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

While this paper does not explicitly define the concept of autonomy, the way Ubel et al describe clinicians’ failures to enhance their patients’ autonomy reflects a broader understanding of autonomy than the default account as free and informed choice. In this OPC I would demonstrate that the communication strategies the authors recommend reflects a more sophisticated conception of autonomy than the understanding that typically prevails in bioethics. I will also distinguish between weak and strong forms of (...) paternalism, and argue that a weak paternalistic approach is not only defensible but also aligns with the strategies the authors propose. Thus, by clarifying the concept of autonomy we can show how it can be enhanced in practice. (shrink)

This book uses the example of informed consent guidelines for international research on human subjects to demonstrate how a philosophical analysis can assist in understanding how underlying concepts affect public policy; how and why such policies are exclusionary; and what methodology can be used to remedy injustices in public policy and practice. Epidemics, such as AIDS, have resulted in an increase in medical research in less developed countries. In an attempt to be more globally applicable, current international guidelines for research (...) on human subjects have attempted to acknowledge the importance of community. This book explains how these attempts fail to adequately acknowledge the importance community has for many people in less developed countries, and how these guidelines fail to attend to constraints to autonomy that oftentimes get magnified once community is involved in the informed consent process. The book further explains how these problems can be traced to a mistaken underlying notion of autonomy and what policymakers can do to remedy these problems . (shrink)

Abstract:The moral and political implications of new forms of organisation and resource allocation in education are explored. Markets, even when heavily regulated and administered, induce effects contrary to the values of individual and social freedom upon which public education is understood to be founded. Their ‘efficiency’ as allocative and distributive mechanisms is questioned and examined specifically in relation to the formative and constitutive role of community life in conferring identity and autonomy upon individuals. Competition, it is claimed, leads to (...) stratification of opportunities and outcomes. Putative efficiency gains may be outweighed by equity losses. (shrink)

I argue that the metaphysical capacity of autonomy is not intrinsically valuable; it is valuable only when used in relation to a community's values and instrumentally for making the proper choices that will promote one's own and the community's well-being. I use the example of the choice to take one's life by suicide to illuminate this view. I articulate a plausible African conception of personhood as a basis for the idea of relational autonomy. I argue that this conception (...) is better understood as a social-moral thesis, and not a metaphysical thesis. A metaphysical thesis gives an account of the abstract nature of an atomic individual, his agency, and rational choice. The social-moral thesis indicates that personhood and autonomy are positive and relational to the life plans, well-being, material conditions, and the best means for achieving them that are made available and possible by harmonious living in a community. This idea of autonomy is not just having the capacity of freewill; it also involves how such freewill is used, in terms of how an individual's choices are guided by internalized communal values. (shrink)

Recently, there have been attempts at offering new justifications of the Rawlsian idea of public reason. Blain Neufeld has suggested that the ideal of political autonomy justifies public reason, while R.J. Leland and Han van Wietmarschen have sought to justify the idea by appealing to the value of political community. In this paper, I show that both proposals are vulnerable to a common problem. In realistic circumstances, they will often turn into reasons to oppose, rather than support, public reason. (...) However, this counterintuitive result can be avoided if we conceive of autonomy and community differently. (shrink)

In this paper, I argue that Kant has a far more communitarian theory of aesthetic life than is usually acknowledged. I focus on two aspects of Kant’s theory that might otherwise be taken to support an individualist reading, namely, Kant’s emphasis on aesthetic autonomy and his characterization of judgments of taste as involving demands for agreement. I argue that the full expression of autonomy in fact requires being a member of an aesthetic community and that within such a (...) community, judgments of taste are issued as invitations to others to engage their faculties towards the goal of shared aesthetic appreciation. (shrink)

The impact and use of Information and Communication Technologies (ICTs) in healthcare settings has been increasing since 2019. This is greatly due to the COVID‐19 pandemic. But beyond accommodating an extraordinary and complex situation in terms of healthcare services, or beyond replacing personalised care delivered by healthcare professionals (HCPs), has there been a process of information and consultation for communities and HCPs? Do we have the basic requirements needed to make such use commonplace in health care? What will the impact (...) be on communities and their governance? Have we arrived here by consensus or by imposition? Our purpose has been to conduct a transnational analysis by approaching communities, social actors, and healthcare professionals in three territories in a pilot study following a qualitative methodology. The aim being to discover the potential impact of such measures beyond the right to health and if such measures are compatible with the purpose of population settling in rural areas. Furthermore, to identify if this entails a conflict of value and priorities or if we need new ethical reviews both for communities and healthcare professionals. (shrink)

