes them problematic. We take an alternative approach, diagnosing some of the main concerns as arising from a core phenomenon of shifting trust relations that come about when the physician plays a less central role in the delivery of care, and new actors and entities are introduced. Correspondingly, we propose an (...) applied ethics of trust based on the idea that patients should be provided with good reasons to trust telecare services, which we call sound trust. On the basis of this approach, we propose several concrete strategies for safeguarding sound trust in telecare. (shrink)

The article proposes a reflection on cultural sign production in social contexts dominated by the socially generalized fear of the unknown other and the obsession for vulnerability avoidance. This phenomenon has been reflected in the generalized tendency of reliance upon contractual trust, where the coherence of the signs legitimating a trustful relationship is maintained by external agencies backed by authoritative forums (e.g., religious, legal, political) and sanctioned by well-defined rewards and punishments. In contrast with the contractual model of trust, I (...) propose a different model, covenantal trust. Taking as a point of departure Levinas’s phenomenological interpretation of the responsible self-opening toward the “sign of the giving of signs” which involves covenantal elements, I advance toward proposing a more active involvement of the participants in the process of joint production of signs. This dynamic involvement is made possible thanks to essential elements of the covenant, such as summoning and response. The covenantal approach aims at proposing a semioethical solution to the social challenges emerging from frustrations of members of both marginal and external communities for being treated distrustfully. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 61-62, July 2012.

The aim of this paper is to better qualify the problem of online trust. The problem of online trust is that of evaluating whether online environments have the proper design to enable trust. This paper tries to better qualify this problem by showing that there is no unique answer, but only conditional considerations that depend on the conception of trust assumed and the features that are included in the environments themselves. In fact, the major issue concerning traditional debates surrounding online (...) trust is that those debates focus on specific definitions of trust and specific online environments. Ordinarily, a definition of trust is assumed and then environmental conditions necessary for trust are evaluated with respect to such specific definition. However, this _modus operandi_ fails to appreciate that trust is a rich concept, with a multitude of meanings and that there is still no strict consensus on which meaning shall be taken as the proper one. Moreover, the fact that online environments are constantly evolving and that new design features might be implemented in them is completely ignored. In this paper, the richness of the philosophical discussions about trust is brought into the analysis of online trust. I first provide a set of conditions that depend on the definition of trust that can be assumed and then discuss those conditions with respect to the design of online environments in order to determine whether they can enable (and under which circumstances) trust. (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)

Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by ‘deontological’ considerations: it is claimed (...) that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples—the provision of supervised injection sites and the Housing First policy to address homelessness—to illustrate the argument. (shrink)

Establishing trust among individual agents has defined a central issue of practical reasoning since the dawning of liberal individualism. Hobbes was convinced that foolish self-interest always threatens to defeat uncompelled cooperation when one can gain by abandoning a joint effort. Against this philosophical background, scientific studies of human beings display a surprisingly cooperative species. It would seem to follow that biologically inherited characteristics impair our reason. The response proposed here distinguishes rationality and reasonableness as two forms of good reasoning. One (...) is consistent with the model of strategic rationality, the other with a model of emotional relationship. From the Hobbesian perspective trusting agents are not rational if their makeup discourages advantageous defection even when one knows it will not be detected or punished. The point is indecisive because reasonable trust insulates cooperative action from the factors that have appeared to make it chancy or unstable without some enforcing power. A critical theme is that trust does not simply rest upon a biological disposition to conform to norms. That would explain but not justify aversion to defection. In fact, trust can survive reasoned challenges to norm-conforming dispositions, displaying the responsible social animal living along with the rational individual. (shrink)

