Adaptive preference formation is the unconscious altering of our preferences in light of the options we have available. Jon Elster has argued that this is bad because it undermines our autonomy. I agree, but think that Elster's explanation of why is lacking. So, I draw on a richer account of autonomy to give the following answer. Preferences formed through adaptation are characterized by covert influence (that is, explanations of which an agent herself is necessarily unaware), and covert (...) influence undermines our autonomy because it undermines the extent to which an agent's preferences are ones that she has decided upon for herself. This answer fills the lacuna in Elster's argument. It also allows us to draw a principled distinction between adaptive preference formation and the closely related phenomenon of character planning. (shrink)

Outcome-adaptive randomization has been proposed as a corrective to certain ethical difficulties inherent in the traditional randomized clinical trial using fixed-ratio randomization. In particular, it has been suggested that OAR redresses the balance between individual and collective ethics in favour of the former. In this paper, I examine issues of welfare and autonomy arising in relation to OAR. A central issue in discussions of welfare in OAR is equipoise, and the moral status of OAR is crucially influenced by (...) the way in which this concept is construed. If OAR is based on a model of equipoise that demands strict indifference between competing interventions throughout the trial, such equipoise is disturbed by accruing data favouring one treatment over another; OAR seeks to redress this by weighting randomization to the seemingly superior treatment. However, this is a partial response, as patients continue to be allocated to the inferior therapy. Moreover, it rests upon considerations of aggregate harms and benefits, and does not therefore uphold individual ethics. Issues of fairness also arise, as early and late enrollees are randomized on a different basis. Fixed-ratio randomization represents a fuller and more consistent response to a loss of equipoise, as so construed. With regard to consent, the complexity of OAR poses challenges to adequate disclosure and comprehension. Additionally, OAR does not offer a remedy to the therapeutic misconception—participants’ tendency to attribute treatment allocation in an RCT to individual clinical judgments, rather than to scientific considerations—and, if anything, accentuates rather than alleviates this misconception. In relation to these issues, OAR fails to offer ethical advantages over fixed-ratio randomization. More broadly, the ethical basis of OAR can be seen to lie more in collective than in individual ethics, and overall it fares worse in this territory than fixed-ratio randomization. (shrink)

It is not uncommon for people to suffer identity crises. Yet, faced with similarly disruptive circumstances, some people plunge into an identity crisis while others do not. How must selfhood be construed given that people are vulnerable to identity crises? And how must agency be construed given that some people skirt potential identity crises and renegotiate the terms of their personal identity without losing their equilibrium -- their sense of self? If an adequate theory of the self and agency must (...) be able to account for this capacity to avert identity crises, I argue that it must include an account of agentic corporeity. After explaining what an identity crisis is, I examine Charles Taylor’s and David Velleman’s accounts of identity and agency and argue that their omission of agentic corporeity makes it impossible for them to convincingly account for the ability to avert an identity crisis. In the spirit of Merleau-Ponty’s account of the intentional arc and J. J. Gibson’s account of the relation between corporeity and affordances, I sketch an account of psychocorporeal practical intelligence that includes three main components – psychocorporeal insight, psychocorporeal values, and psychocorporeal versatility. I conclude by connecting my position to Aristotle’s views about practical understanding and by arguing that both Taylor and Velleman have reason to embrace my position. (shrink)

This article argues against Jon Elster’s contention that there is a fundamental incompatibility between, on the one hand, autonomy and rationality, and, on the other hand, adaptation to the conditions of one’s existence in the sense that one’s desires or preferences are adjusted to what it is possible to achieve. It is claimed that Elster’s conclusions are premised on a defective conception of human faculties and powers, including a defective conception of human experience and rationality. Moreover, the claim is (...) made that these defects are also characteristic of “rational choice theory” more generally. (shrink)

This paper argues against Jon Elster's contention that there is a fundamentalincompatibility between, on one hand, autonomy and rationality and, on theother hand, adaptation to conditions of one's existence in the sense that one'sdesires or preferences are adjusted to what it is possible to achieve. While thefirst part of the paper more narrowly concentrated on Elster's discussion ofthese ideas, this second part goes on to a more general discussion of the conceptof rationality. On the basis of this discussion, it (...) is claimed that Elster's conclusionsconcerning autonomy and adaptation are premised on a defective conceptionof human experience and rationality. Moreover, the claim is made that thesedefects are also characteristic of "rational choice theory" more generally. (shrink)

