Most recent accounts of personal autonomy acknowledge that the social environment a person lives in, and the personal relationships she entertains, have some impact on her autonomy. Two kinds of conceptualizing social conditions are traditionally distinguished in this regard: Causally relational accounts hold that certain relationships and social environments play a causal role for the development and on-going exercise of autonomy. Constitutively relational accounts, by contrast, claim that autonomy is at least partly constituted by (...) a person’s social environment or standing. The central aim of this paper is to raise the question how causally and constitutively relational approaches relate to the fact that we exercise our autonomy over time. I argue that once the temporal scope of autonomy is opened up, we need not only to think differently about the social dimension of autonomy. We also need to reconsider the very distinction between causally and constitutively relational accounts, because it is itself a synchronic (and not a diachronic) distinction. (shrink)

This article is an exploration of how the concept of relational autonomy might be applied in practice. The discussion uses the example of breast cancer nursing as a lens through which to consider how a view of autonomy as relational might affect the ways in which practitioners work with their clients.

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy (...) must incorporate patients’ competence (apart from decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, (...) including self-conception, self-worth, memory, and the imagination. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy (...) needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

Abstract This paper examines a convergence between Heidegger's reconceptualization of subjectivity and intersubjectivity and some recent work in feminist philosophy on relational autonomy. Both view the concept of autonomy to be misguided, given that our capacity to be self-directed is dependent upon our ability to enter into and sustain meaningful relationships. Both attempt to overturn the notion of a subject as an isolated, atomistic individual and to show that selfhood requires, and is based upon, one's relation to (...) and dependence upon others. The paper argues that Heidegger's notion of authentic Mitsein (being-with) rejects traditional notions of autonomy and subjectivity in favor of a relational model of selfhood. Ultimately, it provides a new point of entry into contemporary debates within feminist philosophy on Heidegger's thinking and defends Heidegger from certain feminist critiques. (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)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced (...) as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (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.

This paper suggests that the contemporary feminist debate on relational autonomy is best understood as an attempt at ameliorative inquiry—the concept of autonomy is defined in order to secure political and theoretical advantages. Most theorists adopt some sort of constructionist, or relational, account precisely because of the political and theoretical advantages relational accounts are meant to offer. But there are also significant drawbacks to this approach. I argue that there are reasons to be skeptical of (...) ameliorative inquiries into the concept of autonomy: first, the goals of inquiry have not been made explicit and may not be shared; second, because ameliorative inquiries are guided by unclear and unshared goals, the debate will continue to pull feminists in conflicting directions; and finally, the normative and aspirational nature of ameliorative inquiry unacceptably threatens the exclusion of some women from the category of autonomous agents. (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)

There has been a marked increase in the active involvement of children and young people in social research. This move is underpinned by rights based arguments that children and young people should have a voice, and that this voice should be listened to. However, concerns have been raised about the appropriateness of children’s and young people’s rights and participation in research. This is primarily due to queries over whether they have enough capacity to enact the individual agency required to be (...) rights holders and participate in research. In addition, a focus on their inherent vulnerability continues to be a key feature of research ethics protocols. In this paper I argue that both capacity and vulnerability should be seen as socially produced, meaning that the scope for capacity to be increased and vulnerability decreased also lies within the social. I draw from notions of relational autonomy or ‘associational presence’ to argue that what children and young people need to be active participants in research is the creation of spaces within which relational agency can be nurtured and sustained. Such techniques and values are found in participatory research approaches and can be used to create such emancipatory environments. (shrink)

Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to (...) exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die. (shrink)

Background: Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers’ perceptions and attitudes, as well as facility policies. Objective: This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient (...) class='Hi'>autonomy in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population. Research Design: The focus is on residents with early to moderate dementia in states of daily dependency on professional caregivers. The article critically examines existing empirical research on sexuality among persons with dementia, caregivers’ attitudes, and institutional roadblocks to enabling residents’ sexuality. A relational lens and insights from disability studies are used in the philosophical analysis. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and normative framework only. Findings: The analysis highlights the delicate balance that capacity assessments for sexual activity have to strike; while caregivers should protect those who cannot give adequate consent, the denial of sexuality among residents can cause deep, long-ranging harms. Sexual agency features into an ongoing sense of self for many individuals with dementia, and the imposition of inappropriate standards and expectations for sexual autonomy can lead to unwarranted obstacles to sexual activity. Discussion: Recommendations include developing clear and inclusive institutional policies and practices of care, providing education for caregivers on how to discuss and document residents’ sexual preferences over time, and taking advantage of ethics consultation services. Conclusion: This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

