An increase in autonomy and freedom is often considered one ofthe main arguments in favour of a broad use of genetic testing.Starting from Gerald Dworkin's reflections on autonomy and choicethis article examines some of the implications which accompanythe increase in choices offered by prenatal genetic diagnosis.Although personal autonomy and individual choice are importantaspects in the legitimation of prenatal genetic diagnosis, itseems clear that an increase in choice offered by prenatalgenetic diagnosis also leads to various implications (...) that maynegatively influence the freedom of the persons involved. (shrink)

Disabled women were absent for many years from the discipline that has become known as women and gender studies. This field of study had its origins in the late 1970s following the second wave of feminism. In the latter decades of the twentieth century, disabled women and their allies introduced the necessary task of exploring disabled women's embodiment to the wider feminist community. A wealth of research now exists that incorporates disabled women's bodies into a range of disciplines: from literature, (...) film, art, social sciences, geography, and the environment to many other areas of scholarship. Indeed, many of the themes covered in this special issue have been addressed in different contexts in the disciplines .. (shrink)

Although previous work has linked parent autonomy support to the development of children’s executive function skills, the role of specific autonomy-supportive behaviors has not been thoroughly investigated. We compiled data from four preschool-age samples in the Midwestern United States to examine three relevant autonomy-supportive behaviors and their associations with child EF. We coded parent autonomy-supportive behaviors from a 10-min interaction between parent and child dyads working on challenging jigsaw puzzles together. Children completed a battery of EF. (...) Overall, child EF was most consistently correlated with the offering choice subscale. Additionally, only the offering choice subscale predicted child EF while controlling for the other autonomy support subscales and child age. These results suggest that parent provision of choice is an especially relevant aspect of autonomy-supportive parenting and may be important to the development of EF in early childhood. Future research should directly measure children’s experience with choice and how it relates to emerging EF. (shrink)

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that (...) self-testing provides a specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility. (shrink)

This book examines recent forms of secularisation to demonstrate that we are now witnessing a "fourth secularisation": the autonomy of lifestyles. After introducing two initial secularising movements, from mythosto Logosand from Logosto Christianity, the book sets out how from Max Weber onwards a third movement emerged that practised the autonomy of science. More recently, daily life radicalises Weber's secularisation and its scope has spread out to include autonomy of individual practices, which has given rise to this fourth (...) iteration. The book outlines these first three forms of secularisation and then analyses the fourth secularisation in depth, identifying its three main dimensions: the de-institutionalisation of the religious lifestyle; the individualisation of faith; and the development of new social forms in the religious field. These areas of religious practice are shown to be multiplying partly as a result of the general aestheticization of society. Individuals, therefore, aspire to personal styles of life with regard to beliefs and the choice of their own religious practices. This book will be of great use to scholars of religious studies, secularisation and the sociology of religion. own to be multiplying partly as a result of the general aestheticization of society. Individuals, therefore, aspire to personal styles of life with regard to beliefs and the choice of their own religious practices. This book will be of great use to scholars of religious studies, secularisation and the sociology of religion. (shrink)

In Ethics and the Autonomy of Philosophy, Bernard Walker sets out with two objectives. First, Walker argues that ethics is autonomous as a discipline. Oftentimes ethics books, from a Christian perspective, lean toward grounding ethics in theology or in biblical proof texting. Walker departs from this tradition. Ethics grounded in theology entails a limited scope for those doing ethics in that the Christian God must be assumed for both Christian and non-Christian when at the table of ethical dialogue. For (...) the non-Christian, this loads the dice and shuts down ethical consensus and dialogue, if not ethical truth. With that said, this book does not depart from Christian ethical views on such issues as the sanctity of life, antiracism, the death penalty, the objectivity of ethics, and the importance of integrating faith into ethics; however, Walker does so from a common denominator of philosophy rather than theology. Second, Walker ventures into the streets and engages the man/woman on the streets approach to ethics and ethical decision-making. He points out the shortcomings of the ubiquitous views of the man/woman on the streets, viz., cultural relativism, skepticism, and the attitude that ethics is merely a matter of personal choice. (shrink)

