An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians’ reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from (...) this reluctance serve as a useful filter for women who are not seriously committed to their expressed requests for sterilisation. As women already disproportionally bear the birth control burden, less resistance that men might be getting in terms of voluntary sterilisation works to women’s advantage, providing a much needed balance. Societal attitudes towards women and motherhood should not be confused with individual physicians’ reasonable reluctance to jump at a serious elective procedure at fairly mild expression of interest. (shrink)

Approximately 47 percent of women ages fifteen to forty‐four are currently without children, and slightly more than 20 percent of white women in America will never bear children, the highest percentage in modern history. Many fertile women who are childless are voluntarily so. Although any competent person twenty‐one years or older is legally eligible for voluntary sterilization, many doctors refuse to sterilize childfree women. This essay explores various reasons a woman would want to continue in her childfree lifestyle, evaluates (...) the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization—both from the woman's and the physician's perspective—and assesses the legal status of voluntary sterilization for nonparous women. The essay also urges physicians to follow recommended guidelines for counseling women who, regardless of parity, desire sterilization and to provide this contraception if, after careful consideration, there are no outstanding health or other reasons that the procedure should not be performed. (shrink)

This paper addresses and challenges the pronatalist marginalization and oppression of voluntarily childless women in the Global North. These conditions call for philosophical analyses and for sociopolitical responses that would make possible the necessary moral spaces for resistance. Focusing on the relatively privileged subgroups of women who are the targets of pronatalist campaigns, the paper explores the reasons behind their choices, the nature and methods of Western pronatalism, and distinguishes three specific sources of some of the more lasting, and stigmatizing (...) attacks: popular culture, law and policy, and medicine itself. I then argue that because they are construed by motherhood-essentializing, and increasingly popular, pronatalist narratives as, among other things, “failed” or “selfish,” voluntarily childless women are subsequently burdened with damaged identities that can leave them personally othered and uniquely liminal in ways that are destructive to moral agency. Finally, I conclude with a challenge to the pronatalist master narratives by suggesting the possibility of counter narratives to the voluntarily childless woman's liminality that might serve as the ground of moral and political solidarity among differently situated women, regardless of their motherhood status. (shrink)

Evaluating demographical changes in Poland and Europe at the turn of 20th century, researchers more often use the expression „family crisis”. The increase in the number of divorces and in the number of extra-marital births, prevalence of pre-marital cohabitation, as well as its increased acceptance in the society and the increase in the scope of voluntary childlessness make up such an approach to the situation. This article presents and discusses the results of a survey concerning ethical matters of (...) family life conducted in April 2010 amongst students of Lodz’s colleges. The responses were contrasted with the declared influence of Pope John Paul’s II pontificate. A vast majority of students claim to decide upon religious wedding while entering into marriage. They also declare bringing up their potential off springs in catholic tradition. The students of Lodz are also critical of abortion. It needs to be highlighted that in almost all aspects of family life people, who declared a positive influence of the teaching and life of the Polish Pope on their behaviour, more often than others supported the teaching of Roman Catholic Church. On the basis of the conducted survey it may be noticed that the students of Lodz remember about the Polish Pope and his teaching, however, do not support all of his views as far as family life is concerned. Also the majority of the students would say they belong to „the generation of JPII”. (shrink)

This article reports from the first studies on voluntary childlessness in Sweden and addresses a so far neglected issue – the embodied experiences of childfree women. These childfree women reject and resist pronatalist understandings that conflate being a woman with being a mother. However, instead of explaining their childlessness by external factors, mentioned in previous research, the interviewed women created a positive feminine identity separated from motherhood with reference to their ‘silent bodies’, i.e. bodies without a biological (...) urge to reproduce. Reducing voluntary childlessness to a mere result of biological determinism, the article argues, establishes a legitimate, natural position, less provocative and stigmatized in a pronatalist society. Nevertheless, paradoxically, drawing on biological determinism both challenges and reinstates pronatalism as it builds on the simultaneous acceptance of, and detachment from, the biological reproductive urge. The study hence highlights how persistent the social and cultural link between motherhood and womanhood is, but also how this relationship can be challenged. (shrink)

Because many involuntarily childless people have equal interests in benefitting from assisted reproductive technologies like in vitro fertilization as a mode of treatment, we have normative reasons to ensure inclusive access to such interventions for as many of these people as is reasonable and possible. However, the prevailing eligibility criterion for access to assisted reproductive technologies—'infertility'—is inadequate to serve the goal of inclusive access. This is because the prevailing frameworks of infertility, which include medical and social infertility, fail to precisely (...) capture and unify the relevance of certain involuntarily childless experiences as warranting assisted reproductive technology (ART) treatment. I argue that the least we can do for those who have an interest in accessing ARTs is to conceptualize involuntarily childless experiences in dialogue with interactionist and ecological models of disability, to outline a unified and more inclusive eligibility criterion. (shrink)

Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression “involuntary childlessness” to discuss the normative dimensions of people’s inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. (...) My concern in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire. (shrink)

This study casts light on how the issue of childlessness is portrayed in the Bible. The discussion begins with a commentary on Michal’s story, which provides the foundation for further reflection on how childlessness was dealt with in the biblical world, especially in the situations where no miraculous divine solutions were provided. Several humanly devised solutions, acceptable and practiced in the ancient world are presented. The last part of the paper focuses on the more eschatological view of human (...) existence provided in the New Testament, showing that childlessness is a form of suffering included in the promise of redemption brought about by the inauguration of God’s kingdom. As such the response of the redeemed community is to be characterized by love and compassion. (shrink)

The degree of autonomy present in the choices made by individuals with an addiction, notably in the context of research, is unclear and debated. Some have argued that addiction, as it is commonly understood, prevents people from having sufficient decision-making capacity or self-control to engage in choices involving substances to which they have an addiction. Others have criticized this position for being too radical and have counter-argued in favour of the full autonomy of people with an addiction. Aligning ourselves with (...) middle-ground positions between these two extremes, we flesh out an account of voluntary action that makes room for finer-grained analyses than the proposed all-or-nothing stances, which rely on a rather static metaphysical understanding of the nature of the voluntariness of action. In contrast, a dynamic concept of voluntary action better accounts for varying levels of voluntariness of the person with an addiction which takes into consideration internal and external determinants of choice. Accordingly, like other components of autonomous choices such as level of information, voluntariness can fluctuate. Therefore, there are important implications for research and clinical ethics in matters of consent, recruitment, and therapeutic approaches. Overall, our proposal is inspired by a pragmatist understanding of voluntary action, notably with respect to how voluntariness is both informed by actions and experiences that shape one's view of the world. (shrink)

The permissibility of actions depends upon facts about the flourishing and separateness of persons. Persons differ from other creatures in having the task of discovering for themselves, by conjecture and refutation, what sort of life will fulfil them. Compulsory slavery impermissibly prevents some persons from pursuing this task. However, many people may conjecture that they are natural slaves. Some of these conjectures may turn out to be correct. In consequence, voluntary slavery, in which one person welcomes the duty to (...) fulfil all the commands of another, is permissible. Life-long voluntary slavery contracts are impermissible because of human fallibility; but fixed-term slavery contracts should be legally enforceable. Each person has the temporarily alienable moral right to direct her own life. (shrink)

This paper provides an overview of the societal impact of a rising dementia population and examines the legal and ethical implications posed by voluntary registries as a community-oriented solution to improve interactions between law enforcement and individuals with dementia. It provides a survey of active voluntary registries across the United States, with a focus on Arizona, which has the highest projected growth for individuals living with dementia in the country.

Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. (...) Further, for a consent to be normatively valid (“take the wronging out of the act”) under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation. (shrink)

Military activities with the framework of the IDF [Israel Defense Force] is carried out by citizens in a variety of positions. In addition to the ordinary positions of career officers and NCOs, the IDF consists of conscripted men and women as well as reservists. Some of the latter serve under an ordinary command to serve for a certain relatively short period. Other reservists, including pilots and special forces officers have served since they volunteered to serve. Facing the political clash between (...) the government, who have been viewed as trying to change the democratic nature of the state, and the popular opposition, who have tried to protect the judiciary and other elements of democracy, many officers who belong to the latter reservist group have suspended their voluntary service or even retired. Their decision has raised the obvious issue of whether such decisions can be justified, morally, ethically, and democratically. This is the topic of the present paper. (shrink)

We study imagination as reality-oriented mental simulation : the activity of simulating nonactual scenarios in one’s mind, to investigate what would happen if they were realized. Three connected questions concerning ROMS are: What is the logic, if there is one, of such an activity? How can we gain new knowledge via it? What is voluntary in it and what is not? We address them by building a list of core features of imagination as ROMS, drawing on research in cognitive (...) psychology and the philosophy of mind. We then provide a logic of imagination as ROMS which models such features, combining techniques from epistemic logic, action logic, and subject matter semantics. Our logic comprises a modal propositional language with non-monotonic imagination operators, a formal semantics, and an axiomatization. (shrink)

