Like being able to drive a car, being autonomous is a socially attributed, claimed, and contested status. Normative debates about criteria for autonomy (and what autonomy entitles one to) are best understood, not as debates about what autonomy, at core, really is, but rather as debates about the relative merits of various possible packages of thresholds, entitlements, regulations, values, and institutions. Within different “regimes” of autonomy, different criteria for (degrees of) autonomy become authoritative. (...) Neoliberal, solidaristic, and perfectionist regimes entail conflicting understandings of what gets you autonomy and what autonomy gets you—for example, in relation to policies regarding physician-assisted suicide or financial support for senior citizens. In light of this, justifying a particular understanding of autonomy is inseparable from the task of arguing for the context-specific merits of a regime of autonomy as a whole and in relation to other ethical and political commitments. (shrink)

Ethnic minority status and female gender convey a risk for suicidal behavior, yet research of suicidality of ethnic minority female immigrants is scarce. The authors of this article conducted qualitative interviews with 15 young women in the Netherlands, who either had attempted suicide or contemplated suicide, and analyzed these in a narrative psychology tradition. Suicidality was associated with despair and frustration over the violation of the women’s personal autonomy and self-integrity regarding strategic life choices. Autonomy restrictions and violations (...) followed two patterns, which are interconnected with four criteria regarding the capacity for autonomy. Findings are discussed with referral to Durkheim and feminist theories of autonomy. (shrink)

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

This chapter contains sections titled: Introduction: The Liberal Reliance on Autonomy Autonomy: A Working Definition What is Wrong with Autonomy? An Alternative Option: A Liberalism of Conscience Four Objections to the Argument Conclusion Notes References.

The First World War was supposed to end all wars, though soon followed WWII. Since 1945 wars continued to abound; now we confront a real prospect of a third world war. Many armed struggles and wars arise in attempts to end repressive government; still more are fomented by repressive governments, few of which acknowledge their repressive character. It is historically and culturally naive to suppose that peace is normal, and war an aberration; war, preparations for war and threats of war (...) belong to ‘normal’ human life. Our tolerance, acceptance or fostering of such repeated injustices and atrocities indicate pervasive failures to understand fundamentals of justice, and what we owe morally to ourselves and to all others, together with our responsibilities to preserve the biosphere, not merely our own store(s) of reserves. As matters both of justice and prudence we must re-orient ourselves, individually and collectively, to promote justice, peace and ecological responsibilities by identifying and instituting just forms of social cooperation, domestically and internationally. All of these are our problems, whether we recognize them or continue our pervasive negligence. We urgently require cogent understanding of the social dimensions of human judgment, rational assessment, right action, and public reason. This requires understanding (inter alia) how Kant’s explication of rational judgment and justification is fundamentally social, how these features of rational judgment and justification are constitutive of Kant’s account of individual autonomy, and how they are central to Kant’s account of proper public use of reason. Reasoning publically remains precarious, not because – as often alleged – the ‘Enlightenment project’ has failed. It has not failed, it has been thwarted, and in our public responsibilities we have too often failed it. (shrink)

One of the most widely accepted views in bioethics is that paternalistic interference in others’ self-regarding decisions is justified only if those decisions are not autonomous. Typically, a decision is autonomous if and only if it satisfies certain psychological criteria. Namely, it must be competent and also voluntary. This latter criterion means, roughly, that the agent herself decided without being controlled or unduly influenced by other persons or impersonal forces, in light her own values.The modern locus classicus of this (...) idea is undoubtedly Beauchamp and Childress ; they claim we have a duty to respect autonomous agents. (shrink)

Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and (...) strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world. (shrink)

Several nation states have reasons to halt the import of genetically modified organisms. The current international trend towards a regime of free trade makes such bans problematic. Whether a nation state is deemed justified in banning a certain product is strongly connected to discussions about what are acceptable criteria for proof of risk. The determination of these criteria hinges upon considerations of individual and national autonomy. This paper compares two different points of view in the debate: the (...) WTO opposed to the UN. A distinction between internal and external autonomy explains the differences in approach between the UN and the WTO. The conclusion is reached that adequate respect for autonomy requires a certain amount of flexibility in the criteria for proof of risk. (shrink)