Actually possible and conceivable future uses of preimplantation genetic diagnosis (PGD) and germ-line genetic intervention in assisted reproduction seem to offer increasing possibilities of choosing the kind of persons that will be brought to existence. Many are troubled by the idea of these technologies being used for enhancement purposes. How can we make sense of this worry? Why are our thoughts about therapeutic genetic interventions and non-genetic enhancement (for instance education) not accompanied by the same intuitive uneasiness? I argue that (...) the concepts of autonomy and freedom of choice, typically invoked to delimit the morally acceptable uses of reproductive technologies, cannot fully answer these questions. Instead, I suggest that an alternative answer might begin with reflections on the notion of interfering with nature. Drawing on Martin Heidegger’s critique of modern technology and Hans Jonas’s moral philosophy, I outline an argument that attempts to capture what might be particularly troubling about the idea of “designing” future persons. At the core of the argument is the suggestion that enhancing selections and modifications on embryos might be bound up with an instrumentalising, non-responsive perspective on the future persons into which they are intended to grow. (shrink)

Accounts of the value of patient choice in contemporary medical ethics typically focus on the act of choosing. Being the one to choose, it is argued, can be valuable either because it enables one to bring about desired outcomes, or because it is a way of enacting one’s autonomy. This paper argues that all such accounts miss something important. In some circumstances, it is having the opportunity to choose, not the act of choosing, that is valuable. That is (...) because in many situations whether one has, or is denied, that opportunity conveys how one is seen. In particular, it conveys whether or not one is seen as an equal and competent member of society. Adequately recognising this fact has implications for what healthcare professionals should do, ones that require a move away from the current focus on autonomy. The paper draws out these implications by focusing on patients who may struggle to be recognised as competent and equal members of society, and whose autonomy may thus itself sometimes be in question. (shrink)

Background: Personal genomic testing (PGT) offers individuals genetic information about relationships, wellness, sporting ability, and health. PGT is increasingly accessible online, including in emerging markets such as Australia. Little is known about what consumers expect from these tests and whether their reflections on testing resonate with bioethics concepts such as autonomy. Methods: We report findings from focus groups and semi-structured interviews that explored attitudes to and experiences of PGT. Focus group participants had little experience with PGT, while interview participants (...) had undergone testing. Recordings were transcribed and analyzed using thematic analysis. Findings were critically interpreted with reference to bioethics scholarship on autonomy. Results: Fifty-six members of the public participated in seven focus groups, and 40 individuals were interviewed separately. Both groups valued the choice of PGT, and believed that it could motivate relevant actions. Focus group themes centered on the perceived value of choices, knowledge enabling action and knowledge about the self. Interview themes suggest that participants reflexively engage with their PGT information to make meaning, and that some appreciate its shortcomings. Critical interpretation of findings shows that while consumers of PGT are able to exercise a degree of autonomy in choosing, they may not be able to achieve a substantive conceptualization of autonomy, one that promotes alignment with higher-order desires. Conclusions: PGT consumers can critically reason about testing. However, they may uncritically accept test results, may not appreciate drawbacks of increased choice, or may overestimate the potential for information to motivate behavioral change. While consumers appear to be capable of substantive autonomy, they do so without ongoing support from companies. PGT companies promote a problematic (“default”) account of autonomy, reliant on empowerment rhetoric. This leaves consumers vulnerable to making decisions inconsistent with their higher-order desires. As PGT expands, claims about its power and value need to be carefully drawn. (shrink)

Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or (...) women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all. (shrink)

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)