A key question in the theory of migration and in public debates on immigration policies is when migration can be said to be voluntary and when, conversely, it should be seen as nonvoluntary. In a previous article, we tried to answer this crucial question by providing a list of conditions we view as sufficient for migration to be considered nonvoluntary. According to our account, one condition that makes migration nonvoluntary is when people migrate because they lack acceptable alternatives to (...) doing so. In this article, we take the opportunity to further explore and clarify this crucial condition. More specifically, we focus on two main sets of questions. First, we ask whether migration is always voluntary when it serves goals that are voluntarily chosen, and whether those who decide to migrate voluntarily but only have the option of choosing among a limited set of dangerous, harmful, or illegal means for doing so, can be said to be forced to choose those means. Second, we ask whether what counts as “nonacceptable” alternatives should also include cases in which people could have their needs and fundamental rights met, but at the cost of betraying their moral principles or conceptions of the good. (shrink)

The Voluntary Simplicity Movement can be understood broadly as a diverse social movement made up of people who are resisting high consumption lifestyles and who are seeking, in various ways, a lower consumption but higher quality of life alternative. The central argument of this paper is that the Voluntary Simplicity Movement or something like it will almost certainly need to expand, organise, radicalise and politicise, if anything resembling a degrowth society is to emerge in law through democratic processes. (...) In a sentence, that is the 'grass-roots' or 'bottom up' theory of legal and political transformation that will be expounded and defended in this paper. The essential reasoning here is that legal, political and economic structures will never reflect a post-growth ethics of macro-economic sufficiency until a post-consumerist ethics of micro-economic sufficiency is embraced and mainstreamed at the cultural level. (shrink)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active (...) euthanasia. Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (shrink)

This paper examines the extent to which the voluntary adoption of codes of conduct by multinational corporations (MNCs) renders MNCs accountable for the performance of actions specified in a code of conduct. In particular, the paper examines the ways in which codes of conduct coordinate the expectations of relevant parties with regard to the provision of assistance by MNCs on grounds of rescue or justice. The paper argues that this coordinative role of codes of conduct renders MNCs more accountable (...) for the performance of actions specified in a code of conduct than they would be without a code of conduct. This interpretation of the significance of codes of conduct is contrasted with the view that codes of conduct render MNCs accountable for performing actions specified in a code of conduct by grounding contractual obligations for the performance of such actions. (shrink)

I agree with Nachev and Hacker’s general approach. However, their criticism of claims of covert automaticity can be strengthened. I first say a few words on what voluntary action involves and on the consequent limited relevance of brain research for the determination of voluntariness. I then turn to Nachev and Hacker’s discussion of possible covert automaticity and show why the case for it is weaker than they allow.

The concept of voluntariness permeates the ethics and politics of migration and is commonly used to distinguish refugees from migrants. Yet, neither the precise nature and conditions of voluntariness nor its ethical significance for migrant rights and state obligations has received enough attention. The articles in this collection move the debate forward by demonstrating the complex ethical judgments involved in delineating voluntary from forced migration and in drawing out its political and institutional implications. In addition to highlighting the interplay (...) between the voluntary and nonvoluntary elements of migration over time and across different sites of the migration journey, they provide a nuanced account of the various conditions of voluntariness and they challenge common ideas about its normative political consequences. (shrink)

Poor working conditions remain a serious problem in supplier facilities in developing countries. While previous research has explored this from the developed buyers’ side, we examine this phenomenon from the perspective of developing countries’ suppliers and subcontractors. Utilizing qualitative data from a major knitwear exporting cluster in India and a stakeholder management lens, we develop a framework that shows how the assumptions of conventional, buyer-driven voluntary governance break down in the dilution of buyer power and in the web of (...) factors rooted in suppliers’ traditions, beliefs, local demands and resource dependency. We reveal out how success in governing collaborative global supply chains often falls short within the subcontracting stage, where a stakeholder management mindset is elusive to most participants. We suggest that success in governing collaborative global supply chains is dependent on concepts of stakeholder utility and the presence of shared value that is often at odds with the realities of power, information asymmetry and compliance/reward systems inherent in the non-market coordination of global supply chains. Our findings offer important insights for delineating the concepts of value creation from CSR concepts and practices, and for modifying the basic assumptions of conventional supply chain governance. (shrink)

Some maintain that voluntariness is a value-neutral concept. On that view, someone acts involuntarily if subject to a controlling influence or has no acceptable alternatives. I argue that a value-neutral conception of voluntariness cannot explain when and why consent is invalid and that we need a moralized account of voluntariness. On that view, most concerns about the voluntariness of consent to participate in research are not well founded.