The moral and political implications of new forms of organisation and resource allocation in education are explored. Markets, even when heavily regulated and administered, induce effects contrary to the values of individual and social freedom upon which public education is understood to be founded. Their 'efficiency' as allocative and distributive mechanisms is questioned and examined specifically in relation to the formative and constitutive role of community life in conferring identity and autonomy upon individuals. Competition, it is claimed, leads to (...) stratification of opportunities and outcomes. Putative efficiency gains may be outweighed by equity losses. (shrink)

Autonomy is traditionally considered to be an epistemic capacity of individuals to think for themselves, and the community is held to be its central obstruction. Autonomy is the internal capacity to freely use reason to form beliefs and preferences that are one’s own. It is premised on the atomistic individual conceived as a decontextualized rational mind. Accordingly, natural, physical, and social externalities have not been included in discourse on autonomy. But if individuals are seen as embodied dwellers (...) within social and natural environments and are reconceived as ecological, that is, partly constituted by their environments, then autonomy must likewise be reconceived. Ecological autonomy is an internal epistemic capacity to think and an external actional capacity to act for oneself in relation to other individuals and environments. Whereas traditional and even relational autonomy require that competency and authenticity conditions must be met for internal thinking, ecological autonomy requires two sets of competency and authenticity conditions, one for internal thought and one for external action. An ecological treatment holds that while community can obstruct autonomy, it also generates and sustains it to reveal how community and place are co-defined as mutually constitutive companion concepts with alternate emphases. Place emphasizes physical and social, and natural and artificial environments, but includes people and social practices. Community emphasizes people, social practices, knowledge, and values, but includes the environing world. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

My dissertation traces key aspects of the conceptual influence of Heidegger's work on feminist poststructuralist theories. This archeology enables me to indicate that poststructualism cannot provide the foundation necessary to forming three normative ideals requisite to a viable feminist theory: personal autonomy, heterogeneous community, and solidarity. I argue that certain versions of poststructuralism repeat Heidegger's abstraction from an hermeneutics of suspicion and his totalizing rejection of modernity. Without a theory of willed ignorance, post-Lacanian feminism undercuts women's agency. And, without (...) tying a vision of Sittlichkeit to ideology critique, feminist ethics falls prey to abstraction and antinormativism. ;In Part I, I recover a dialectical theory of autonomy that can account for the deliberate ways that subjects mediate their environment. In Part II, I flesh out Heidegger's and Irigaray's respective visions of heterogeneous community. In Part III, however, I show how neither Heidegger nor US appropriations of Irigaray yield either a sufficiently complex moral theory or a theory of solidarity. After delineating Heidegger's antinormative tendencies, I reveal similar deficiencies in the works of Irigaray and Drucilla Cornell. I demonstrate that the nominalist underpinnings of post-Lacanian feminism threaten to normalize a fragmented view of pluralism rather than tackle the hard problem of developing interactive models of universalism and of solidarity. ;I conclude by developing features of a feminist methodology that can support solidarity and avoid antinormativism. These features include: a hermeneutic of the symbolic order complex enough to address the overlap between race, class and gender; grounding theory in ideology critique; a model of critical social consciousness rooted in the ability to disdain the immiseration of others and to acknowledge one's own interests; and an interactionist basis for moral theory. (shrink)

The claim that indigenous communities are entitled to have intellectual property rights (IPRs) to both their plant varieties and their botanical knowledge has been put forward by writers who wish to protect the plant genetic resources of indigenous communities from uncompensated use by biotechnological transnational corporations. We argue that while it is necessary for indigenous communities to have suchrights, the entitlement argument is an unsatisfactory justification for them. A more convincing foundation for indigenous community IPRs is the autonomy theory (...) developed by Will Kymlicka. (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)

What can the Jewish tradition contribute to the current public debate about vaccination? Much of the rhetoric surrounding vaccine refusal appeals to concepts of individual autonomy and fears of political and intellectual authority, claiming that the individual is the best expert on his or her own health and on whether to actively deny accepted medical consensus. Unlike many other health decisions, vaccine refusal has direct and measurable consequences for one's community. The Jewish tradition's emphasis on community and the well-being (...) of the collective, as well as its tradition of respect for intellectual authority, can be a critical support to the medical community in encouraging wide-spread vaccination. (shrink)