The principle of autonomy presupposes Patient Decision Making Competence (PDMC). For a few decades a considerable amount of empirical research has been done into PDMC. In this contribution that research is explored. After a short exposition on four qualities involved in PDMC, different approaches to assess PDMC are distinguished, namely a negative and a positive one. In the negative approach the focus is on identifying psychopathologic conditions that impair sound decision making; the positive one attempts to assess whether a (...) patient actually has the required abilities and qualities. Characteristic of the latter approach is the use of (or development of) test-like instruments for PDMC assessment. Some of these tests are discussed and commented on. Although they may be useful in investigating aspects of PDMC, none of the described approaches and tests offers a reliable and valid method for PDMC assessment. In response to a potential misuse of tests, the concept of a supportive situation is briefly introduced in order to draw attention to the risk of prematurely deeming patients incompetent on the basis of low test scores, whereas their insufficient performance may be (partly) attributable to alack of situational support. Also, the need for and possibility of an emotionalist concept of PDMC are suggested, as an alternative to the more common rationalist one. In this regard,the legitimacy of competence being conceived as a presumption or fiction of law, deserves further investigation. (shrink)

Kant's concept of autonomy and the Kantian notion of autonomy are often conflated in bioethics. However, the contemporary Kantian notion has very little at all to do with Kant's original. In order to further bioethics discourse on autonomy, I critically distinguish the contemporary Kantian notion from Kant's original concept of moral autonomy. I then evaluate the practical relevance of both concepts of autonomy for use in bioethics. I argue that it is not appropriate to appeal (...) to either concept toward assessing which patients we ought to respect as autonomous. Finally, I sketch criteria for what I take to be a more promising concept of autonomy for patients. (shrink)

A set of eight criteria for a satisfactory theory of educational aims at the primary level is proposed. The concept of neutrality is developed with respect to educational aims and with respect to the justification of those aims, and the criteria of content and justificatory neutrality are defended. An early theory of education aimed at autonomy is evaluated in order to introduce the concept of autonomy and the idea of education aimed at autonomy. A version (...) of the theory of education aimed at democracy is also evaluated. Both of these theories are ultimately dismissed, however, because it is demonstrated that they do not fulfill the criteria for a satisfactory theory. ;The concept of paternalism is extensively developed as a neutral justification for a satisfactory theory of educational aims. And the concepts of full voluntariness, and autonomy are extensively developed as satisfactory neutral aims. Paternalism and autonomy are then viewed in a developmental context, and the autonomy continuum and a paternalism continuum are introduced and developed. ;In conclusion, the theory of primary education aimed at autonomy is evaluated in light of the criteria of a satisfactory theory originally proposed. (shrink)

Much of the literature devoted to the topics of agent autonomy and agent responsibility suggests strong conceptual overlaps between the two, although few explore these overlaps explicitly. Beliefs of this sort are commonplace, but they mistakenly conflate the global state of being autonomous with the local condition of acting autonomously or exhibiting autonomy in respect to some act or decision. Because the latter, local phenomenon of autonomy seems closely tied to the condition of being responsible for an (...) act, we tend to think of the former, global phenomenon as a condition of responsibility as well. But one can act autonomously, or manifest autonomy with respect to some occurrent state, without satisfying the conditions for autonomous agency. Autonomous agency and responsible agency are logically distinct in part due to the varient conceptions of rationality each calls for. Both agent responsibility and holding a person responsible imply a fairly ``thick'''' form of rationality, where rationality embodies a normative component and is a matter of satisfying criteria that are objective in the sense that they are independent of what a person happens to want or to value. But autonomous agency calls for a quite different, ``thin'''' conception of instrumental rationality. (shrink)

Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to (...) override autonomy in times of critical care resource shortages. Dignity affirms the worth of the human individual as a meaning-making embodied subject, who is always in relationship to others, the world, time, and transcendence, and who realizes their dignity through their moral behaviour. Such an understanding means people should be helped to make morally right decisions about their own treatment, which may include forgoing potentially beneficial treatment for the good of others. Respect for dignity does not require fulfilling the morally wrong choices of one who insists on treatment at the expense of others. Dignity also protects the discretion of clinicians to make decisions appropriate to their competence by prohibiting the application of broad-based criteria such as age. (shrink)

Some feminists have argued that the “master's tools” cannot be utilized for feminist projects. When read through the lens of non-ideal theory, Judith Butler's reevaluation of “autonomy” and “universality” and Peaches's engagement with guitar rock are instances in which implements of patriarchy are productively repurposed for feminist ends. These examples evince two criteria whereby one can judge the success of such an attempt: first, accessibility and efficacy; second, that the use is deconstructive of its own conditions.

