The concept of autonomy plays atleast two roles in moral theory. First, itprovides a source of constraints upon action:because I am autonomous you may not interferewith me, even for my own good. Second, itprovides a foundation for moral theory: humanautonomy has been thought by some to producemoral principles of a more general kind.This paper seeks to understand what autonomyis, and whether the autonomy of which we arecapable is able to serve these roles. We wouldnaturally hope for a concept of autonomy (...) thatis value-neutral rather than value-laden. Thatis to say, we would want the judgement that Iam autonomous to depend wholly on, say,structural features of my psychology, and in noway to require us to make ethical judgements, orother value judgements. Being value-neutral isperhaps desirable in a concept of autonomyserving the first role, and plausiblyindispensible in one playing the second. Ishall argue, however, that value-neutral conceptionsof autonomy are impoverished and out of linewith our intuitions; set out and defendan explicitly value-laden conception ofautonomy; and explore the implications of such a view for theability of autonomy to play the rolesmentioned above. (shrink)

This paper examines recent attempts to defend Rule-Consequentialism against a traditional objection. That objection takes the form of a dilemma, that either Rule-Consequentialism collapses into Act-Consequentialism or it is incoherent. Attempts to avoid this dilemma based on the idea that using RC has better results than using AC are rejected on the grounds that they conflate the ideas of a criterion of rightness and a decision procedure. Other strategies, Brad Hooker's prominent amongst them, involving the thought that RC need contain (...) no overarching concern to maximize the good are acknowledged to avoid the original dilemma, but lead to further problems of motivating and justifying RC in the absence of such a concern. The paper argues that Hooker's attempt to deal with these problems by using a 'Reflective Equilibrium plus method is unsuccessful. (shrink)

Many people are uncomfortable with the idea that pleasure from certain sources is genuinely beneficial. These sources can be sorted into two classes: ones that involve others’ pain; and ones that involve what seems to be damage rather than benefit to the person involved. Here’s an example of the latter: a woman who claims that she enjoys her work performing in hard-core pornographic films. Some find it hard to take such a claim at face value – they instinctively assume that (...) the woman is insincere or self-deceived.1 The reason seems a strongly paternalistic one: because the activity is assumed to be bad, it’s thought that only someone who was in some way damaged could genuinely like it. A statement from Brian Hill, the director of a documentary about such women, illustrates this: ‘I felt certain that she couldn’t enjoy what she does, that there must be some reason why she’s undergoing this kind of experience. But there was nothing: no messed-up childhood, no sense of pain or humiliation.’ Forced to conclude that the woman in question really does enjoy her work, Hill changes his view to imply that the pleasure gained cannot be truly beneficial: ‘When I hear a young woman talking about doing videos of fisting and asphyxiation, I have to wonder what it’s doing to her – even if she says that she’s having fun.’. (shrink)

The so-called ‘Humean’ view of motivation is pretty standard in the Philosophy of Mind. Its most prominent contemporary defender, Michael Smith, calls it a ‘dogma’. Humeans believe in a strict divide between beliefs and desires. Beliefs have no intrinsic motivating force: I may believe anything at all, but only with the contribution of a separate desire will I be motivated to act. This claim should be broadened out to include all cognitive states (belief, knowledge…). The Humean claim is that cognitive (...) states are wholly lacking in conative power. If some beliefs seem to us to motivate action, that can only be due to a contingent association with a separate conative state. (shrink)

This paper suggests the adoption of a ‘capability approach’ to key concepts in healthcare. Recent developments in theoretical approaches to concepts such as ‘health’ and ‘disease’ are discussed, and a trend identified of thinking of health as a matter of having the capability to cope with life’s demands. This approach is contrasted with the WHO definition of health and Boorse’s biostatistical account. We outline the ‘capability approach’, which has become standard in development ethics and economics, and show how existing work (...) in those areas can profitably be adapted to healthcare. Cases are used to illustrate the value of adopting a capability approach. (shrink)

This paper argues that the demands of respect for autonomy in the context of biobanking are fewer and more limited than is often supposed. It discusses the difficulties of agreeing a concept of autonomy from which duties can easily be derived, and suggests an alternative way to determine what respect for autonomy in a biobanking context requires. These requirements, it argues, are limited to provision of adequate information and non-coercion. While neither of these is in itself negligible, this is a (...) smaller set of demands than is often suggested. In particular, it is argued here that securing ‘one time consent’ is consistent with respect for autonomy. Finally, the paper notes that while the demands of respect for autonomy may be less than some suppose, respecting autonomy is not the only way in which biobanks and their users may have moral duties to donors. (shrink)