Endgame proposals strive for a tobacco‐free (or at least cigarette‐free) society. Some endgame proposals are radical and include, for example, a complete ban on cigarettes. Setting aside empirical worries, one worry is ethical: would such proposals not go too far in interfering with individual freedom? I argue that concerns around freedom do not speak against endgame proposals, including strong proposals such as a ban on cigarettes. I first argue that when balancing freedom with public health goals in tobacco control, the (...) latter win out. But I also argue that, in principle, a concern with freedom itself already justifies endgame measures. First, such measures can increase people's lifetime freedom, that is, the freedom they have across their entire lives. Second, such measures can facilitate a better interpersonal distribution of freedom by increasing aggregate societal freedom and by reducing inequalities. Overall, freedom does not preclude strict tobacco control but supports it. (shrink)

Individuals use their capacity for autonomy to express preferences regarding food choices. Food choices are fundamental, universal, and reflect a diversity of interests and cultural preferences. Traditionally, autonomy is cast in only epistemic terms, and the social and political dimension of it, where autonomy obstruction tends to arise, is omitted. This reflects problematic limits in the Cartesian notion of the individual. Because this notion ignores context and embodiment, the external and internal constraints on autonomy that extend (...) from social location are not considered. Therefore, reconceptions of the individual and autonomy which emphasize social location and relational interdependency are needed. To combat autonomy obstruction, individuals can appeal to community and community autonomy as a social mechanism. Communities are social groups characterized by people living in places with shared goals. Recognizing their interdependency, individuals can organize as communities in order to accomplish objectives that they cannot on their own. While community autonomy is valuable unto itself, it can also enhance individual autonomy. (shrink)

Individuals’ food choices are intimately connected to their self-images and world views. Some dietary choices adopted by consumers pose restrictions on their use of genetically modified food (GMF). It is quite generally agreed that some kind of labeling is necessary for respecting consumers’ autonomy of choice regarding GMF. In this paper, we ask whether the current practice of mandatory labeling of GMF products in the European Union is a sufficient administrative procedure for respecting consumers’ autonomy. Three issues (...) concerning this question are discussed. First, we argue that labeling needs to be accompanied by relevant and understandable information on genetic modification, genetically modified food, and the European practice of GMF labeling. Second, we claim that this type of informing makes it less likely that consumers start to avoid GMF products just because labels make them suspicious of the products. It is further noted that even though some consumers may react to labels this way, labels do not restrict their autonomy of choice. Third, a need for more precise labels indicating the source of the transferred gene is considered. It is found out that such labels are not morally necessary when also non-GMF products are available and no relevant differences (such as differences in price and healthiness) exist between them and GMF products. However, in some other cases more precise labels may be needed for respecting consumers’ autonomy of choice. (shrink)

Autonomy is fundamental to liberalism. But autonomous individuals often choose to do things that harm themselves or undermine their equality. In particular, women often choose to participate in practices of sexual inequality—cosmetic surgery, gendered patterns of work and childcare, makeup, restrictive clothing, or the sexual subordination required by membership in certain religious groups. In this book, Clare Chambers argues that this predicament poses a fundamental challenge to many existing liberal and multicultural theories that dominate contemporary political philosophy. Chambers argues (...) that a theory of justice cannot ignore the influence of culture and the role it plays in shaping choices. If cultures shape choices, it is problematic to use those choices as the measure of the justice of the culture. Drawing upon feminist critiques of gender inequality and poststructuralist theories of social construction, she argues that we should accept some of the multicultural claims about the importance of culture in shaping our actions and identities, but that we should reach the opposite normative conclusion to that of multiculturalists and many liberals. Rather than using the idea of social construction to justify cultural respect or protection, we should use it to ground a critical stance toward cultural norms. The book presents radical proposals for state action to promote sexual and cultural justice. (shrink)