In April 2020, close to the start of the first U.K. COVID-19 lockdown, the U.K. government announced the development of a COVID-19 contact tracing app, which was later trialled on the U.K. island, the Isle of Wight, in May/June 2020. United Kingdom surveys found general support for the development of such an app, which seemed strongly influenced by public trust. Institutions developing the app were called upon to fulfil the commitment to public trust by acting with trustworthiness. Such calls presuppose (...) that public trust associated with the app can emerge if the conditions for trustworthiness are met and that public trust is simplistic, i.e., linearly the sum of each member of the publics’ individual – U.K. government trust relationship. Drawing on a synthesis of the trust literature and fifteen interviews with members of the public trialling the app on the Isle of Wight, this paper aims to explore what trust mechanisms and relationships are at play when thinking about public trust in the context of the U.K. COVID-19 app. We argue that public trust is a complex social phenomenon and not linearly correlated with institutional trustworthiness. As such, attention needs to widen from calls for trustworthy infrastructures as a way to build public trust, to a deeper understanding of those doing the trusting; in particular, what or whom do people place their trust in when considering whether using the app and why. An understanding of this will help when trying to secure public trust during the implementation of necessary public health measures. (shrink)

In The Ethics of Care, Virginia Held explores what values of care might fulfil normative criteria for evaluating the moral worth of relations. Held identifies seven potential values: attentiveness, empathy, mutual concern, sensitivity, responsiveness, taking responsibility, and trustworthiness. Though Held’s work is helpful as a starting point for conceptualizing some normative criteria, two problems need addressing. First, Held does not provide sufficient justification for why these potential values ought to be considered genuine values in the care ethical framework. Second, Held (...) overlooks two other potential values cited in the care literature: competence and respect. This paper builds upon Held’s work to offer a more coherent understanding of the values of care. It does so by scrutinizing and conceptually organizing the above nine potential values. Of these nine, only four are considered genuine values: attentiveness, mutual concern, responsiveness, and trustworthiness. It is concluded that good caring relations are those that exemplify the four values of care in their deliverance of caring practices. (shrink)

Secular moral philosophy has devoted little attention to the nature and significance of faith. Perhaps this is unsurprising. The significance of faith is typically thought to depend on the truth of theism, and so it may seem that a careful study of faith has little to offer non-religious philosophy. But I argue that, whether or not theism holds, certain kinds of faith are centrally important virtues, that is, character traits that are morally admirable or admirable from some broader perspective of (...) human flourishing. I discuss three varieties of faith that a virtuous person has in people: faith in herself, faith in people to whom she bears certain personal relationships, and faith in humanity. Coming to understand the nature of these forms of faith and the roles they play in human life promises to deepen our understanding of aspects of moral life and aspects of human flourishing that are poorly grasped. Beyond this, it makes valuable contributions to the literature on self-trust and the literature on epistemic partiality in friendship, and it helps us better understand the relation between our epistemic and practical ideals. (shrink)

Philosophical literature has focused on the concept of trust, but often considers distrust merely as an afterthought. Distrust however, because of its pervasive role in our everyday lives, can be quite damaging. Thus, understanding the rationality of distrust is crucial for understanding our testimonial practices. In this paper I analyze whether it is rational or irrational to distrust an informant on the basis of identity bias. My aim is to show that distrust is irrational when based on negative identity bias. (...) First, I adopt Annalisa Coliva’s account of social hinge epistemology where it is rationally required to assume certain basic presuppositions, such that people are generally reliable informants, to obtain propositional justification and participate in the testimonial practice. Secondly, I show how distrust based on negative identity bias can spread across other domains of interaction and jeopardize the testimonial practice as we fail to assume that people are generally reliable informants. Thirdly, I argue that considering bias as a defeater is beneficial to maintain the claim that bias-based distrust is irrational, as it prevents the acquisition of propositional justification. Finally, I show that distrust is rational when based on evidence and reason that the speaker is not reliable or sincere. (shrink)

This paper sets out an account of trust in AI as a relationship between clinicians, AI applications, and AI practitioners in which AI is given discretionary authority over medical questions by clinicians. Compared to other accounts in recent literature, this account more adequately explains the normative commitments created by practitioners when inviting clinicians’ trust in AI. To avoid committing to an account of trust in AI applications themselves, I sketch a reductive view on which discretionary authority is exercised by AI (...) practitioners through the vehicle of an AI application. I conclude with four critical questions based on the discretionary account to determine if trust in particular AI applications is sound, and a brief discussion of the possibility that the main roles of the physician could be replaced by AI. (shrink)

