In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

Consider that an individual improves her capacities by neuroscientific means. It turns out that, besides altering her in the way(s) she intended, the enhancement also changes her personality in significant way(s) she did not foresee. Yet the person endorses her new self because the neuroenhancement she underwent changed her. Can the person’s approval of her new personality be autonomous? While questions of autonomy have already gathered a significant amount of attention in philosophical literature on human enhancement, the problem just described—henceforth (...) referred to as the question whether selfvalidating neuroenhancement can be autonomous—would not appear to have received due consideration. This article takes a step towards remedying the shortage. I start by explicating the main points of departure of its argument. In the subsequent sections of the article, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with autonomy. On the basis of the consideration, I propose that self-validating neuroenhancement can be autonomous. (shrink)

Human rights theory generally conceptualizes freedom of thought, conscience, religion, and belief as well as freedom of opinion and expression, as offering absolute protection in what is called the forum internum. At a minimum, this is taken to mean the right to maintain thoughts in one’s own mind, whatever they may be and independently of how others may feel about them. However, if we adopt this stance, it seems to imply that there exists an absolute right to hold psychotic delusions. (...) This article takes the position that this conclusion is ethically problematic from the perspective of psychiatric treatment and the rights of persons with psychosis. The article reflects on this particular challenge and sets forth an understanding of freedom in the forum internum that might apply to situations where for various reasons it is not, necessarily accurate to maintain that persons have an absolute right to their own thoughts. For the purpose of proposing such an understanding, the article engages with current debates within human rights theory and political philosophy and analyzes discussions about psychotic delusions and the way in which involuntary treatment is justified. Based on this analysis, this article in turn conceptualizes freedom in the forum internum as ‘negative liberty’, ‘authenticity’, and ‘capability’. This article suggests that when forum internum is redefined as encompassing a right to certain internal capabilities, the right remains meaningful for persons with psychotic delusions as well. (shrink)

In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where issues related (...) to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 42-50, January/February 2022.

Choice architecture is heralded as a policy approach that does not coercively reduce freedom of choice. Still we might worry that this approach fails to respect individual choice because it subversively manipulates individuals, thus contravening their personal autonomy. In this article I address two arguments to this effect. First, I deny that choice architecture is necessarily heteronomous. I explain the reasons we have for avoiding heteronomous policy-making and offer a set of four conditions for non-heteronomy. I then provide examples of (...) nudges that meet these conditions. I argue that these policies are capable of respecting and promoting personal autonomy, and show this claim to be true across contrasting conceptions of autonomy. Second, I deny that choice architecture is disrespectful because it is epistemically paternalistic. This critique appears to loom large even against non-heteronomous nudges. However, I argue that while some of these policies may exhibit epistemically paternalistic tendencies, these tendencies do not necessarily undermine personal autonomy. Thus, if we are to find such policies objectionable, we cannot do so on the grounds of respect for autonomy. (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)

It has recently been pointed out that the cloudiness of the concept of authenticity as well as inflated ideologies of the ‘true self’ provide good reasons to criticize theories and ideals of authenticity. Nevertheless, there are also good reasons to defend an ethical ideal of authenticity, not least because of its critical and oppositional force, which is directed against experiences of self-abandonment and self-alienation. I will argue for an elaborated ethical ideal of authenticity: the ambitious ideal of a continuous self-reflective (...) process of ‘self-authentication’. For this purpose, the ideal of being authentic in expressing and unfolding one’s individual personality and characteristics will be combined with the ideal of being ‘an authentic person’ - whereby ‘a person’ is to be understood in a Kantian sense as an autonomous person who is reasonable and morally responsible. (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)