Kant’s concept of autonomy promises to solve the problem of the actuality of freedom. The latter has actuality as a practical capacity insofar as the will is objectively determined through the form of law. In later writings, however, Kant situates the actuality of freedom in the “absolute spontaneity” of choice, and connects the reality of autonomy itself to the condition of a “radical” act of free choice. The reason for this resides in the fact that his (...) first solution is marked by a certain defect: it does not contain a sufficient concept of the actuality of a practical capacity. This essay elaborates a revised account of Kant’s concept of freedom in light of this insight. The argument is that we need to distinguish force and faculty in order to understand the actuality of a capacity. Only on this basis can we introduce the idea of imagination as a pre-reflexive force of practical reason and the idea of reflective judgment as a power of practical judgment in order to realize how free choice is capable of generating a maxim that has the form of a law spontaneously and of its own accord. In this way, we see that the actuality of freedom necessarily includes the spontaneity of choice, and that human freedom manifests a certain paradoxicality: the university of the will is bound to a subjective ground of determination, to a pre-reflexive act of "radical" choice. (shrink)

Kant’s concept of autonomy promises to solve the problem of the actuality of freedom. The latter has actuality as a practical capacity insofar as the will is objectively determined through the form of law. In later writings, however, Kant situates the actuality of freedom in the “absolute spontaneity” of choice, and connects the reality of autonomy itself to the condition of a “radical” act of free choice. The reason for this resides in the fact that his (...) first solution is marked by a certain defect: it does not contain a sufficient concept of the actuality of a practical capacity. This essay elaborates a revised account of Kant’s concept of freedom in light of this insight. The argument is that we need to distinguish force and faculty in order to understand the actuality of a capacity. Only on this basis can we introduce the idea of imagination as a pre-reflexive force of practical reason and the idea of reflective judgment as a power of practical judgment in order to realize how free choice is capable of generating a maxim that has the form of a law spontaneously and of its own accord. In this way, we see that the actuality of freedom necessarily includes the spontaneity of choice, and that human freedom manifests a certain paradoxicality: the university of the will is bound to a subjective ground of determination, to a pre-reflexive act of "radical" choice. (shrink)

The importance of economic freedom for economic development can no longer be denied. What is often denied, however, is respect for individuals’ rights and personal choices. The role of individual choice is often dismissed or set aside by the development community. In this essay, I argue that inherent to economic freedom’s economic success is the promotion and acceptance of individual choice. Development theory should include recognition of and respect for personal choices, a theory I call “Catfish Man of (...) the Woods” theory of development. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but (...) also authenticity; the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical (...) aspects of preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductive medicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice — paradoxically — can hamper couples' choice. (shrink)

Since Herbert Hart’s “fresh start” encouraged us to interpret legal and political phenomena from an “internal point of view,” and Lon Fuller pointed out the severe constraints upon a conceptually viable construction of this view, jurisprudence has had little choice but to become, methodologically speaking, genuinely and critically sociological. By this, we mean that in breaking with the common-sensical half-truths which produced the imperative or command theory of law, the conceptual problem of modelling the practical rationale of the legal (...) enterprise for the purposes of a general description of the phenomenon as subject matter, has become central and acute. In the past 20 years or so, the sociological awareness of the need to transcend the flux of empirical subjectivity, as well as important recent reinterpretations of the tradition of Natural Law, does seem to put jurisprudence within striking distance of achieving a mature status of integration with the methodology of the social sciences; not merely as some adjunct to, or opportunity for, empirically oriented “social studies,” but, as the source of a genuine epistemological synthesis in the approach to the problem of conceptualising the very subject matter of social science, namely, social action at the institutional level. In terms of concept formation this has gone some way towards the rehabilitation of the idea of “essential” or “focal” viewpoints in contrast to the enthusiasm for the contingencies and relativity of historical, linguistic and cultural conventionalisms. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy (...) in this paper is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly (...) speaking compel people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

This article examines the “Choice Argument” for sweatshops, i.e., the claim that it is morally wrong or impermissible for third parties to interfere with the choice of sweatshop workers to work in sweatshops. The Choice Argument seeks, in other words, to shift the burden of proof onto those who wish to regulate sweatshop labor. It does so by forcing critics of sweatshops to specify the conditions under which it is morally permissible to interfere with sweatshop workers’ (...) class='Hi'>choice. My aim in this article is to meet that burden. Unlike other critics of sweatshop labor, however, my argument does not proceed from contested economic or moral assumptions. To the contrary, my strategy will be to demonstrate that even if we grant the truth of the economic and moral assumptions made by defenders of the Choice Argument, it never- theless does not follow that it is morally wrong to interfere with the choice of sweatshop workers to work in sweatshops. The Choice Argument thus fails on its own terms. (shrink)