In this paper we raise the question whether technological artifacts can properly speaking be trusted or said to be trustworthy. First, we set out some prevalent accounts of trust and trustworthiness and explain how they compare with the engineer’s notion of reliability. We distinguish between pure rational-choice accounts of trust, which do not differ in principle from mere judgments of reliability, and what we call “motivation-attributing” accounts of trust, which attribute specific motivations to trustworthy entities. Then we consider some examples (...) of technological entities that are, at first glance, best suited to serve as the objects of trust: intelligent systems that interact with users, and complex socio-technical systems. We conclude that the motivation-attributing concept of trustworthiness cannot be straightforwardly applied to these entities. Any applicable notion of trustworthy technology would have to depart significantly from the full-blown notion of trustworthiness associated with interpersonal trust. (shrink)

In this paper we raise the question whether technological artifacts can properly speaking be trusted or said to be trustworthy. First, we set out some prevalent accounts of trust and trustworthiness and explain how they compare with the engineer’s notion of reliability. We distinguish between pure rational-choice accounts of trust, which do not differ in principle from mere judgments of reliability, and what we call “motivation-attributing” accounts of trust, which attribute specific motivations to trustworthy entities. Then we consider some examples (...) of technological entities that are, at first glance, best suited to serve as the objects of trust: intelligent systems that interact with users, and complex socio-technical systems. We conclude that the motivation-attributing concept of trustworthiness cannot be straightforwardly applied to these entities. Any applicable notion of trustworthy technology would have to depart significantly from the full-blown notion of trustworthiness associated with interpersonal trust. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...) of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

My aim in this paper is to move toward a relational moral theory of harm through examination of a common yet underexplored form of child maltreatment: childhood psychological abuse. I draw on relational theory to consider agential, intrapersonal, and interpersonal ways in which relational harms develop and evolve both in intimate relationships and in conditions of oppression. I set forth three distinctive yet interconnected forms of relational harm that childhood psychological abuse causes: harm to the relational agency of individuals, harm (...) to the relationships individuals hold with themselves, especially with regard to how they respect, know, and trust themselves, and harm to interpersonal relationships of both a direct and indirect nature in present and future timeframes. I close by noting that while relationships can be the site of human brutality that destroys the relational self, paradoxically and promisingly, they also can be a primary means of the relational reconstitution of the self. Ultimately, relational analyses of the harms of childhood psychological abuse reveal several key elements of a relational theory of harm and demonstrate the significance of relational harms for moral philosophy. (shrink)

Robert Baker (2005) has urged that bioethicists develop a code of ethics on several related but distinct grounds: that, based on his analysis of the history of development of other professions, the...

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the way that (...) people usually assume. (shrink)

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. I argue that the referral requirement is justifiable, although not in the way that (...) people usually assume that it is. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

Infertility can be an agonizing experience, especially for women. And, much of the agony has to do with luck: with how unlucky one is in being infertile, and in how much luck is involved in determining whether one can weather the storm of infertility and perhaps have a child in the end. We argue that bad luck associated with being infertile is often bad moral luck for women. The infertile woman often blames herself or is blamed by others for what (...) is happening to her, even when she cannot control or prevent what is happening to her. She has simply had bad luck. We focus on the self-blame of infertile women and show how it stems from pro-natalism that targets women. We also argue that overall for women, regret is a better moral response to infertility than self-blame. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

En los sectores políticos democráticos liberales, el principio del respeto a la autonomía es ampliamente aceptado —en teoría, si no siempre en la práctica— como un valor moral cardinal que debería guiar tanto la deliberación política, la política pública y las prácticas, como nuestras actitudes respecto a nuestros conciudadanos. En términos simples, respetar la autonomía es respetar los intereses de cada persona de vivir su vida según su propia concepción del bien. En la base del requisito normativo de respetar la (...) autonomía de otro está la presunción de que la autonomía confiere autoridad normativa sobre la propia vida; la autoridad para tomar decisiones de importancia práctica para la propia vida, por razones propias, cualesquiera que sean. Se asume que las personas autónomas tienen la capacidad, el derecho y la responsabilidad de ejercer esta autoridad, incluso si no siempre lo hacen sabiamente. (shrink)