As scholars integrate empirical approaches to ethical questions in healthcare, relational autonomy theory must inform research design and change practice. Qualitative approaches are well suited to issues where patient values play a central role, and they can be combined with relational autonomy theory to investigate the factors influencing autonomy-rich experiences. This paper draws upon my experience conducting bioethics research related to clinical trial decision-making to develop a systematic method for applying relational autonomy as (...) a theoretical lens to qualitative health research. The resultant practical guide utilizes Susan Sherwin’s theory of relational autonomy and presents an empirical method responsive to autonomy-relevant questions. (shrink)

Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of (...) a principle of respect for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Over the last years, some of Spinoza studies have shifted to a consideration of the relational character of his ethics by focusing on the notion of autonomy. This concept is foreign to Spinoza's vocabulary. Therefore, I will attempt to explain what Spinozan relational autonomy is and its connection with the most important ethical concept in his philosophy: freedom. Following considerations about Spinozan freedom, I claim that it entails a relational character and that, for this reason, (...) it is equal to relational autonomy. We are free when our joint action is based on adequate ideas of what we have in common with others. (shrink)

Drawing from an ethics of care, relational approaches to autonomy have recently emerged in bioethics. Unlike individual autonomy with its emphasis on patients’ rights, choice, and self-determination which has been the hallmark of bioethics consistent with the ideology of individualism in neoliberal democracies in Western countries, relational autonomy highlights the relatedness, interdependency, and social embeddedness of patients. By examining the mediating role that male Hospital Liaison Committee members in Germany play in facilitating care that supports (...) Jehovah's Witnesses’ refusal of blood transfusions, this article moves beyond ‘dyadic relations’ and contexts of caregiving. It also contributes to a deeper understanding of care and relational conceptualizations of Witness patients’ autonomy globally. (shrink)

I want to get both personal and philosophical in this piece. I want to reflect on how my relationship with Sue Sherwin has fostered my own relational autonomy. At the same time, I want to discuss what theories of relational autonomy, like Sue's, add to the bioethics literature on autonomy. With this second objective, I hope to begin clearing up some confusion that I see in this literature about the nature of relational autonomy.Sue (...) was my PhD supervisor, but more than that, she has been my mentor and my role model. I doubt I would still be part of the discipline of philosophy if it weren't for Sue. I came to Dalhousie University as a PhD student in 1995 with a burning love for philosophy but an intense dislike for... (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Conceptions of autonomy in western philosophy and ethics have often centred on self-governance and self-determination. However, a growing bulk of literature also questions such conceptions, including the understanding of the autonomous self as a self-governing independent individual that chooses, acts, and lives in accordance with her or his own values, norms, or sense of self. This article contributes to the critical interrogation of selfhood, autonomy, and autonomous decision making by combining a feminist focus on relational dimensions of (...) selfhood and autonomy with phenomenological philosophy of the embodied self as being-in-the-world. It offers a philosophical investigation of different dimensions of bodily relational autonomy by turning to phenomenological accounts of the lived body as self-reflexive. When so doing, we hope to contribute to bridging the gap that sometimes exists between discussions of autonomy in analytic moral philosophy and of freedom and facticity in phenomenological philosophy. We see this gap as unfortunate, and hold that a nuanced understanding of autonomy and autonomous decision making can be reached if these strands of philosophy are brought into dialogue. (shrink)

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct (...) a concept of informed consent from the perspective of ethics of care which is here called relational autonomy-in-informed consent. Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism. (shrink)

Autonomy, at least in one sense of the term, requires sovereign authority over one’s choices and actions. In this paper, I argue that such authority is relational in at least two respects. First, I argue that sovereign authority may be shared – and, indeed, must be shareable – with others through the exercise of normative powers. Second, I argue that normative powers are themselves relational powers, powers that depend in part on the recognition of agents as having (...) an equal basic authority to exercise such powers in the first place. Drawing on feminist speech-act analyses of silencing and subordination, I examine how failures of uptake for exercises of normative powers compromise personal autonomy. (shrink)

Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social (...) environment inhibits their ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action (...) and decision-making. Descriptively, it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