Computational functionalism [5] fails to understand the embodied and situated nature of behaviour by taking steady state functions as theoretical primitives, and by interpreting cognitive behaviour from a language-like, observer dependant framework without a naturalized normativity. Evolutionary functionalism [28, 27], on the other hand, by grounding functional normativity on historical processes fails to give an account of normative functionality based on the present causal mechanism producing behaviour. We propose an alternative autonomous dynamical framework where functionality is defined as contribution to (...) self-maintenance [15, 10, 35] and normativity as satisfaction of closure criteria. We develop this framework by a set of formal definitions in the framework of dynamical system theory and propose the hypothesis of an homeostatic-plasticity [31, 40] based general purpose value system as an internalized normative mechanism that selects between internal state trajectories to produce adaptive functionality under different environmental conditions. To test the hypothesis we develop a simulation model where lower level specifications of a control arquitecture (an homeostatic plastic DRNN) give rise (through a simulated evolutionary process) to adaptive behaviour in a foraging task where food sources can be poisonous or profitable. Analysis of the evolved agent show that plastic changes occur when the agent produces salient adaptive interactions, those plastic changes determining the adaptive strategy. The embodied and interactive adaptive functionality is dynamically analysed, illustrating the autonomous dynamical framework. (shrink)

This volume gathers together previously unpublished articles focusing on the relationship between preference adaptation and autonomy in connection with human enhancement and in the end-of-life context.

Consider a case of a patient receiving life-supporting treatment. With appropriate care the patient could be kept alive for several years. Yet his latest prognosis also indicates that his mental abilities will deteriorate significantly and that ultimately he will become incapable of understanding what happens around and to him. Despite his illness, the patient has been eager to live. However, he finds the prospect that he is now faced with devastating. He undergoes an unconscious process that results in his finding (...) himself with a preference to die. Consequently, he requests his doctor to stop the treatment that she is providing. Other things being equal, standard medical ethics and the legislations of most Western countries allow the doctor to adhere to the patient’s request if it is autonomous. While its origins can be traced back to at least J.S. Mill’s work on women’s rights, unconscious alteration of one’s preferences in light of the options available for one has figured, for example, in recent discussion on female oppression and social choice theory. Yet the topic has not received attention in the debate on voluntary euthanasia. The inattention is unfortunate because the central problem with such adaptation has been taken to be that it undermines personal autonomy. This motivates the main question examined in this chapter, i.e. the problem of whether a request for euthanasia based on an adaptive preference is autonomous. (shrink)

The starting point regarding consent has to be that it is both extremely important, and that it is often suspicious. In this article, the author tries to make sense of both of these claims, from a largely liberal perspective, tying consent, predictably, to the value of autonomy and distinguishing between autonomy as sovereignty and autonomy as nonalienation. The author then discusses adaptive preferences, claiming that they suffer from a rationality flaw but that it's not clear that (...) this flaw matters morally or politically. What matters is whether they suffer from an autonomy flaw. To answer this question, the author develops an account of autonomy failure, according to which a preference is nonautonomous if an injustice played an appropriate role in its causal history. The author then discusses the moral implications—and in an initial way, the political ones as well—of proclaiming a preference, or consent based on it, nonautonomous in this way. (shrink)

(2000). Machines and meaning: Technological autonomy and social adaptation. World Futures: Vol. 55, Challenges of Evolution at the Turn of the Millennium: Part II: The Chllenges of Civilizational Transition, pp. 71-90.