I discuss the argument of Persson and Savulescu that moral enhancement ought to accompany cognitive enhancement, as well as briefly addressing critiques of this argument, notably by John Harris. I argue that Harris, who believes that cognitive enhancement is largely sufficient for making us behave more morally, might be disposing too easily of the great quandary of our moral existence: the gap between what we do and what we believe is morally right to do. In that regard, Persson and Savulescu's (...) position has the potential to offer more. However, I question Persson and Savulescu's proposal of compulsory moral enhancement, proposing the alternative of voluntary moral enhancement. (shrink)

In philosophy, economics, and law, the idea of voluntary agreements plays a central role. But contractarianism in political philosophy stands on altogether different grounds from enthusi...

This book chapter aims at exploring how intentional a piece of behavior should be to count as an action, and how a minimal view on action, not requiring a richly intentional causation, may still qualify such a behavior as voluntary.

In an earlier article in this journal I argued that the question of whether heroin addicts can give voluntary consent to take part in research which involves giving them a choice of free heroin does not – in contrast with a common assumption in the bioethics literature – depend exclusively on whether or not they possess the capacity to resist their desire for heroin. In some cases, circumstances and beliefs might undermine the voluntariness of the choices a person makes (...) even if they do possess a capacity for self-control. Based on what I took to be a plausible definition of voluntariness, I argued that the circumstances and beliefs typical of many vulnerable heroin addicts are such that we have good reasons to suspect they cannot give voluntary consent to take part in such research, even assuming their desire for heroin is not irresistible. In a recent article in this journal, Uusitalo and Broers object to this on the grounds that I misdescribe heroin addicts' options set, that the definition of voluntariness on which I rely is unrealistic and too demanding, and, more generally, that my view of heroin addiction is flawed. I think their arguments derive from a misunderstanding of the view I expressed in my article. In what follows I hope therefore to clarify my position. (shrink)

Voluntariness of consent to research has not been sufficiently explored through empirical research. The aims of this study were to develop a more comprehensive approach to assessing voluntariness and to generate preliminary data on the extent and correlates of limitations on voluntariness. We developed a questionnaire to evaluate subjects’ reported motivations and constraints on voluntariness. 88 subjects in five different areas of clinical research—substance abuse, cancer, HIV, interventional cardiology, and depression—were assessed. Subjects reported a variety of motivations for participation. Offers (...) of financial incentives were common but not influential, pressures from others were rare, and no threats were reported. However, certain financial incentives and—paradoxically—altruistic motivations led some subjects to feel more constrained. Consistent with previous studies, no one pattern of motivation was common to all research subjects. There was little evidence of constrained voluntariness, but some suggestion of areas of concern. Voluntariness appears to be susceptible to systematic empirical investigation. (shrink)

I discuss the argument of Persson and Savulescu that moral enhancement ought to accompany cognitive enhancement, as well as briefly addressing critiques of this argument, notably by John Harris. I argue that Harris, who believes that cognitive enhancement is largely sufficient for making us behave more morally, might be disposing too easily of the great quandary of our moral existence: the gap between what we do and what we believe is morally right to do. In that regard, Persson and Savulescu's (...) position has the potential to offer more. However, I question Persson and Savulescu's proposal of compulsory moral enhancement , proposing the alternative of voluntary moral enhancement. (shrink)

This paper examines the relative voluntariness of three types of virtue: ‘epistemic’ virtues like open-mindedness; ‘motivational’ virtues like courage, and more robustly ‘moral’ virtues like justice. A somewhat novel conception of the voluntariness of belief is offered in terms of the limited, but quite real, voluntariness of certain epistemic virtues.

In this paper, I discuss an example from Buchanan of active voluntary euthanasia (AVE). I first refute objections to the intuitive permissibility of the killing described in the example. After explaining why the killing is intentional, I evaluate Buchanan's solution to the ‘problem of intending death’. According to Buchanan, what justifies a physician in intentionally bringing about a patient's death by AVE is a principle that embodies the values of patient self-determination and well-being. I argue that these two considerations (...) are not sufficient for justifying AVE. The motive of the physician matters, but it is his desire rather than his intention that is relevant. An ethical physician may bring about intentionally the death of his patient if in forming his intention, he began with an appropriate desire to keep the patient alive as well as a legitimate desire to prevent prolonged suffering, with the latter outweighing the former. The ethical physician also desires to respect the choice of his patient wherever possible. On my account, the physician should be guided by the virtues and goals of his profession rather than by strict ‘all-or-nothing’ principles. I defend my account by describing the advantages of my account, and dismissing possible objections. (shrink)

