Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous decision-making process? Why make the distinction? Examples are drawn (...) from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed. (shrink)

John Christman has argued that constitutively relational accounts of autonomy, as defended by some feminist theorists, are problematically perfectionist about the human good. I argue that autonomy is constitutively relational, but not in a way that implies perfectionism: autonomy depends on a dialogical disposition to hold oneself answerable to external, critical perspectives on one's action-guiding commitments. This type of relationality carries no substantive value commitments, yet it does answer to core feminist concerns about autonomy.

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and (...) provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative. (shrink)

This article is one of the author’s serial writings to assimilate Ricoeur’s three-fold ethical investigation into various areas of human acts of forgetting, including 1) the therapeutic or pathological area, 2) the pragmatic area, dealing with individual and group’s self-identity in relation to time and otherness, and 3) the more explicitly ethical-political (social and institutional) area, in a wide context. Corresponding to the second area of the Ricoeurian three-fold investigation, this paper probes the ethical dimension of the Zhuangzian forgetfulness of (...) personal identity in relation to time and otherness. It first examines textual materials of the Zhuangzi to navigate on the narrative meanings of forgetting oneself or personal identity, and then delves into three domains of Zhuangzian conception on the forgetting of one’s fixed identity. Finally, it elaborates on the Zhuangzian notion of relational autonomy or agency that underlies the practice of forgetfulness of oneself or personal identity. (shrink)

This article is one of the author’s serial writings to assimilate Ricoeur’s three-fold ethical investigation into various areas of human acts of forgetting, including 1) the therapeutic or patholog...

This paper challenges the view that contentment leads to personal freedom and autonomy and argues for a relational and exercise concept of de facto freedom in the Zhuangzi 莊子. I first review influential interpretations of freedom in the Zhuangzi that equate freedom with contentment and nonfrustration, starting with Guo Xiang's 郭象 (d. 312 CE). By putting these interpretations in dialog with contemporary social philosophy (Christman, Meyers, Pettit, Elster, and Khader), I reflect on the two seminal problems of the psychologizing causal (...) and procedural approaches that allow the interpretation of freedom as contentment: the “happy slave” problem and the “sour grapes” problem. Proving this account of freedom inadequate, I argue for a different interpretation of freedom in the Zhuangzi that resembles a weakly substantive and constitutive account of freedom and autonomy in modern‐day social philosophy terms, such as Marina Oshana's. The theory of freedom that I analyze in the Zhuangzi, however, helps us correct the risk of material determinism of the constitutive account, offering a description of relational freedom and autonomy as constituted by socio‐material conditions but not determined by them. (shrink)

How social media impacts the autonomy of its users is a topic of increasing focus. However, much of the literature that explores these impacts fails to engage in depth with the philosophical literature on autonomy. This has resulted in a failure to consider the full range of impacts that social media might have on autonomy. A deeper consideration of these impacts is thus needed, given the importance of both autonomy as a moral concept and social media as a feature of (...) contemporary life. By drawing on this philosophical literature, we argue that autonomy is broadly a matter of developing autonomy competencies, having authentic ends and control over key aspects of your own life, and not being manipulated, coerced, and controlled by others. We show how the autonomy of users of social media can be disrespected and harmed through the control that social media can have over its users’ data, attention, and behaviour. We conclude by discussing various recommendations to better regulate social media. (shrink)

Social inclusion can refer to the ability of individuals and groups to participate in social activities and the extent to which they feel included and recognized as valuable and able to make contributions. I explore the social inclusion of children in K-12 education (ages 4 - 18), and argue it is vital for the development and exercise of attitudes and capacities such as hope and local autonomy. Since schools are tasked with developing children's skills and knowledge, the extent to which (...) they succeed will play a large role in limiting or enabling children's social inclusion both when they become adults and as children. Children's relationships are an important aspect of their school experiences, as they affect not only whether they feel connected to others but also what they deem to be the grounds of their inclusion. Schools can also equip children with the skills and experiences required for social interactions with others in better and worse ways, fostering children's attitudes towards themselves, others, and the world and affecting whether they think they have the resources to have an impact on their environment and society and can achieve both personal and shared goals. (shrink)

A response to Susan Hekman's article "Reconstituting the Subject: Feminism, Modernism, and Postmodernism" and to her review of Diana T. Meyers' book Self, Society, and Personal Choice both of which appeared in Hypatia 6.