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads (...) to the very uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny. (shrink)

This metatheoretical paper investigates mind wandering from the perspective of philosophy of mind. It has two central claims. The first is that, on a conceptual level, mind wandering can be fruitfully described as a specific form of mental autonomy loss. The second is that, given empirical constraints, most of what we call “conscious thought” is better analyzed as a subpersonal process that more often than not lacks crucial properties traditionally taken to be the hallmark of personal-level cognition - such (...) as mental agency, explicit, consciously experienced goal-directedness, or availability for veto control. I claim that for roughly two thirds of our conscious life-time we do not possess mental autonomy (M-autonomy) in this sense. Empirical data from research on mind wandering and nocturnal dreaming clearly show that phenomenally represented cognitive processing is mostly an automatic, non-agentive process and that personal-level cognition is an exception rather than the rule. This raises an interesting new version of the mind-body problem: How is subpersonal cognition causally related to personal-level thought? More fine-grained phenomenological descriptions for what we called “conscious thought” in the past are needed, as well as a functional decomposition of umbrella terms like “mind wandering” into different target phenomena and a better understanding of the frequent dynamic transitions between spontaneous, task-unrelated thought and meta-awareness. In an attempt to lay some very first conceptual foundations for the now burgeoning field of research on mind wandering, the third section proposes two new criteria for individuating single episodes of mind-wandering, namely, the “self-representational blink” (SRB) and a sudden shift in the phenomenological “unit of identification” (UI). I close by specifying a list of potentially innovative research goals that could serve to establish a stronger connection between mind wandering research and philosophy of mind. (shrink)

Two ways of understanding the notion of autonomy are outlined and discussed in this article, in order to clarify how and if informed consent requirements in biotechnological research are to be justified by the promotion of personal autonomy: A proceduralist conception linking autonomy with authenticity, and a substantivist conception linking autonomy with control. The importance of distinguishing autonomy from liberty is emphasised, which opens for a possible conflict between respecting the freedom and the autonomy (...) of research participants. It is argued that this has implications for how consent requirements based on different criteria of specificity and understanding should be viewed and justified. (shrink)

In this paper we will demonstrate that a computational system can meet the criteria for autonomy laid down by classical enactivism. The two criteria that we will focus on are operational closure and structural determinism, and we will show that both can be applied to a basic example of a physically instantiated Turing machine. We will also address the question of precariousness, and briefly suggest that a precarious Turing machine could be designed. Our aim in this paper (...) is to challenge the assumption that computational systems are necessarily heteronomous systems, to try and motivate in enactivism a more nuanced and less rigid conception of computational systems, and to demonstrate to computational theorists that they might find some interesting material within the enactivist tradition, despite its historical hostility towards computationalism. (shrink)

Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy (...) are cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed. (shrink)

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we (...) describe two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

