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)

Controversial and provocative, To Be Real is a blueprint for the creation of a new political force.

As part of the ongoing attempt to fully naturalize the concept of human being--and, more specifically, to re-center it around the notion of agency--this essay discusses an approach to defining the content of representations in terms ultimately derived from their central, evolved function of providing guidance for action. This 'guidance theory' of representation is discussed in the context of, and evaluated with respect to, two other biologically inspired theories of representation: Dan Lloyd's dialectical theory of representation and Ruth Millikan's biosemantics.