Drawing on recent cognitive theories of the emotions, this article develops an account of critical reflection as requiring emotional flexibility and involving the ability to envisage alternative reasons for action. The focus on the role of emotions in critical reflection, and in agents' resistance to reflection, suggests the need to move beyond an introspective to a more social and relational conception of the process of reflection. It also casts new light on the intractable problem of explaining how oppressive socialisation impairs (...) the capacity for autonomy. (shrink)

Decisions based on ethics confront nurses daily. In this account, a cardiac nurse struggles with the challenge of securing health care benefits for Justin, a patient within the American system of health care. An exercise therapy that is important for his well-being is denied. The patient’s nurse and an interested insurance agent develop a working relationship, resulting in a relational narrative based on Justin’s care. Gadow’s concept of a relational narrative and Keller’s concept of a relational autonomy guide this particular (...) case. As an ethics framework influenced by feminist ethical theory, Gadow’s, Keller’s and Tisdale’s ideas demonstrate the fluidity with which the nurse and others can work while maintaining both autonomy and engagement without being self-sacrificing. (shrink)

Decisions based on ethics confront nurses daily. In this account, a cardiac nurse struggles with the challenge of securing health care benefits for Justin, a patient within the American system of health care. An exercise therapy that is important for his well-being is denied. The patient’s nurse and an interested insurance agent develop a working relationship, resulting in a relational narrative based on Justin’s care. Gadow’s concept of a relational narrative and Keller’s concept of a relational autonomy guide this particular (...) case. As an ethics framework influenced by feminist ethical theory, Gadow’s, Keller’s and Tisdale’s ideas demonstrate the fluidity with which the nurse and others can work while maintaining both autonomy and engagement without being self-sacrificing. (shrink)

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to date. I critically (...) review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates. (shrink)

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. (...) Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter. (shrink)

The extent to which English law remedies injury to autonomy as a stand-alone actionable damage in negligence is disputed. In this article I argue that the remedy available is not only partial and inconsistent but also gendered and discriminatory against women. I first situate the argument within the broader feminist critique of tort law as failing to appropriately remedy gendered harms, and of law more broadly as undervaluing women’s interest in reproductive autonomy. I then show by reference to English remedies (...) law’s first principles how imposed motherhood cases—Rees v Darlington and its predecessor McFarlane v Tayside Health Board—result in gender injustice when compared with other autonomy cases such as Chester v Afshar and Yearworth v North Bristol NHS Trust: A minor gender-neutral ITA is better remedied than the significant gendered harm of imposing motherhood on the claimant; men’s reproductive autonomy is protected to a greater extent than women’s; women’s reproductive autonomy is protected by an exceptional, derisory award. Worst of all, courts refuse to recognise imposed motherhood as detriment; and the deemed, mansplained, nonpecuniary joys of motherhood are used to offset pecuniary upkeep costs, forcing the claimant into a position she sought to avoid and thus further undermining her autonomy. The recent Singaporean case ACB v Thomson Medical Pte Ltd, awarding compensation for undermining the claimant’s genetic affinity in an IVF wrong-sperm-mix-up demonstrates some improvement in comparison to English law, and some shared gender injustices in the context of reproductive autonomy. ACB’s analysis is oblivious to the nature of reproductive autonomy harm as gendered; and prioritises the father’s interest in having genetic affinity with the baby over a woman’s interest in not having motherhood imposed upon her. (shrink)

While care ethics has frequently been criticized for lacking an account of autonomy, this paper argues that care ethics' relational model of moral agency provides the basis for criticizing the philosophical tradition's model of autonomy and for rethinking autonomy in relational terms. Using Diana Meyers's account of autonomy competency as a basis, a dialogical model of autonomy is developed that can respond to internal and external critiques of care ethics.

This paper identifies, develops, and argues for an interpretation of Mary Astell’s understanding of self-government. On this interpretation, what is essential to self-government, according to Astell, is an agent’s responsiveness to her own reasoning. The paper identifies two aspects of her theory of self-government: an “authenticity” criterion of what makes our motives our own and an account of the capacities required for responsiveness to our own reasoning. The authenticity criterion states that when our motives arise from some external source without (...) validation by our own understanding of the reasons supporting them, then they are not our own. The capacities requisite for responsiveness to our own reasoning are those of examining and evaluating our own motives and of resisting the social pressure to conform to others’ opinions. An upshot of this interpretation of Astell’s theory of self-government is that it reveals her insights into the ways “custom” can undermine an individual’s ability to govern oneself. (shrink)

Relational conceptions of autonomy attempt to take into account the social aspects of autonomous agency. Those views that incorporate not merely causally, but constitutively necessary relational conditions, incorporate a condition that has the form: A necessary condition for autonomous agency is that the agent stands in social relations S. I argue that any account that incorporates such a condition cannot play one of autonomy’s key normative roles: identifying those agents who ought to be protected from paternalistic intervention. I argue, against (...) objections from Oshana, that there are good reasons for maintaining the notion of autonomy in this role, and thus that such relational conceptions should not be accepted. This rejection goes beyond that from John Christman, which holds only for those relational conditions which are value-laden. (shrink)