Respect for patient autonomy is a central principle of medical ethics. However, there are important unresolved questions about the characteristics of an autonomous decision, and whether some autonomous preferences should be subject to more scrutiny than others. In this paper, we consider whether _inappropriately adaptive preferences_—preferences that are based on and that may perpetuate social injustice—should be categorised as autonomous in a way that gives them normative authority. Some philosophers have argued that inappropriately adaptive preferences do not (...) have normative authority, because they are only a reflection of a person’s social context and not of their true self. Under this view, medical professionals who refuse to carry out actions which are based on inappropriately adaptive preferences are not in fact violating their patient’s autonomy. However, we argue that it is very difficult to articulate a systematic and principled distinction between normal autonomous preferences and inappropriately adaptive preferences, especially if this distinction needs to be useful for clinicians in real-life situations. This makes it difficult to argue that inappropriately adaptive preferences are straightforwardly non-autonomous. Given this problem, we argue that there are significant theoretical issues with contemporary understandings of autonomy in bioethics. We discuss what this might mean for the practice of medicine and for medical ethics education. (shrink)

People with disabilities often report enjoying a much higher quality of life than people without disabilities would expect. For instance, many people believe that their lives would be much worse if they were to become paraplegic. Indeed, some people believe that life with paraplegia would be barely worth living. Yet many paraplegics report being roughly as happy as able-bodied people. This conflict in attitudes has come to be known as “the disability paradox.” Many psychologists claim that the disability paradox is (...) at least partly explained by affective forecasting errors. Someone makes an affective forecasting error when she makes a mistaken prediction about the effect of some event on her experiential quality of life. Such affective forecasting errors raise moral problems that are especially pressing in the context of medical decision-making. For instance, when a recommended treatment would leave someone disabled, she may refuse on the grounds that she would rather live a shorter life without the disability than a longer life with the disability. Yet it may be that she would feel very differently after adapting to the condition in question. What should we say about such cases? On the one hand, some ethicists have argued that affective forecasting errors compromise autonomy, so that decision-makers should take account of the likelihood that they will adapt. On the other, it may appear that decision-makers should have no regard for adaptive preferences they may form in the future. My central goal in this paper is to argue that both of these views are mistaken. If sound, my arguments suggest that legitimate moral concerns about a subject’s well-being are sometimes misrepresented as concerns about her autonomy. (shrink)

Adaptive preferences have been extensively studied in decision theory and feminist political theory, but not in experimental philosophy. In feminist contexts, the term is used to discuss cases in which women seem to accept abusive treatment and other conditions of oppression. According to one class of theories, women who accept abusive behavior are cognitively deficient: irrational, lacking autonomy, or not acting in accordance with their identity. Other theories deny this, saying that under certain conditions, accepting abuse can be (...) a sound response, given available alternatives. We survey lay opinions about a case in which a woman endures domestic violence and find that people often attribute adaptive attitudes and tend to see them as rational, free, and reflective of identity. We also examine lay normative judgments, including options about the right course of action, and the locus of blame, finding, for example, some tendency to blame the victim in such cases. Such attitudes are impacts by gender and political orientation. We also manipulated the cultural setting of our vignette, but found no impact. (shrink)

Current AI policy recommendations differ on what the risks to human autonomy are. To systematically address risks to autonomy, we need to confront the complexity of the concept itself and adapt governance solutions accordingly.

This study investigated new avenues for understanding the association between parental autonomy support and academic engagement among Chinese secondary vocational students based on Self-Determination Theory and Career Construction Theory. We highlighted the mediator role of career adaptability and career decision-making self-efficacy in the relationship between parental autonomy support and academic engagement. Using self-reported data from 1,930 secondary vocational students in a city in Central China, we performed correlation analysis and mediation analysis by using SPSS and Mplus. The results (...) revealed that parental autonomy support was positively associated with students’ academic engagement. Moreover, as an adaptability resource and adapting response, career adaptability and career decision-making self-efficacy played mediating roles between parental autonomy support and academic engagement. These findings offered crucial empirical evidence for understanding the association between parental support and academic engagement among Chinese secondary vocational students. Meanwhile, it also validated the application of Career Construction Theory in a sample of secondary vocational students in China and provided constructive insights for implementing diverse support measures to boost their academic and career development. (shrink)

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy (...) as a phenomenon, and a moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it. (shrink)

Adaptive preferences give rise to puzzles in ethics, political philosophy, decision theory, and the theory of action. Like our other preferences, adaptive preferences lead us to make choices, take action, and give consent. In 'False Consciousness for Liberals', recently published in The Philosophical Review, David Enoch (2020) proposes a criterion by which to identify when these choices, actions, and acts of consent are less than fully autonomous; that is, when they suffer from what Natalie Stoljar (2014) calls an (...) 'autonomy deficit'. According to Enoch, such actions are not protected in the usual way against interference by others; there is not the same prohibition against trying to prevent someone from acting in a particular way when that action is motivated by such adaptive preferences and is an attempt to satisfy them. In this note, I raise two concerns about Enoch's criterion. (shrink)