A new landscape of prenatal testing is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development (...) supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling. (shrink)

The prelims comprise: Introduction Controversial Choices Kinds of Normative Reasons for Action Limits on Respect for Autonomy Children and Controversial Choice Controversial Choices and the Duty to Strive Toward Perfection and Full Autonomy Acknowledgments Notes References.

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen (...) autonomy and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

In most areas of our lives, legal protections are in place to ensure that we have autonomous control over what happens in and to our bodies. However, there are fewer protections in place for autonomous choice when it comes to the food we purchase and consume. In fact, the current trend in US legislation is pushing us away from autonomous food choice. In this paper, I discuss two examples of this trend: corporate resistance to GM labeling laws and (...) farm protection laws. These examples are quite different from a legislative point of view. In one case, laws that would promote autonomous choice are actively resisted, whereas in the other case, laws that undermine autonomy are enacted. The common core of the two examples is the effect: in both cases, we are unable to determine whether the food we purchase and consume is consistent with our values. In both cases, then, autonomous choice about the food we purchase and put into our bodies is undermined. (shrink)

Probably the main purpose of reproductive technologies is to enable people who choose to do so to avoid the birth of a baby with a disabling condition. However the conditions women want information about and the ‘price’ they are willing to pay for obtaining that information vary enormously. Individual women have to arrive at their own prenatal testing choices by ‘trading off’ means and ends in order to resolve the dilemmas facing them. We know very little about how individuals make (...) these trade-offs, so it is difficult to predict how new technologies will affect their choices and preferences. Uptake decisions can be expected to change, especially in the group of women who now are put off by some aspect of the current screening approach, where the avoidance of miscarriage risk may have provided a kind of ‘psychological shelter’, protecting a lot of people from having to make other decisions. Technologies such as Pre-implantation Genetic Diagnosis may remove a second ‘psychological shelter’ because they offer the means of avoiding the birth of an affected child without terminating a pregnancy. Even if new technologies will make some decisions easier in terms of their cognitive demands, they will also create new dilemmas and decision making will not necessarily become less stressful in emotional terms. Key challenges concern information and decision-making. (shrink)

Savulescu has recently introduced the "rational non-interventional paternalist" model of the patient-doctor relationship. This paper addresses objections to such a model from the perspective of an anaesthetist. Patients need to make their own decisions if they are to be fully autonomous. Rational non-interventional paternalism undermines the importance of patient choice and so threatens autonomy. Doctors should provide an evaluative judgment of the best medical course of action, but ought to restrict themselves to helping patients to make their own (...) choices rather than making such choices for them. (shrink)

Adolescence is an important developmental period marked by a transition from primarily parental-controlled eating to self-directed and peer-influenced eating. During this period, adolescents gain autonomy over their individual food choices and eating behavior in general. While parent-feeding practices have been shown to influence eating behaviors in children, little is known about how these relationships track across adolescent development as autonomy expands. The purpose of this qualitative study was to identify factors that impact food decisions and eating autonomy (...) among adolescents. Using the food choice process model as a guide, four focus groups were conducted with 34 adolescents. Focus group discussion was semi-structured, asking teens about influences on their food choices across different food environments, their involvement with food purchasing and preparation, and perceived control over food their choices. Focus group transcripts were analyzed using deductive and inductive code creation and thematic analysis. This study found six leading influences on adolescents' food choices and identified additional factors with prominence within specific environmental contexts. This study distinguished a broader spectrum of factors influencing adolescent food choice that extend beyond “convenience” and “taste” which have previously been identified as significant contributors. The degree of control that teens reported differed by eating location, occasion, and social context. Finally, adolescents demonstrated various levels of engagement in behaviors related to their eating autonomy. Identifying the emergent themes related to adolescent autonomy was the first step toward the goal of developing a scale to evaluate adolescent eating autonomy. (shrink)

This essay examines the right of health care freedom of choice contained in some state constitutions. It explores how courts have, and could, use this constitutional health care right as a basis for recognizing or reinforcing a fundamental right to choose an abortion.