COVID-19 has turned many ethical principles and presuppositions upside down. More precisely, the principle of respect for autonomy has been shown to be ill suited to face the ethical challenges posed by the current health crisis. Individual wishes and choices have been subordinated to public interests. Patients have received trial therapies under extraordinary procedures of informed consent. The principle of respect for autonomy, at least in its mainstream interpretation, has been particularly questioned during this pandemic. Further reflection on (...) the nature and value of autonomy is urgently needed. Relational autonomy has been proposed as an alternative account of autonomy that can more adequately respond to contemporary ethical issues in general and to a pandemic such as the one we are currently facing in particular. As relational autonomy is an emerging notion in current bioethics, it requires further consideration and development to be properly operationalized. This paper aims to show how six different philosophical branches––namely, philosophy of nature, philosophical anthropology, existential phenomenology, discourse ethics, hermeneutics, and cultural anthropology––have incorporated the category of relation throughout the twentieth century. We first delve into primary philosophical sources and then apply their insights to the specific field of medical ethics. Learning from the historical developments of other philosophical fields may provide illumination that will enable bioethics to experience a successful “relational turn”, which has been partially initiated in contemporary bioethics but not yet achieved. (shrink)

Joseph Raz’s The Morality of Freedom is well known for defending both a perfectionist form of liberalism and an ‘externalist’ conception of autonomy. John Christman proposes that there is a logical connection between the two theses and argues that externalist accounts of autonomy should be rejected on the basis that they are perfectionist. Christman’s perfectionism argument contains two premises: externalist theories of autonomy entail political perfectionism and political perfectionism is not defensible. I argue that neither premise is (...) true. Externalist theories of autonomy do not entail political perfectionism. Further, even assuming for the sake of argument that premise is true, premise is false. The strongest challenge to political perfectionism is that it is incompatible with the value of respect. I argue that those defending political perfectionism misconstrue what is required for respect. Once we see that respect is secured through features inherent in processes, the value of respect can be reconciled with political perfectionism. Political perfectionism is a defensible thesis and premise is false. (shrink)

This article investigates the factors affecting how public relations autonomy, legal dominance, and strategic orientation affect crisis communicative response in corporate contexts. Communication managers, crisis managers, public affairs managers, and/or public relations managers were solicited from Taiwan’s top 500 companies to participate in a survey. The results revealed that, in contrast to public relations autonomy being the strongest and sole predictor of concession strategy, legal dominance could predict defensive and diversionary responses in crisis events. The article concludes with (...) a discussion of practical applications and theoretical implications. (shrink)

The clinical relationship has been underexplored in dementia care. This is in part due to the way that the clinical relationship has been articulated and understood in bioethics. Robert Veatch’s social contract model is representative of a standard view of the clinical relationship in bioethics. But dementia presents formidable challenges to the standard clinical relationship, including ambiguity about when the clinical relationship begins, how it weathers changes in narrative identity of patients with dementia, and how the intimate involvement of family (...) fits alongside a paradigmatically dyadic relationship. Drawing on work in recent feminist theory, a critique is offered of the standard clinical relationship in bioethics as underwritten by an individualistic conception of autonomy. An alternative view of the clinical relationship in dementia, one that embraces a relational account of autonomy, is put forward. (shrink)

The principle of autonomy, through various court rulings, gradually became part of medical practice and tradition in the second half of the 1800s, notably when the emergence of surgical anaesthesia began to raise serious questions regarding informed consent. In fact, surgical anaesthesia was initially used not only to avoid pain but also to combat patients’ resistance to operations.

Hojjat Soofi successfully developed a novel dementia-specific model of human flourishing.1 Based on a modified version of Nussbaum’s account of dignity (ie, the theoretical framework of the capabilities approach), and integrated with Kitwood and Bredin’s empirically informed list of indicators of well-being for people with dementia (ie, the field of empirically informed ethics), this model provides guidance on how to actually care for people with dementia in real-life practices, according to the moral requirements of respect for dignity. More specifically, we (...) deem the contributive value of the model to be threefold. (1) It is a successful specification and contextualisation of Nussbaum’s original list of capabilities in the context of dementia care. (2) The table clearly distinguishes between dementia-specific capabilities and their possibly dementia-related progressive deprivation (ie, the internal conditions), and the possible external setbacks or facilitators for human flourishing. (3) The model is proposed as being open to include new and additional insights from further empirical research on what forms of caregiving do (or do not) align with respect for the dignity of people with dementia. In our commentary, we want to focus on the source of dignity, that is, the locus and starting point of our moral requirements on which the author takes an explicit stance. First of all, by being founded on the list of dementia-specific capabilities, Soofi’s model places the source of our moral requirements of respect for the dignity of people with dementia within the persons themselves, ‘having some of the basis capabilities listed’ (p.6). This, in turn, brings classic discussions concerning a …. (shrink)