Accounts of adaptive preferences are of two kinds: well-being accounts fully theorized for their own sake and political accounts theorized to facilitate the political project of reducing oppression and marginalization. Given their practical role, the latter are often less fully theorized, and are therefore less robust to theoretical criticism. In this paper, I first draw on well-being accounts to identify the well-theorized elements that political accounts should want to adopt in order to strengthen their project and avoid common criticisms. (...) Second, I appeal to the political project to show the shortcomings of the well-being accounts on which I draw. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study (...) was conducted in a professional development course for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

Adaptive preferences are preferences formed in response to circumstances and opportunities – paradigmatically, they occur when we scale back our desires so they accord with what is probable or at least possible. While few commentators are willing to wholly reject the normative significance of such preferences, adaptive preferences have nevertheless attracted substantial criticism in recent political theory. The groundbreaking analysis of Jon Elster charged that such preferences are not autonomous, and several other commentators have since followed Elster’s lead. (...) On a second front, Capacity Theorists Martha Nussbaum and Amartya Sen have objected that adaptive preferences lead people away from objective goods and constitute an impediment to progressive change in developing countries. In this paper I argue that the criticisms of Elster, Sen and Nussbaum fail on the one hand to take into account what may be positively said in favour of this type of preference formation, and fail on the other hand to distinguish between different types of psychological changes – with the result that many of the critiques offered have a narrower purview than is currently allowed. My analysis of adaptive preferences, even in their most ideal form, is however not entirely positive; I adduce reasons why we can be cautious about allowing adaptive preferences to play certain types of roles in political processes, even as we accept those very preferences as normative and autonomous for the agent holding them. [International scholars without access to the AJPAE are invited to email [email protected] for a pdf copy of this article.]. (shrink)

This collection of new essays examines philosophical issues at the intersection of feminism and autonomy studies. Are autonomy and independence useful goals for women and subordinate persons? Is autonomy possible in contexts of social subordination? Is the pursuit of desires that issue from patriarchal norms consistent with autonomous agency? How do emotions and caring relate to autonomous deliberation? Contributors to this collection answer these questions and others, advancing central debates in autonomy theory by examining basic components, (...) normative commitments, and applications of conceptions of autonomy. Several chapters look at the conditions necessary for autonomous agency and at the role that values and norms -- such as independence, equality, inclusivity, self-respect, care and femininity -- play in feminist theories of autonomy. Whereas some contributing authors focus on dimensions of autonomy that are internal to the mind -- such as deliberative reflection, desires, cares, emotions, self-identities and feelings of self-worth -- several authors address social conditions and practices that support or stifle autonomous agency, often answering questions of practical import. These include such questions as: What type of gender socialization best supports autonomous agency and feminist goals? When does adapting to severely oppressive circumstances, such as those in human trafficking, turn into a loss of autonomy? How are ideals of autonomy affected by capitalism? and How do conceptions of autonomy inform issues in bioethics, such as end-of-life decisions, or rights to bodily self-determination? (shrink)

While the concept of adaptive preferences is an important tool for criticizing injustice, it is often claimed that using the concept involves showing disrespect for persons judged to have adaptive preferences. In this paper, I propose an account of adaptive preferences that does the relevant political work while still showing persons two centrally important kinds of respect. My account is based in what I call an indirect substantive account of autonomy, which places substantive requirements on the (...) options available to a person, rather than on the option that she ultimately prefers. This allows us to pinpoint cases in which a person's circumstances have rendered her insufficiently autonomous, without saying that any conception of the good must be non-autonomous tout court. (shrink)