Although autonomy is clearly still the paradigm in bioethics, there is increasing concern over its value and feasibility. In agreeing with those concerns, I argue that autonomy is not just a status, but a skill, one that must be developed and maintained. I also argue that nearly all healthcare interactions do anything but promote such decisional skills, since they rely upon assent, rather than upon genuinely autonomous consent. Thus, throughout most of their medical lives, patients are socialised to (...) be heteronomous, rather than autonomous. Yet, at the worst possible time – critical care decision-making – when life and death consequences are attached to the choices, the paradigm shifts and real consent is sought, even demanded, thereby making an often traumatic situation even harder.I go on, though, to also reject paternalistic models of beneficence as an alternative. Rather, I conclude that the problem is so fundamental in healthcare that a genuine solution would require a radical restructuring. I recommend steps that can be taken in the interim to improve the situation and to move toward such a restructuring. (shrink)

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for auton omy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty. Patients attempting to choose the (...) best practitioner do not have data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge. The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery sys tem. (shrink)

It is frequently argued that home birth is morally irresponsible because it involves the taking of risks on behalf of the fetus. Against this position, I argue three things. First, the fact that home birth involves risks does not necessarily entail that choosing or attending one is morally unacceptable, irresponsible or wrong. Second, parents have a prima facia prerogative to decide on behalf of their fetuses and children whether risks should be taken. While this prima facia prerogative can be overridden, (...) reasonable and widely accepted criteria for doing so are not met in the case of home birth. Third, since the current attitudes and behaviours of physicians with regard to home birth constitute a de facto morally and socially unjustifiable overriding of an informed parental decision, physician autonomy should be restricted so as to preserve the autonomy of the medical consumer. (shrink)

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people’s health and autonomy in childbirth and argue that this remains crucial (...) during the current emergency. We consider some potential arguments—based on pregnant people’s health and resource allocation—that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital’s ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances. (shrink)

This book explores the steady decline in the status of the individual in recent years and addresses common misunderstandings about the concept of individuality. Drawing from psychology, neuroscience, technology, economics, philosophy, politics, and law, White explains how and why the individual has been devalued in the eyes of scholars, government leaders, and the public. He notes that developments in science have led to doubts about our cognitive competence, while assumptions made in the humanities have led to questions about our moral (...) competence. In this book, White goes on to argue that both of these views are mistaken and that they stem from overly simplistic ideas about how individuals make choices, however imperfectly, in their interests, which are multifaceted and complex. In response, he proposes a new way to look at individuals that preserves their essential autonomy while emphasizing their responsibility to others, inspired by the moral philosophy of Immanuel Kant and the legal and political philosophy reflected in the Bill of Rights to the U.S. Constitution. This book explains how individuality combines both rights and responsibilities, reconciles the popular yet false dichotomy between individual and society, and provides the basis for a humane and respectful civil society and government. This book is part of White's trilogy on the individual and society, which includes The Manipulation of Choice and The Illusion of Well-Being. (shrink)

The prelims comprise: Introduction Types of Gene Selection Issues Relating to Gene Selection and Personal Autonomy Individual Autonomy in a Liberal Society Parental Choice Procreative Autonomy versus Children's Autonomy Conclusion Acknowledgments Note.

An original examination of the relevance of behavioral economics for the practice of medical ethics.