Background Professional autonomy, which directly affects the quality of professional nursing in patient care, and cognitive flexibility, which is an important factor for adaptation to change and developing nursing roles, are important concepts for nursing. Research objectives This research was carried out to determine the effect of cognitive flexibility on attitudes towards professional autonomy in nurses. Research design This was a descriptive study. Participants and research context The research was conducted with 415 nurses working in a city hospital (...) of a province, meeting the inclusion criteria and agreeing to participate in the study. A questionnaire form, The Cognitive Flexibility Inventory (CFI), and the Attitude Toward Professional Autonomy Scale for Nurses (APASN) were used to collect data. Ethical considerations Ethical approval was obtained from the university ethics committee before starting the study. Institutional permission was obtained from the city hospital where the study was conducted. Electronic informed consent was obtained from the nurses included in the study. Findings In the study, the mean CFI score was 80.62 ± 11.55 and the mean APASN score was 70.42 ± 18.79. There was a weak positive correlation (r = 0.270; p < 0.05) between CFI and APASN scores. Moreover, the effect of the CFI mean score on the APASN mean score was found to be statistically significant (β = 0.278; p < 0.001). Furthermore, CFI explains 7.7% of APASN. Conclusion In the study, nurses’ attitudes towards professional autonomy and cognitive flexibility scores were found to be at a good level. Cognitive flexibility has a positive effect on attitudes towards professional autonomy. Interventional studies that will increase the level of cognitive flexibility are recommended in the development of nurses' attitudes towards professional autonomy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Popular Autonomy and Imperial Power in Bartolus of Saxoferrato:An Intrinsic ConnectionFloriano Jonas CesarI. IntroductionBartolus of Saxoferrato is well known because of his ideas on the autonomy of the populus or civitas.1 He asserts that the populus can claim autonomous jurisdiction as a result not only of imperial concession but also of prescription, custom, or even eventual use on the ground of a de facto situation. Thus, the (...) populus needs no authorization from a superior, not even the emperor, to make its own laws. The idea of an autonomous populus did not originate with Bartolus, however. Marsilius of Padua had already worked out a quite developed theory about the authority of the whole body of the citizens to legislate.2 As opposed to the Aristotelian Marsilius, however, Bartolus bases his opinion about the populus essentially on the Corpus Iuris,3 though he knew at least the Politics and the Ethics too.4 What is important is not whether his knowledge of Aristotle [End Page 369] was immediate or through Giles of Rome's De Regimine Principum but that he proves his ideas basically by showing that they agree with certain authoritative texts and that he considers the Corpus Iuris, not Aristotle, as the proper authority to support his opinion on the populus.Such an emphasis on the autonomy of the civitas must not conceal the fact that, unlike Marsilius, Bartolus introduces the pope and the emperor alongside the populus as having jurisdiction of their own. Nor must the omnipresence of the Corpus Iuris hide the significance of the Bible in relation to the issue of the empire. Indeed he turns to the Scriptures not to substantiate the autonomy of the populus but to establish the divine origin of the royal (and papal) jurisdiction in general. Moreover, he uses them along with a particular interpretation of the popular origin of the empire to present the imperial jurisdiction as not subordinate to the populus.The concept of an autonomous civitas based in human premises, therefore, coexists in Bartolus with a notion of imperial power established by God, the former being inseparable from the latter, by virtue of his use of authorities. In fact Bartolus turns to the Corpus Iuris and the Scriptures not simply to illustrate but to substantiate his point of view. The authority of the Corpus Iuris, however, which supports his views on the populus, comes from the fact that emperor Justinian was its autor. But the Corpus Iuris is by the same token less authoritative than the Scriptures, whose author is God and which support the divine origin of the imperial power. Thus, working out a theory grounded on the authority of the Corpus Iuris, Bartolus also favors the base on which the imperial power was founded.The texts of interest here are the De Regimine Civitatis, De Guelphis et Gebellinis, and De Tyranno, where Bartolus more systematically presents his political ideas. In the De Regimine Civitatis he is concerned about "how many ways there are of governing a city,""which is the better way" and "which is the worst."5 The De Guelphis et Gebellinis treats both old and "recent" meanings of these nouns, whether these factions are licit, and the criteria to prove to which one belongs. At last the De Tyranno explains the origin of the word and the characteristics of the tyrant. Having discussed if there can be tyrant in a neighbourhood, household, and city, Bartolus divides the tyrants in the civitas into manifest, concealed, and tacit, and discusses whether their acts are valid. In tackling all of these issues, he turns to different sorts of proof—several authorities, including the Corpus Iuris, Scriptures, Aristotle, Giles of Rome, Gregory I, and Aquinas, as well as the jurisdictions of the populus, pope, and emperor. [End Page 370] This essay shall refer mainly to these treatises, while picking up, from other works, any additional instructive elements.Although Bartolus is particularly concerned about the de facto autonomous Italian cities in his time, his defense of their autonomy lies in arguments, and he has clear rules which define a valid form of argumentation. He generally considers that to prove a point means to show that... (shrink)

Respect for autonomy is problematic in relation to public health programmes such as vaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors to vaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned policies. (...) Objectors have different arguments for not participating in vaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of 'narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refuse vaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. (shrink)

Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our (...) study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps. (shrink)