Subjectivism about well-being holds that an object contributes to one's well-being to the extent that one has a pro-attitude toward this object under certain conditions. Most subjectivists have contended that these conditions should be ideal. One reason in favor of this idea is that when people adapt their pro-attitudes to situations of oppression, the levels of well-being they may attain is diminished. Nevertheless, I first argue that appealing to idealized conditions of autonomy or any other condition to erase or (...) replace adaptive pro-attitudes is mistaken. Second, I show that the most natural version of subjectivism that does not appeal to any such idealizing condition can explain why the well-being of people having adaptive pro-attitudes should not be restricted to the fulfillment of these pro-attitudes. In sum, the existence of adaptive preferences does not militate in favor of the introduction of conditions of idealization but against it. (shrink)

This paper explores the assumption of autonomy. Several arguments are presented against the assumption of runtime autonomy as a principle of design for artificial intelligence systems. The arguments vary from being theoretical, to practical, and to analytic. The latter parts of the paper focus on one strategy for building non-autonomous systems (the practice view). One critical theme is that intelligence is not located in the system alone, it emerges from a history of interactions among user, builder, and designer (...) over a given set of data as mediated by the system. A second critical theme is that artificially intelligent systems are ongoing projects that must be continuously adapted and revised using joint person-machine efforts. (shrink)

Rosenberg has recently argued that explanations supplied by (what he calls) functional biology are mere promissory notes for macromolecular adaptive explanations. Rosenberg's arguments currently constitute one of the most substantial challenges to the autonomy, irreducibility, and indispensability of the explanations supplied by functional biology. My responses to Rosenberg's arguments will generate a novel account of the autonomy of functional biology. This account will turn on the relations between counterfactuals, scientific explanations, and natural laws. Crucially, in their treatment (...) of the laws' relation to counterfactuals, Rosenberg's arguments beg the question against the autonomy of functional biology. This relation is considerably more subtle than is suggested by familiar slogans such as Laws support counterfactuals; accidents don't. (shrink)

Autonomy of people on the autism-spectrum has only been very rarely conceptually explored. Autism spectrum is commonly considered a hetereogenous disorder, and typically described as a behaviorally-defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors. Autism research mainly focuses on the behavior of autistic people and ways to teach them skills that are in line with social norms. Interventions such as therapies are being justified with the assumption that autists lack the capacity to (...) be self-reflective and to be “author of their lives”. We question this assumption, as some empirical research shows that autists are aware of their strengths and are critical about social norms, we take this as a starting point to reconsider the beliefs about autistic people’s capacities. As a theoretical framework, we draw on Berlin’s idea of positive and negative liberty as he clearly distinguishes between one’s own developed preferences and the simple absence of interference. By drawing on the concept of positive liberty, we illustrate that a lot of autists are aware of their own needs, and usually do not deny their own needs, values and interests. This makes them less prone than non-autistic people to adapt their preferences to external influences, which might be seen as sticking to an authentic way of living. Our analysis shows that many autists are hindered to be autonomous due to unjustified interference, unreflected assumptions about their self-determination, or by paternalistic actions. These observations contribute to a better understanding when help and interference are justified and a more differentiated understanding of autonomy of autistic people. (shrink)

In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued (...) that autonomy and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of Socratic autonomy is introduced. (shrink)

This article analyses supplier-buyer relationships where the suppliers adapt to the buyers' needs and expectations to gain mutual advantages. In some cases, such closely knit relationships lead to violations of the autonomy of one or both partners. A concept of corporate autonomy (CA) is developed to analyze this problem. Three different facets can be distinguished: rule autonomy, executive autonomy, and control autonomy. A case study of Mattel's problems with lead-contaminated toys produced in China shows that (...) the CA of buyer and supplier can be restricted as a result of a dysfunctional partnership involving a moral dilemma. (shrink)