Before sailing past the sirens' “flowery meadow,” Ulysses instructed his sailors to lash him to the mast so that he would not succumb to the siren's singing. His advance directive demonstrated that he valued his dispositional or long-term autonomy over his unquestioned right to make decisions. He also indicated to his oarsmen that he understood the nature of temptation and his inability to resist it. Ideas of autonomy and sexual choice are central to this discussion of new AIDS (...) treatments, especially the trials of preventative vaccines. Questions arise over the rights of individuals and the extent that these should be limited by concerns of the gay community. Should the gay community intervene in the risky decisions of individuals if no explicit advance directive exists? If so, how do they justify their paternalism? Could their aims not be better served through strengthening the individual dispositional autonomy of trial participants rather than making specific claims about the common good? (shrink)

This volume brings together leading philosophers of Judaism on the issue of autonomy in the Jewish tradition. Addressing themselves to the relationship of the individual Jew to the Jewish community and to the world at large, some selections are systematic in scope, while others are more historically focused. The authors address issues ranging from the earliest expressions of individual human fulfillment in the Bible and medieval Jewish discussions of the human good to modern discussions of the necessity for the (...) Jew to maintain both a Jewish sensibility as well as an active engagement in the modern pluralistic state. Contributors include Eugene Borowitz, Elliot N. Dorff, Daniel H. Frank, Robert Gibbs, Lenn E. Goodman, Ze'ev Levy, Kenneth Seeskin, and Martin D. Yaffe. (shrink)

In Autonomy and Community, contemporary Kant scholars apply Kant's moral and political views to current social issues, examining contemporary topics through the ...

In my contribution I want to describe a notion of autonomy in social terms namely in discursive practices. I already presented autonomy as grounded on the Sellarsian “metaphor” of the game of giving and asking for reasons reinterpreted by Robert Brandom. The model was centered mostly on practices of justification starting from an inferentialist view of the propositional content. However, I think that together with speech acts in ordinary language we must provide a description of the role of (...) prelinguistic practices for autonomy. This further step is implied by the fact that it is important to clarify the dimension of “readiness” to give or ask for reasons on which Swindler rightly insists in his Introduction to my book Autonomy. A Matter of Content. Autonomy develops in a language game that is connected with cooperation. The language game I want to point out is similar to the functional approach of Wittgenstein but starts from a Fregean perspective and takes into consideration neurobiological processes which bridge the gap between brain and world and represent the “motor” of our activity in the world. (shrink)

In bringing intentions, understandings, meanings and interactions down to earth this book invites its readers to account for the complex communications between ...

This paper attempts to construct a concept of moral autonomy thai is compatible with a relationally-based or care-based ethical theory. After critiquing the traditional liberal identification of the ethical self with an abstract rational self detached from community and historical narrative, I argue that the ethical self emerges in a dialectical relation with the community itself. Essentially, I argue for a concept of autonomy that will be analyzed as a critical perspective from within a community rather than as (...) a privileged view from outside. Central to this argument is an understanding of the nature and role of moral conversation in the regeneration of community. The nature of that conversation is examined. (shrink)