Causal Determinism (CD) entails that all of a person’s choices and actions are nomically related to events in the distant past, the approximate, but lawful, consequences of those occurrences. Assuming that history cannot be undone nor those (natural) relations altered, that whatever results from what is inescapable is itself inescapable, and the contrariety of inevitability and freedom, it follows that we are completely devoid of liberty: our choices are not freely made; our actions are not freely performed. Instead of disputing (...) the soundness of this reasoning, some philosophers prefer to maintain that we could yet have a small measure of freedom were CD true of our world: although being unable to choose or act differently, one could at least under normal circumstances truly claim to be acting ‘on one’s own’, beyond the control of ‘outside forces’, in a word, autonomous. They further argue that being free in this sense suffices for moral responsibility. Call their philosophy ‘Autonomy Compatibilism’ (AC). -/- In adopting here reactive attitudes towards an agent, one is choosing to highlight the fact that the individual in question is of sound mind, reasoning and acting free from the interference of others. These facts alone, the adherent of AC claims, justify his stance, despite the necessity of the agent’s choices. Why would we not regard a sane individual who is not being coerced, intimidated, deceived or unduly put upon as in charge of his life so as to be responsible for his activities? -/- The Manipulation Argument (MA) is supposed to cut off this line of retreat. Its authors hold that, were CD true of our world, we would be no more autonomous than a victim of “covert, non-constraining control” (CNC): manipulation whereby one person causes another, through the use of methods such as brainwashing or circumspect operant conditioning, to ‘do his bidding’ without the latter being aware of his subjugation or feeling in any way coerced. Since a CNC victim obviously lacks autonomy, then so must “persons” living in a deterministic universe. Defenders of AC have, then, the following argument with which to contend: -/- 1. Victims of CNC (obviously) lack autonomy. 2. Thus, AC would be true only if some definition of autonomy succeeds in specifying a freedom relevant difference between victims of CNC and agents whose choices/actions are necessary consequences of prior events. 3. There could be no such definition. 4. Therefore, AC must be false. -/- The challenge issued here is clear: find a way to refute the claim that being subject to natural laws would be tantamount to being a victim of CNC, to show that Nature is no manipulator. Moreover, this challenge cannot be met by responding with a Frankfurt case: a situation in which things have been surreptitiously arranged so that an agent is unable to avoid doing something that he manages to do ‘on his own’, thus, being autonomous despite his inability to act otherwise. For, even if CD is not inconsistent with autonomy because it eliminates the ability to do otherwise per se, it may yet entail that no human agent ever does act of his own accord, an implication of which would be a lack of alternatives on anyone’s part. In other words, the fact that causally determined beings could never act differently than they do does is perhaps only symptomatic of the reason why such beings would lack autonomy: forces beyond their control would have dominion over their psychological development. Thus, AC advocates must show that the way that an agent’s character would be shaped, were she (merely) subject to natural laws, would leave unimpaired an ability that CNC would destroy. What follows is a definition of this ability, which I also use to solve the Problem of Freedom and Foreknowledge. (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)

Nudging is considered a promising approach for behavioural change. At the same time, nudging has raised ethical concerns, specifically in relation to the impact of nudges on autonomous choice. A complexity is that in this debate authors may appeal to different understandings or dimensions of autonomy. Clarifying the different conceptualisations of autonomy in ethical debates around nudging would help to advance our understanding of the ethics of nudging. A literature review of these considerations was conducted in order (...) to identify and differentiate between the conceptualisations of autonomy. In 33 articles on the ethics of nudging, we identified 280 autonomy considerations, which we labelled with 790 unique autonomy codes and grouped under 61 unique super-codes. Finally, we formulated three general conceptualisations of autonomy. Freedom of choice refers to the availability of options and the environment in which individuals have to make choices. Agency involves an individual's capacity to deliberate and determine what to choose. Self-constitution relates to someone's identity and self-chosen goals. In the debate about the ethics of nudging, authors refer to different senses of autonomy. Clarifying these conceptualisations contributes to a better understanding of how nudges can undermine or, on the other hand, strengthen autonomy. (shrink)