The development of modern science, as everybody knows, has come largely through naturalizing domains of inquiry that were traditionally parts of philosophy – a process that philosophers have, by and large, applauded. But could this worthwhile endeavor now move on to include critical thinking? Here we argue that critical thinking, a discipline devoted principally to the study of the normative aspects of reasoning, cannot be assimilated to purely naturalistic, descriptive studies of reasoning of the sort now prevalent in the social (...) sciences and in what is now called „experimental philosophy.‟ Critical thinking, on our view, is a discipline whose central task is not that of constructing a catalogue of common patterns of reasoning, but instead of accounting for the normative worth of such patterns. Plainly, it is an enterprise that raises philosophical questions about the nature of such normativity and requires an evaluation of possible answers. The normativity issues at stake in critical thinking are parallel in significant ways to those arising in normative ethics and traditional epistemology. And this is why successful arguments offered against attempts at eliminating or reducing the latter disciplines to the sciences could be adapted to support the philosophical autonomy of critical thinking. A glance at the naturalistic approaches to reasoning currently on offer reveals that there is so far no naturalistic account of the normativity of reasoning in the offing. Not surprisingly, naturalistic studies of reasoning concerned with such normativity either fail to account for it or simply rehash traditional philosophical accounts. In a recent study, Sripada and Stich (2005) 1 seem to assume that all there is to explaining what moral judgments are can be captured by some results of experimental tests about what people standardly make of moral norms in general (e.g., Turiel‟s moral/conventional task experiments) – perhaps together with some psychological account of the role of emotions and motivation in normative judgment.. (shrink)

Autonomy is a core value that is deeply entrenched in the moral, legal, and political practices of many societies. The development and deployment of artificial intelligence (AI) have raised new questions about AI’s impacts on human autonomy. However, systematic assessments of these impacts are still rare and often held on a case-by-case basis. In this article, I provide a conceptual framework that both ties together seemingly disjoint issues about human autonomy, as well as highlights differences between them. (...) In the first part, I distinguish between distinct concerns that are currently addressed under the umbrella term ‘human autonomy’. In particular, I show how differentiating between autonomy-as-authenticity and autonomy-as-agency helps us to pinpoint separate challenges from AI deployment. Some of these challenges are already well-known (e.g. online manipulation or limitation of freedom), whereas others have received much less attention (e.g. adaptive preference formation). In the second part, I address the different roles AI systems can assume in the context of autonomy. In particular, I differentiate between AI systems taking on agential roles and AI systems being used as tools. I conclude that while there is no ‘silver bullet’ to address concerns about human autonomy, considering its various dimensions can help us to systematically address the associated risks. (shrink)

Resumen La renta básica proporciona a la ciudadanía una autonomía económica que se traduce en una libertad real para conducir sus vidas. Sin embargo, en este artículo defiendo que la renta básica no sería efectiva en situaciones de pobreza donde se generan preferencias adaptativas en las personas. Para mostrarlo analizaré las bases psicológicas del comportamiento de personas con preferencias adaptativas. A continuación, abordaré qué estrategias son las indicadas para revertir la situación de preferencias adaptativas. Implementar estas políticas permitirá que la (...) renta básica pueda empoderar también a los más pobres.Basic income provides citizenship an economic autonomy which is translated in a real liberty to drive their lives. However, in this article I aim to analyze why basic income would not be effective in situations of poverty in which people have “adaptive preferences”. I will analyze the psychological bases of the behavior of persons with adaptive preferences. Then, I will study which strategies are more proper to reverse that situation. This would allow understanding how basic income could empower to the poorest too. (shrink)

Book review of Serene Khader's "Adaptive Preferences and Women's Empowerment".

Both mainstream and disability bioethics sometimes contend that the self-assessment of disabled people about their own well-being is distorted by adaptive preferences that are only held because other, better options are unavailable. I will argue that both of the most common ways of understanding adaptive preferences—the autonomy-based account and the well-being account—would reject blanket claims that disabled people’s QOL self-assessment has been distorted, whether those claims come from mainstream bioethicists or from disability bioethicists. However, rejecting these generalizations (...) for a more nuanced view still has dramatic implications for the status quo in both health policy and clinical ethics. (shrink)

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired (...) by problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care. (shrink)

Precision medicine promises to develop diagnoses and treatments that take individual variability into account. According to most specialists, turning this promise into reality will require adapting the established framework of clinical research ethics, and paying more attention to participants’ attitudes towards sharing genotypic, phenotypic, lifestyle data and health records, and ultimately to their desire to be engaged as active partners in medical research.Notions such as participation, engagement and partnership have been introduced in bioethics debates concerning genetics and large-scale biobanking to (...) broaden the focus of discussion beyond individual choice and individuals’ moral interests. The uptake of those concepts in precision medicine is to be welcomed. However, as data and medical information from research participants in precision medicine cohorts will be collected on an individual basis, translating a participatory approach in this emerging area may prove cumbersome. Therefore, drawing on Joseph Raz’s perfectionism, we propose a principle of respect for autonomous agents that, we reckon, can address many of the concerns driving recent scholarship on partnership and public participation, while avoiding some of the limitations these concept have in the context of precision medicine. Our approach offers a normative clarification to how becoming partners in precision is compatible with retaining autonomy.Realigning the value of autonomy with ideals of direct engagement, we show, can provide adequate normative orientation to precision medicine; it can do justice to the idea of moral pluralism by stressing the value of moral self-determination: and, finally, it can reconcile the notion of autonomy with other more communitarian values such as participation and solidarity. (shrink)