This paper addresses whether universal, general education programs are enough to satisfy basic criteria of human rights, or whether comprehensive family planning programs, in conjunction with universal education programs, might also be morally required. Even before the Reagan administration instituted the ‘global gag rule’ at the 1984 conference in Mexico City, prohibiting funding to nongovernmental organizations that included providing information about abortion as a possible method of family planning, the moral acceptability of family planning programs has been called into (...) question. This paper makes a moral argument for family planning by appealing to both data and to theory: data about the efficacy of universal and comprehensive family planning education programs at reducing fertility and infant mortality, and theory about what is required for the establishment of autonomy. It reasons that universal educational programs are insufficient for the promotion of autonomy, and therefore argues on substantive autonomy grounds for comprehensive family planning programs in addition to universal education programs. (shrink)

This chapter offers a fine-grained analysis of the relationship between autonomy and responsibility in order to address a challenge according to which considering autonomy and responsibility as closely related is misleading since these concepts serve different normative objectives. In response to this challenge, I first explore two criteria of ascription – rationality and control – that autonomy and responsibility seem to share. I then contrast and compare three pairs of autonomy and responsibility conceptions. Examining these (...) pairs rescues the idea that there are normatively significant connections between autonomy and responsibility, albeit that what that connection is and why it matters is highly sensitive to the different understandings of autonomy and responsibility one might adopt. The first pair, self-governance and accountability, posits a notion of core agency as irreducibly valuable. The second, authenticity and attributability, rests on a shared ideal of actively becoming a distinctive self. The third and final, relational autonomy and answerability, derives from the thought that unequal standing impacts heavily on whether and how the criteria of rationality and control are applied in specific cases. This analysis demonstrates that rationality and control are not independent criteria but always work in tandem. Failing to appreciate these conceptual interactions could obfuscate promising pathways for both supporting personal autonomy and challenging unwarranted responsibility ascriptions. (shrink)

Should society intervene to prevent the risky behavior of precocious teenagers even if it would be impermissible to intervene with adults who engage in the same risky behavior? The problem is well illustrated by the legal case of the 13-year-old Dutch girl Laura Dekker, who set out in 2009 to become the youngest person ever to sail around the world alone, succeeding in January 2012. In this paper we use her case as a point of entry for discussing the fundamental (...) question of how to demarcate childhood from adulthood. After summarizing the case, we identify a ‘demarcation dilemma’ that frames much of the public and expert debate. On the one hand, it seems morally imperative ‘to treat like alike’, which means that both children and adults should be allowed to undertake all actions for which they have the relevant competences. On the other hand, requiring proportional treatment of children and adults seems to neglect the special nature of childhood as a distinct stage in life that ends at a specific age. We introduce the notion of a ‘regime of childhood’ to deal with this problem. This regime includes several dimensions, including the limited liability for children, the supervisory responsibilities of parents, the role of age-based thresholds, and the overarching purpose of childhood as a context for developing autonomy. We argue that, all things considered, there are good reasons not to shift to a regime that offers individual children the option of qualifying for adulthood on the basis of age-neutral criteria. (shrink)

In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful (...) goals, values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

Law functions on the basis of some presuppositions of what a person is. The purposes and tasks that are projected on a legal system depend on an understanding of personhood. Also, courts continuously find themselves in situations where they have to define the person or the legal subject, at times with surprising consequences. However, legal theory lacks clear criteria for personhood. We do not know who or what a legal person is, nor do we know what kind of being (...) we want her to be. There is clearly a need for critical examination of the concept of legal personhood. This article takes its inspiration from a historical theory, which sheds light on the complex logics of subjectivity. Reflecting on the thought of Johann Gottlieb Fichte we can contemplate fundamental aspects of personhood, especially in its politico-legal dimensions. It is claimed in this article that even though the legal subject has to be autonomous to some degree, acknowledging otherness inside the self is a compelling way of understanding legal personhood. (shrink)

John Tillson concludes the symposium on his Children, Religion and the Ethics of Influence by replying to his five respondents. The reply focusses on Michael Hand’s defence of parental rights to raise their children in their faith; Ruth Wareham’s suggestion that the value of autonomy rules out a wider range of impermissible religious influences than Tillson’s account is able to; David Lewin’s alternative criteria for ethical influence and scepticism about rationality’s objectivity; Anca Gheaus’ proposal that initiation into multiple (...) contradictory religious faiths is permissible; and Matthew Clayton’s rejection of the book’s perfectionist political morality. (shrink)