In the debates regarding the ethics of human enhancement, proponents have found it difficult to refute the concern, voiced by certain bioconservatives, that cognitive enhancement violates the autonomy of the enhanced. However, G. Owen Schaefer, Guy Kahane and Julian Savulescu have attempted not only to avoid autonomy-based bioconservative objections, but to argue that cognition-enhancing biomedical interventions can actually enhance autonomy. In response, this paper has two aims: firstly, to explore the limits of their argument; secondly, and more importantly, to develop (...) a more complete understanding of autonomy and its relation to cognitive enhancement. By drawing a distinction between the capacity for autonomy and the exercise and achievement of autonomy and by exploring the possible effects of cognitive enhancement on both competence and authenticity conditions for autonomy, the paper identifies and explains which dimensions of autonomy can and cannot, in principle, be enhanced via direct cognitive interventions. This allows us to draw conclusions regarding the limits of cognitive enhancement as a means for enhancing autonomy. (shrink)

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

This article explores egg freezing experiences of women in Turkey. Since 2014, it has been legal in Turkey to use egg freezing technology for ageing women, while it was previously allowed only for disease-related purposes. In cooperation with a private fertility clinic in Istanbul, the authors conducted 21 interviews with older, single women who held either professional or managerial positions and who were undergoing or had undergone the procedure. Drawing on a qualitative analysis of these interviews, the authors explore the (...) social context in which women postpone motherhood and decide to freeze their eggs. The study also looks at the women’s emotional responses to ageing that were triggered by the experience of egg freezing and their narratives of empowerment as a result of the procedure. (shrink)

The majority of current attention on the question of autonomy has focused on the internal reflection of the agent. The quality of an agent’s reflection on her potential action (or motivating desire or value) is taken to determine whether or not that action is autonomous. In this paper, I argue that there is something missing in most of these contemporary accounts of autonomy. By focusing overwhelmingly on the way in which the agent reflects, such accounts overlook the importance of what (...) the agent is reflecting upon. Whichever of these current formulations of autonomy we accept, reflection could be undertaken in full accordance with the conditions set, and yet the action fail to be autonomous. This will occur, I argue, if the agent is mistaken about the object of her reflection. More precisely, if she has a particular kind of false belief about the action she is contemplating undertaking, then no amount of reflection can render that action autonomous. This suggests the need for externalist conditions to be incorporated into an account of autonomy. (shrink)

According to doxastic accounts of trust, trusting a person to \(\varPhi \) involves, among other things, holding a belief about the trusted person: either the belief that the trusted person is trustworthy or the belief that she actually will \(\varPhi \) . In recent years, several philosophers have argued against doxastic accounts of trust. They have claimed that the phenomenology of trust suggests that rather than such a belief, trust involves some kind of non-doxastic mental attitude towards the trusted person, (...) or a non-doxastic disposition to rely upon her. This paper offers a new account of reasons for trust and employs the account to defend a doxastic account of trust. The paper argues that reasons for trust are preemptive reasons for action or belief. Thus the Razian concept of preemptive reasons, which arguably plays a key role in our understanding of relations of authority, is also central to our understanding of relations of trust. Furthermore, the paper argues that acceptance of a preemptive account of reasons for trust supports the adoption of a doxastic account of trust, for acceptance of such an account both neutralizes central objections to doxastic accounts of trust and provides independent reasons supporting a doxastic account. (shrink)

The therapeutic misconception has been seen as presenting an ethical problem because failure to distinguish the aims of research participation from those receiving ordinary treatment may seriously undermine the informed consent of research subjects. Hence, most theoretical and empirical work on the problems of the therapeutic misconception has been directed to evaluate whether, and to what degree, this confusion invalidates the consent of subjects. We argue here that this focus on the understanding component of informed consent, while important, might be (...) too narrow to capture the ethical complexity of the therapeutic misconception. We show that concerns about misplaced trust and exploitation of such trust are also relevant, and ought to be taken into account, when considering why the therapeutic misconception matters ethically. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

I outline a number of parallels between trust and distrust, emphasising the significance of situations in which both trust and distrust would be an imposition upon the (dis)trustee. I develop an account of both trust and distrust in terms of commitment, and argue that this enables us to understand the nature of trustworthiness. Note that this article is available open access on the journal website.