This paper is an attempt to identify certain consonances between contemporary liberalism and classical pragmatism. I identify four of the most trenchant criticisms of classical liberalism presented by pragmatist figures such as James, Peirce, Dewey, Addams, and Hocking: that liberalism overemphasizes negative liberty, that it is overly individualistic, that its pluralism is suspect, that it is overly abstract. I then argue that these deficits of liberalism in its historical incarnations are being addressed by contemporary liberals. Contemporary liberals, I show, have (...) taken on board a surprising number of classical pragmatist insights and have responded to a surprising number of classical pragmatist criticisms. I thus argue that both contemporary pragmatism and contemporary liberalism have much to gain by joining forces. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

European Journal of Philosophy, EarlyView.

Philosophical anarchists have made their living criticizing theories of state legitimacy and the duty to obey the law. The most prominent theories of state legitimacy have been called into doubt by the anarchists' insistence that citizens' lack of consent to the state renders the whole justificatory enterprise futile. Autonomy requires consent, they argue, and justification must respect autonomy. In this essay, I want to call into question the weight of consent in protecting our capacity for autonomy. I argue that if (...) we care about all of the preconditions for autonomy, then we have good reasons to leave the state of nature. This leaves the philosophical anarchist with a dilemma. If she truly cares about autonomy, then she must welcome the state. But if she wants to deny the legitimacy of the state because of the value of consent, then she needs to downplay the moral significance of autonomy in people's lives. If autonomy matters, the state does too. If it doesn't, then consent doesn't. The philosophical anarchist can't have it both ways. (shrink)

According to relational views of autonomy, some social relations or forms of dependence are necessary for autonomous agency. Recent relational theorists have primarily focused on autonomy of action or practical autonomy, and the result has been a shift away from individualistic conceptions of autonomy in the practical realm. Despite these trends, individualistic conceptions are still the default when it comes to autonomy of belief or intellectual autonomy. In this paper, I argue for a relational account of intellectual autonomy. Specifically, I (...) claim that intellectual autonomy requires a sense of one’s standing as an equal member of the epistemic community. (shrink)

In this paper I look at various ways that interpersonal and social relations can be seen as required for autonomy. I then consider cases where those dynamics might play out or not in potentially paternalistic situations. In particular, I consider cases of especially vulnerable persons who are attempting to reconstruct a sense of practical identity required for their autonomy and need the potential paternalist’s aid in doing so. I then draw out the implications for standard liberal principles of paternalism, specifically (...) in clinical or therapeutic situations. The picture of potential paternalism that emerges here is much more of a dynamic, interpersonal scenario rather than a case of two separate individuals making decisions independent of each other. (shrink)

Although depression is among the more common types of mental disorders, it is significantly more common in women than in men. In this article, I draw on feminist analyses of personhood and of autonomy to explain the greater prevalence of depression among women. I argue that such an approach builds on earlier feminist critiques of psychiatry, but provides a more nuanced explanation of how social factors can affect women’s mental health by emphasizing that women with depression are not merely passive (...) victims of oppressive social practices, but rather that these women are actively responding to their environment and interpreting their own experiences. (shrink)

Timothy Brown invites us to think about the ways in which people who are being treated with deep brain stimulation might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators". We agree that it is important to develop conceptual frameworks that (...) both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three... (shrink)

This essay suggests that common themes in recent feminist ethical thought can dislodge the guiding assumptions of traditional theories of free agency and thereby foster an account of freedom which might be more fruitful for feminist discussion of moral and political agency. The essay proposes constructing that account around a condition of normative-competence. It argues that this view permits insight into why women's labor of reclaiming and augmenting their agency is both difficult and possible in a sexist society.

Feminists debate whether women can autonomously embrace their own subordination. Some argue that it is the process of identifying with desires and values that matters; others, that it is the content of the desires and values that matters. In this paper, I introduce a novel class of cases of ‘thwarted autonomy,’ in which women pursue autonomy but in ways that reinforce gendered subordination, and draw on these cases to develop an expressivist view of women’s autonomy. On this view, agents must (...) embody desires and values in the social world if they are to achieve self-understanding, such that the social world mediates the relation-to-self. Oppressive meanings and norms can channel this expressive activity in ways that violate women’s physical integrity and involve self-abnegation that is incompatible with autonomy. (shrink)

To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems that (...) when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question. (shrink)