Previous research has suggested that bodily signals from internal organs are associated with diverse cortical and subcortical processes involved in sensory-motor functions, beyond homeostatic reflexes. For instance, a recent study demonstrated that the preparation and execution of voluntary actions, as well as its underlying neural activity, are coupled with the breathing cycle. In the current study, we investigated whether such breathing-action coupling is limited to voluntary motor action or whether it is also present for mental actions not involving (...) any overt bodily movement. To answer this question, we recorded electroencephalography (EEG), electromyography (EMG), and respiratory signals while participants were conducting a voluntary action paradigm including self-initiated motor execution (ME), motor imagery (MI), and visual imagery (VI) tasks. We observed that the voluntary initiation of ME, MI, and VI are similarly coupled with the respiration phase. In addition, EEG analysis revealed the existence of readiness potential (RP) waveforms in all three tasks (i.e., ME, MI, VI), as well as a coupling between the RP amplitude and the respiratory phase. Our findings show that the voluntary initiation of both imagined and overt action is coupled with respiration, and further suggest that the breathing system is involved in preparatory processes of voluntary action by contributing to the temporal decision of when to initiate the action plan, regardless of whether this culminates in overt movements. -/- . (shrink)

Many previous treatments of voluntary behavior have viewed intentions as causes of behavior. This has resulted in several dilemmas, including a dilemma concerning the origin of intentions. The present article circumvents traditional dilemmas by treating intentions as constraints that restrict degrees of freedom for behavior. Constraints self-organize as temporary dynamic structures that span the mind-body divide. This treatment of intentions and voluntary behavior yields a theory of intentionality that is consistent with existing findings and supported by current research.

Although euthanasia has been a pressing ethical and public issue, empirical data are lacking in Japan. We aimed to explore Japanese nurses’ attitudes to patients’ requests for euthanasia and to estimate the proportion of nurses who have taken active steps to hasten death. A postal survey was conducted between October and December 1999 among all nurse members of the Japanese Association of Palliative Medicine, using a self-administered questionnaire based on the one used in a previous survey with Australian nurses in (...) 1991. The response rate was 68%. A total of 53% of the respondents had been asked by patients to hasten their death, but none had taken active steps to bring about death. Only 23% regarded voluntary active euthanasia as something ethically right and 14% would practice it if it were legal. A comparison with empirical data from the previous Australian study suggests a significantly more conservative attitude among Japanese nurses. (shrink)

In this paper, I examine Alston's arguments for doxastic involuntarism. Alston fails to distinguish (i) between volitional and executional lack of control, and (ii) between compatibilist and libertarian control. As a result, he fails to notice that, if one endorses a compatibilist notion of voluntary control, the outcome is a straightforward and compelling case for doxastic voluntarism. Advocates of involuntarism have recently argued that the compatibilist case for doxastic voluntarism can be blocked by pointing out that belief is never (...) intentional. In response to this strategy, I distinguish between two types of intentionality and argue that belief is no less intentional than action is. (shrink)

This paper examines the extent to which the voluntary adoption of codes of conduct by multinational corporations (MNCs) renders MNCs accountable for the performance of actions specified in a code of conduct. In particular, the paper examines the ways in which codes of conduct coordinate the expectations of relevant parties with regard to the provision of assistance by MNCs on grounds of rescue or justice. The paper argues that this coordinative role of codes of conduct renders MNCs more accountable (...) for the performance of actions specified in a code of conduct than they would be without a code of conduct. This interpretation of the significance of codes of conduct is contrasted with the view that codes of conduct render MNCs accountable for performing actions specified in a code of conduct by grounding contractual obligations for the performance of such actions. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, (...) depending on the circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised (...) in these two scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. (shrink)

Voluntary acts are preceded by electrophysiological (RPs). With spontaneous acts involving no preplanning, the main negative RP shift begins at about200 ms. Control experiments, in which a skin stimulus was timed (S), helped evaluate each subject's error in reporting the clock times for awareness of any perceived event.

In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised (...) in these two scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. (shrink)

Philosophers have shown little interest in the concept of voluntariness during the last fifty years, mainly because Anscombe's book Intention persuaded us that it plays a relatively minor role in thought about human action, compared to the concept of acting intentionally or acting for a reason, and does not raise any interesting problems of its own, once the nature of intentional action has been explained. But this seems to be wrong. The nature of voluntariness, and its relationship with guilt, coercion, (...) obligation, intention, knowledge and choice, merit careful analysis. This article makes a start. (shrink)