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and (...) autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

In his book The Morality of Freedom, Joseph Raz argues that the promotion of personal autonomy can serve as a constitutive principle for a comprehensive political theory. He maintains that three conditions are necessary for attainment of individual autonomy: appropriate mental abilities, an adequate range of options, and independence. In this essay, by focusing on Raz’s conception of an adequate range of options, we suggest that Raz’s theory justifies environmental conservation in general. We present an empirical framework of (...) present-day assaults on personal autonomy, construct a heuristic scenario, and argue against both neoclassical economics and utility maximization as adequate criteria regarding environmental decisions. We conclude that successful environmental policies should directly or indirectly strive to provide the conditions necessary for promoting individual autonomy. (shrink)

Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention, memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making still remain highly unclear. Here it will be argued that also in the medical domain the use of cognition-enhancing drugs is not intrinsically unethical and that, in fact, physicians should assume an important role in (...) gating their usage. For finding normative orientation, concepts of disease, normality or medicine will not be helpful since—due to their cryptonormative nature—they rather hamper than allow targeted discussion and decision-making. As an alternative, the common and widely accepted bioethical criteria of beneficence, non-maleficence, autonomy and distributive justice allow a clinically applicable, highly differentiated context- and case-sensitive approach. By embedding decision-making in a participative physician–patient relationship extrinsic objections against neurocognitive enhancement (e.g. invalid perceptions about efficacy, benefit or risk; questionable voluntariness; restrained decision-making capacity) can be curtailed. (shrink)

Joseph Agassi, together with Yehuda Fried, presented the paradoxes of paranoia and proposed to explain and solve them by introducing innovative diagnostic criteria for psychosis as reflecting a specific kind of rationality. Their ethical-clinical framework however, discouraged discussion of placing impositions on the mentally ill, even when in danger. According to these very criteria, Agassi’s institutional individualism framework renders paranoiacs defective in autonomy. Introducing the idea of degrees of autonomy as a guiding principle for research and (...) practice will promote responsible commitment to the mentally ill and to all other persons in society. (shrink)

Joseph Agassi, together with Yehuda Fried, presented the paradoxes of paranoia and proposed to explain and solve them by introducing innovative diagnostic criteria for psychosis as reflecting a specific kind of rationality. Their ethical-clinical framework however, discouraged discussion of placing impositions on the mentally ill, even when in danger. According to these very criteria, Agassi’s institutional individualism framework renders paranoiacs defective in autonomy. Introducing the idea of degrees of autonomy as a guiding principle for research and (...) practice will promote responsible commitment to the mentally ill and to all other persons in society. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole‐genome sequencing and micro‐array based analysis enable genome‐wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre‐test information and achieving autonomous decision‐making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized (...) by the International Association of Bioethics, these challenges were presented for three different areas in which these so‐called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set‐up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set‐up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct‐to‐consumer applications of the new genetics. (shrink)

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for auton omy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty. Patients attempting to choose the best practitioner (...) do not have data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge. The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery sys tem. (shrink)

The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy depends (...) upon such responsiveness to reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

How should we read Foucault's claims, in his late work, for the relevance of ‘aesthetic criteria’ to politics? What is Foucault's implicit understanding of the nature of aesthetics and the autonomy of the aesthetic sphere? Would an ethics which gave a place to the aesthetic legitimize a politics of manipulation, brutality and aggression ‐ in short, a ‘fascist’ politics ‐ as some of Foucault's critics argue? In this paper, I examine key accounts of the fascist ‘aestheticization of politics’ (...) ‐ from Walter Benjamin's classic essay, ‘The Work of Art in the Age of Mechanical Reproduction’ (1936), to Philippe Lacoue‐Labarthe's work on the relation between Heidegger's philosophy and the fascist theme of politics as the plastic art of the state. Through a discussion of Foucault's late work, the paper demonstrates the connection between Foucault's turn to ancient Greek ethical practices and his call for a contemporary renewal of the idea of ethics as an art of living. The aim of the paper is to show in what ways the ethico‐political position which is presented in Foucault's late work, far from contributing to a fascist politics, in fact provides ways of thinking about the relationship between the aesthetic and the political which avoid both mindless radicalism and totalitarian narcissism. In doing so, the key question is, ‘What's aesthetic about Foucault's “aesthetics of existence"?’. (shrink)