Upshot: I revisit the basic assumptions of constructivism on which the solutions presented in the target article rest, and argue that communication is difficult to understand until the cognitive autonomy of individuals resulting from operational closure is adopted as the point of departure.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Autonomy and Community: Readings in Contemporary Kantian Social Philosophy ed. by Jane Kneller and Sidney AxinnJeanine GrenbergJane Kneller and Sidney Axinn, editors, Autonomy and Community: Readings in Contemporary Kantian Social Philosophy. Albany: State University of New York Press, 1998. Pp. xi + 334. Paper, $21.95.The intent of this volume is not narrow textual exegesis but the application of Kantian themes to “problems of contemporary society,” (xi). (...) The editors thus advise their readers that “[t]he present collection is … ‘Kantian’ in a broad sense,” and that the opinions put forward by the contributors may “diverge rather widely” (viii) from Kant’s own. In an introductory essay, Jane Kneller notes further that the book distinguishes between “political” philosophy in a narrow sense, and “social” philosophy, which is concerned with “the behaviour of human beings” more broadly construed. Kant, Kneller argues, does have such a “social philosophy,” and this volume will reveal it.The book is largely successful in its stated goal. The essays run the gamut of careful, if controversial, textual analyses (e.g., Allen Wood’s and Robert Paul Wolff’s essays) to those which take Kant simply as a launching pad for an analysis of a variety of social issues. At times, this relation to Kant is a positive one (e.g., Harry van der Linden’s claim that Kant provides the basis for enterprise democracy), and at times negative (e.g., Charles Mills’ claim that Kantian respect for persons masks a “dark ontology” which supports structural racism).A careful reader can find among these varied essays interestingly opposed approaches to similar topics. Wolff and Sharon Anderson-Gold [End Page 538] end up at loggerheads over the relation of Kant’s ethical and social philosophies. Wolff makes Kant’s justification of morality derivative of the establishment of the social contract. But Anderson-Gold argues for a reversed relationship; for her, Kant’s “principle of humanity” grounds a basic human right of persons in any society to be free from certain types of state interference.Another interesting juxtaposition is found between Nelson Potter and Thomas Auxter, both of whom tackle Kant’s views on retributivism. Potter seeks to humanize retributivism by showing its basis in equality and respect for persons. Auxter takes a diametrically opposed approach, arguing that Kant’s moral theory can stand unscathed if we eliminate his now outdated retributivist commitments.A meta-issue looms in all these discussions: what does and doesn’t count as “Kantian”? This book, wisely, provides no hard and fast definition; rather, by presenting a broad variety of at times seriously divergent points of view, it constitutes a refreshingly pluralistic response to what counts as Kantian: Kantian is as Kantian does. It is rare to find such diversity of interpretation in a single volume, and this book is to be commended for achieving it.There are, however, prices to pay for the achievement of diversity, the largest being a certain disconnectedness of thought. The sectioning of the book into two parts—“Kantian Social Theory” and “Kant and Contemporary Social Issues” —instead of helping to guide the reader, ends up encouraging an ultimately strained distinction. Why does Robin Schott’s essay on feminism belong with “social theory” instead of “contemporary social issues”? Why don’t Anderson-Gold’s reflections on the relationship between moral and social issues qualify as “social theory”? It might have been better, organizationally, to highlight more specific themes by distinguishing sections on “Retributivism,” “International Law,” and the like.The individual essays vary in their success in defending their stated theses. Allen Wood is insightful and even-handed in convincing this initially skeptical reader of what seems, at first blush, a rather implausible view of Kant as an historical materialist. Though some may not find his own position to be very “liberal,” Gerald Gaus’ assessment of the current state of Kantian liberalist approaches to environmental values and his proposed alternative are cogent, enlightening and challenging. Sidney Axinn’s acceptance, without argument, of a simple analogy between individual persons and individual nation states to argue for the need for a world government makes his account ultimately dissatisfying. Charles Mills rightly takes note of an editor’s concern that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Autonomy and Community: Readings in Contemporary Kantian Social Philosophy ed. by Jane Kneller and Sidney AxinnJeanine GrenbergJane Kneller and Sidney Axinn, editors, Autonomy and Community: Readings in Contemporary Kantian Social Philosophy. Albany: State University of New York Press, 1998. Pp. xi + 334. Paper, $21.95.The intent of this volume is not narrow textual exegesis but the application of Kantian themes to “problems of contemporary society,” (xi). (...) The editors thus advise their readers that “[t]he present collection is … ‘Kantian’ in a broad sense,” and that the opinions put forward by the contributors may “diverge rather widely” (viii) from Kant’s own. In an introductory essay, Jane Kneller notes further that the book distinguishes between “political” philosophy in a narrow sense, and “social” philosophy, which is concerned with “the behaviour of human beings” more broadly construed. Kant, Kneller argues, does have such a “social philosophy,” and this volume will reveal it.The book is largely successful in its stated goal. The essays run the gamut of careful, if controversial, textual analyses (e.g., Allen Wood’s and Robert Paul Wolff’s essays) to those which take Kant simply as a launching pad for an analysis of a variety of social issues. At times, this relation to Kant is a positive one (e.g., Harry van der Linden’s claim that Kant provides the basis for enterprise democracy), and at times negative (e.g., Charles Mills’ claim that Kantian respect for persons masks a “dark ontology” which supports structural racism).A careful reader can find among these varied essays interestingly opposed approaches to similar topics. Wolff and Sharon Anderson-Gold [End Page 538] end up at loggerheads over the relation of Kant’s ethical and social philosophies. Wolff makes Kant’s justification of morality derivative of the establishment of the social contract. But Anderson-Gold argues for a reversed relationship; for her, Kant’s “principle of humanity” grounds a basic human right of persons in any society to be free from certain types of state interference.Another interesting juxtaposition is found between Nelson Potter and Thomas Auxter, both of whom tackle Kant’s views on retributivism. Potter seeks to humanize retributivism by showing its basis in equality and respect for persons. Auxter takes a diametrically opposed approach, arguing that Kant’s moral theory can stand unscathed if we eliminate his now outdated retributivist commitments.A meta-issue looms in all these discussions: what does and doesn’t count as “Kantian”? This book, wisely, provides no hard and fast definition; rather, by presenting a broad variety of at times seriously divergent points of view, it constitutes a refreshingly pluralistic response to what counts as Kantian: Kantian is as Kantian does. It is rare to find such diversity of interpretation in a single volume, and this book is to be commended for achieving it.There are, however, prices to pay for the achievement of diversity, the largest being a certain disconnectedness of thought. The sectioning of the book into two parts—“Kantian Social Theory” and “Kant and Contemporary Social Issues” —instead of helping to guide the reader, ends up encouraging an ultimately strained distinction. Why does Robin Schott’s essay on feminism belong with “social theory” instead of “contemporary social issues”? Why don’t Anderson-Gold’s reflections on the relationship between moral and social issues qualify as “social theory”? It might have been better, organizationally, to highlight more specific themes by distinguishing sections on “Retributivism,” “International Law,” and the like.The individual essays vary in their success in defending their stated theses. Allen Wood is insightful and even-handed in convincing this initially skeptical reader of what seems, at first blush, a rather implausible view of Kant as an historical materialist. Though some may not find his own position to be very “liberal,” Gerald Gaus’ assessment of the current state of Kantian liberalist approaches to environmental values and his proposed alternative are cogent, enlightening and challenging. Sidney Axinn’s acceptance, without argument, of a simple analogy between individual persons and individual nation states to argue for the need for a world government makes his account ultimately dissatisfying. Charles Mills rightly takes note of an editor’s concern that... (shrink)