In this article, I consider recent debates on the notion of procreative liberty, to argue that reproductive freedom can be understood as a form of positive freedom—that is, the freedom to make oneself according to various ethical and aesthetic principles or values. To make this argument, I draw on Michel Foucault’s later work on ethics. Both adopting and adapting Foucault’s notion of ethics as a practice of the self and of liberty, I argue that reproductive autonomy requires enactment to (...) gain meaning within the life contexts of prospective parents. Thus, I propose a shift away from the standard negative model of freedom that sees it solely as a matter of noninterference or nonimpedance, a view advocated by major commentators such as John Harris and John Robertson. Instead, reproduction should be understood as a deeply personal project of self-making that integrates both negative and positive freedom. (shrink)

This article analyses supplier–buyer relationships where the suppliers adapt to the buyers’ needs and expectations to gain mutual advantages. In some cases, such closely knit relationships lead to violations of the autonomy of one or both partners. A concept of corporate autonomy is developed to analyze this problem. Three different facets can be distinguished: rule autonomy, executive autonomy, and control autonomy. A case study of Mattel’s problems with lead-contaminated toys produced in China shows that the (...) CA of buyer and supplier can be restricted as a result of a dysfunctional partnership involving a moral dilemma. (shrink)

This section welcomes submissions addressing literature as a means to explore ethical issues arising in healthcare. “Literature” will be understood broadly, including fiction and creative nonfiction, illness narratives, drama, and poetry; film studies might be considered if the films are adaptations from a literary work. Topics include in-depth analysis of literary works as well as theoretical contributions, discussions, and commentary about narrative approaches to disease and medicine, the way literature shapes the relationship between patients and healthcare professionals, the role of (...) speculative fiction as a testing ground for future scenarios in healthcare, and so on. Articles discussing the uses of literature for bioethics education and outreach will be particularly appreciated. Research on literature not originally written in English will be considered as long as it has also been published in translation. Submissions should include an abstract and should conform to theCQGuidelines for Contributors. To submit an article or discuss a suitable topic, write to Antonio Casado da Rocha [email protected].:This article proposes a concept of narrative autonomy to supplement existing accounts in healthcare ethics. This is done by means of a comparison between three end-of-life scenarios: Tolstoy’sThe Death of Ivan Ilyichand two related contemporary stories by Lorrie Moore and Bernhard Schlink, which explore some problems arising when extremely individualistic notions of patient autonomy are put into practice. It is argued that the best model for palliative care is a cooperative one in which patient autonomy is understood as essentially social, and that involves decisional, executive, informational, and narrative dimensions. (shrink)

BackgroundStreet-connected children and youth in low- and middle-income countries have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.MethodsAs part of three interrelated research projects in western Kenya, we created procedures to (...) address SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.ResultsSubstantial community engagement provided input on SCCY’s participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.ConclusionsAlthough a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

Scientific research that requires space flight has always been subject to comparatively strong external control. Its agenda has often had to be adapted to vacillating political target specifications. Can space scientists appeal to one or the other form of the widely acknowledged principle of freedom of research in order to claim more autonomy? In this paper, the difficult question of autonomy within planned research is approached by examining three arguments that support the principle of freedom of research in (...) differing ways. Each argument has its particular strengths and limitations. Together they serve to demonstrate particular advantages of scientific autonomy, but in the case of space science, their force ultimately remains limited. However, as the arguments highlight the interrelations between scientific autonomy, the democratic process and the collective interest in scientific knowledge, they suggest that a coherent and sustained space science agenda might best be ensured by increasing the transparency of science policy decisions and involving the democratic public. (shrink)