A hallmark of good antenatal care is to respect prospective parent’s choices and provide information in a way that encourages their autonomy and informed decision making. In this paper, we analyse the meaning of autonomous and informed decision making from the theoretical perspective and attempt to show how those concepts are described among prospective parents in early pregnancy and in the public media in a society where NT screening is almost a norm. We use interviews with Icelandic prospective parents in (...) early pregnancy (N = 40) and material covering the discourse around prenatal screening in the media over 5 years period. Our analysis indicates that both prospective parents and the public media include ethical terms in their rhetoric around prenatal screening although those concepts differ in their expression. We conclude that the context in which these decisions are taken does not encourage moral reflection. Prospective parents describe that there is a lack of dialogue with professionals when decisions are made about screening. With routine offer of screening the conceptualization of bioethical concepts finds its own way through a mainstream discourse which has limited connections to the theoretical notions. This has been neglected in the implementation of screening, as limited effort has been subject to audit with reference to explore how the offer of screening and informed choice is experienced among prospective parents. (shrink)

I provide an account of the cognitive attitude of trust that explains the role trust plays in the planning of rational agents. Many authors have dismissed choosing to trust as either impossible or irrational; however, this fails to account for the role of trust in practical reasoning. A can have therapeutic, coping, or corrective reasons to trust B to ${\phi}$ , even in the absence of evidence that B will ${\phi}$ . One can choose to engage in therapeutic trust to (...) inspire trustworthiness, coping trust to simplify one’s planning, or corrective trust to avoid doing a testimonial injustice. To accommodate such types of trust, without accepting doxastic voluntarism, requires an account of the cognitive attitude of trust broader than belief alone. I argue that trust involves taking the proposition that someone will do something as a premise in one’s practical reasoning, which can be a matter of believing or accepting the proposition. I defend this account against objections that it (i) provides insufficient rational constraints on trust, (ii) conflates trust and pretense of trust, and (iii) cannot account for the rationality of back-up planning. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

The conception of conscience that dominates discussions in bioethics focuses narrowly on private regulation of behaviour resulting from explicit attitudes. It neglects to mention implicit attitudes and the role of social feedback in becoming aware of one's implicit attitudes. But if conscience is a way of ensuring that a person's behaviour is in line with her moral values, it must be responsive to all aspects of the mind that influence behaviour. There is a wealth of recent psychological work demonstrating the (...) influence of implicit attitudes on behaviour. A necessary part of having a well-functioning conscience must thus be awareness and regulation of one's implicit attitudes in addition to one's explicit attitudes; this cannot be done by an individual in isolation. On my revised conception of conscience, heeding social feedback, being emotionally self-aware and engaging in self-monitoring are important for the possession of a well-functioning conscience. Health professionals may need specific training to help them develop and maintain a well-functioning conscience, which should involve cultivation of awareness of implicit attitudes, emphasis on social feedback and techniques to enable better control over them. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Reproductive genetic carrier screening is increasingly being offered more widely, including to people with no family history or otherwise elevated chance of having a baby with a genetic condition. There are valid reasons to reject a prevention-focused public health ethics approach to such screening programs. Rejecting the prevention paradigm in this context has led to an emphasis on more individually-focused values of freedom of choice and fostering reproductive autonomy in RCS. We argue, however, that population-wide RCS has sufficient features in (...) common with other public health screening programs that it becomes important also to attend to its public health implications. Not doing so constitutes a failure to address the social conditions that significantly affect people’s capacity to exercise their reproductive autonomy. We discuss how a public health ethics approach to RCS is broader in focus than prevention. We also show that additional values inherent to ethical public health—such as equity and solidarity—are essential to underpin and inform the aims and implementation of reproductive carrier screening programs. (shrink)