This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness (...) and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages. (shrink)

_Shows how Kant's basic position applies to and clarifies present-day problems of war, race, abortion, capital punishment, labor relations, the environment, and marriage._.

Many health care decisions depend not only upon medical facts, but also on value judgments—patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state (...) of medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients—failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals. (shrink)

In this article, I present a sociological approach to the problem of meaningful work that dwells on its broad social and cultural sources, as opposed to the focus on subjective and organizational factors currently prevailing in the field. Specifically, I consider two sociological perspectives, those of community and autonomy, as important conceptual tools for understanding the ambivalent character of modern culture in providing individuals with a sense of meaningfulness of their activities. I also review some of the existing research (...) on meaningful work and interpret it through this conceptual distinction, both to show the latter’s relevance for the field and to identify the gaps it might help fill. As a result, based on the sociological perspectives, I propose a general conceptual model and discuss five directions to further advance the theoretical comprehension of meaningful work, and I suggest some implications of these perspectives for normative business ethics. (shrink)

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls (...) for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

This chapter contains section titled: The Cosmic Community Social and Individual Autonomy The World Out of Balance Multiple Communities, Multiple Identities Renewing the Cosmic Community.

This paper investigates the idea of clinical autonomy. Whilst there is a considerable literature on moral autonomy there is very little on clinical autonomy except as a sociological phenomenon. Using the results of interviews with Community Psychiatric Nurses in England, the three main theories that they have about clinical autonomy are examined. It is argued that there are substantial problems with these theories and an alternative way of understanding clinical autonomy is proposed, the idea of (...) contractual space. (shrink)

One common approach to autonomy begins by drawing boundaries around the agent, dividing her from external forces that limit her options, hostile agents who would harness her to their projects, and rebellious motivations embedded within her own psychology. Relational approaches to autonomy blur these boundaries, demonstrating the ways in which autonomy is possible only in mutually respectful, caring relationships. I develop a particular kind of relational approach, on which autonomy requires others’ recognition that certain choices belong (...) to us. That is because agency involves responsibility for one’s actions. Crucially, the responsibility in question is not simply causal responsibility. Rather, to be an agent is to be the proper object of reactive attitudes like resentment or gratitude for specific actions. Whether one is responsible (in this sense) for any state of affairs depends, not simply on whether one caused that state of affairs to occur, but on whether the choice to bring this state of affairs about belonged to you. Moreover, I argue that that while some tools – specifically, violence – might bolster one’s causal powers, they simultaneously threatening the social contexts that make “choice-ownership” possible. While these tools seem apt to secure our agency, they in fact threaten to destroy it. (shrink)

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals’ formation of choices. In response to this problem, I will present a brief overview of Diana Meyers’s account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, (...) self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical ‘self-reading’. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills. (shrink)

BackgroundThe Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding (...) informed consent and potential limitations to the principle of respect for autonomy in African communities.MethodsWe conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.ResultsBased on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.ConclusionsWe conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities. (shrink)