The commonplace view of autonomy involves the ability of individuals to be self-governing and self-legislating, and to make freely and reflectively deliberate choices and decisions. This idea of autonomy — that persons are metaphysically free, that is, that they have free will and may use reason to choose how they shall act — is considered to be a defining feature of a responsible person. There is a commonplace view that autonomy is intrinsically good such that overriding it (...) cannot be justified.1 This intrinsic value implies a negative sense of autonomy, which involves non-interference with one’s free choices, as opposed to a positive sense, which involves helping or enabling one to.. (shrink)

Integrates Spinoza's thought into the contemporary debate on interpersonal relationships and individual autonomy The question of how to understand autonomy has emerged as a critical issue in contemporary political philosophy. Feminists and others argue that autonomy cannot be adequately conceived without taking into consideration the ways in which it is shaped by our relationships with others. This collection of 13 new essays shows what Baruch Spinoza can add to our understanding of the relational nature of (...) class='Hi'>autonomy. By offering a relational understanding of the nature of individuals centred on the role played by emotions, Spinoza offers not only historical roots for contemporary debates but also broadens the current discussion. At the same time, reading Spinoza as a theorist of relational autonomy underscores the consistency of his overall metaphysical, ethical and political project, which has been clouded by the standard rationalist interpretation of his works. (shrink)

There is much to learn from and admire in Danielle Wenner's "Nondomination and the Limits of Relational Autonomy." The core claim Wenner advances is that the very concerns that have motivated feminist relational autonomy theorists would be better pursued by foregoing their concern with autonomy and pursuing instead the political aim of promoting a neorepublican conception of freedom as nondomination. While leaving open the possibility that "autonomy speak may remain valuable in some contexts", Wenner (...) nevertheless claims that "for the purposes of understanding and combating relations of oppression and subjection, freedom as nondomination provides a more useful conceptual apparatus than the ideal of... (shrink)

I approach the person in the context of ren and li in dialogue with role ethics and the issue of autonomy. The hypotheses are as follows: first, even if the person...

In recent years, the notion of relational autonomy has transformed the old debate about the freedom of the individual in society. For Spinoza, individual humans are embedded in natural, social and political circumstances from which they derive their power and freedom. I take this to mean that Spinoza’s is best described as a constitutive theory of relational autonomy. I will show how by defining freedom in terms of power, Spinoza understands individual freedom as irreducibly relational. (...) I propose that Spinoza develops his theory of power to understand how individual power or freedom is limited and enhanced by the power of those around one. For Spinoza, the power of an individual is a function of that individual’s emotions, imaginative conceptions of itself and the world and its appetites. In this paper (1) I will argue that Spinoza reformulates a concept of freedom in terms of power. (2) His mature theory of freedom as power proposes that individual power is determined through social interaction, and is thus best understood as a relational theory of freedom. (3) I will show that as a consequence of Spinoza’s theory, individual power and empowerment relies on those around the individual, and thus, to achieve individual liberation we must pursue collective empowerment. (shrink)

Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms (...) and adopted Western led atomistic concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered “content neutral” not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and “operationalize” the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore. (shrink)

This essay examines whether Confucian role ethics offers resources to identify and redress gender inequality and oppression. On its face, Confucian role ethics seems ill suited for this task for two reasons. First, a central tenet of role ethics is that a person is constituted by her roles. Because roles are constituted by norms that govern them, many social roles are, and have been, historically oppressive. Second, discussions of Confucian role ethics tend to avoid talk of autonomy, yet (...) class='Hi'>autonomy is helpful in identifying and rectifying gender inequalities insofar as autonomy tracks the ways oppression disables individuals’ abilities to achieve personhood. My goal in this essay is to work... (shrink)

Susan Sherwin's approach to bioethics promotes more inclusive and less oppressive sociopolitical environments within healthcare for marginalized groups. Sherwin's relational theory of autonomy endorses this aim in targeting live options as bellwethers for recognizing contexts constraining or promoting autonomy. Those contexts closing off certain options as pursuable in practice limit autonomy while those promoting a plurality of practically pursuable courses of action are autonomy enhancing. Attending to what is possible in practice is thus key to (...) understanding how autonomy is impacted. In healthcare contexts, those implicated in social structures systematically limiting autonomy sustain oppressive contexts... (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 59-61, July 2012.