There are multiple and diverse voices of jurists who have expressed their fear of the unrestricted power of law enforcement and have announced the crisis of the formalist sense of Law. The widespread reaction against the abstract and formalist character of the positivist theory of law manifested itself as the Krausist philosophy of law and was backed by the philosophy of Krause, Schelling, Hegel and the most recent Natural Law theories that seek to establish substantial criteria for moral action. (...) This distrust was caused by the heteronomy of modest and obedient civil servants of the judicial order that rely on political balance of power in which nothing depends on the human bottom of institutions. Let us consider briefly the impressive analyses performed by different thinkers on this issue, which they considered characteristic of their era, but that continues to constitute a difficulty that challenges contemporary society. (shrink)

There are multiple and diverse voices of jurists who have expressed their fear of the unrestricted power of law enforcement and have announced the crisis of the formalist sense of Law. The widespread reaction against the abstract and formalist character of the positivist theory of law manifested itself as the Krausist philosophy of law and was backed by the philosophy of Krause, Schelling, Hegel and the most recent Natural Law theories that seek to establish substantial criteria for moral action. (...) This distrust was caused by the heteronomy of modest and obedient civil servants of the judicial order that rely on political balance of power in which nothing depends on the human bottom of institutions. Let us consider briefly the impressive analyses performed by different thinkers on this issue, which they considered characteristic of their era, but that continues to constitute a difficulty that challenges contemporary society. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole-genome sequencing and micro-array based analysis enable genome-wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre-test information and achieving autonomous decision-making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized (...) by the International Association of Bioethics, these challenges were presented for three different areas in which these so-called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set-up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set-up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct-to-consumer applications of the new genetics. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from (...) the American Medical Association masterfile. Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

Author discusses the problem of the relation between scientific and theological discourses. He argues both against the thesis about science and religion as complementary parts as well as against the thesis that they stay in conflict. He defends the position of the strong separation of theology and science. The author considers three fundamental philosophical problems that mark the difference in rational consideration between science and theology: emergence of the world, foundations of belief and knowledge, modes of scientific and religious discourses. (...) The author claims that the incompatibility in the understanding of the emergence of the world in science and religion lies in the concept of the observer: the “external" observer in theology and the “internal" observer in science. “Experience" in science and “religious experience" have different sources, different criteria for reliability, different existential meaning. Religion and science have different purposes: the domination of man over himself in religions and the domination of man over the outside world in science. Therefore, religion and science use fundamentally various discourses: a descriptive discourse in science and prescriptive discourse in religion. Therefore, I think that the dialogue between religion and science doesn't make any sense neither for religion nor for science. (shrink)

_ Source: _Page Count 19 The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It (...) argues that autonomy depends upon such responsiveness to reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

Nowadays, new directions for the development of artificial intelligence (AI) have emerged, the task has been set to develop artificial general intelligence (AGI), which is able to go beyond the narrow AI, gain a high degree of autonomy, independently solve problems in different environmental conditions and thus have the ability to perform the functions of natural intelligence. In this regard, important philosophical, theoretical, and methodological questions arise concerning the definition and evaluation of the social significance of new AI achievements, (...) especially regarding the correlation of their socio-humanitarian and technological aspects. It is necessary to overcome a purely technocratic approach, which usually ignores the negative consequences of digitalization, the possible risks and threats of AI development. These difficulties are conditioned by the paradigm gap between the system of concepts used to describe technologies and the systems of concepts specific to socio-humanitarian descriptions and explanations. The so-called ontological paradox arises during digital transformation and the introduction of AI into social systems. An ontological paradox is also an epistemological paradox, since any statement of an ontological type presupposes its epistemological justification. To overcome this gap, V.E. Lepskiy proposes the conception of self-developing polysubjective environments – cybernetics of the third order. This conception allows to create a conceptual “bridge” between two systems of definitions that do not have direct logical connections between them. A productive tool for this can be the information approach, which is widely used to solve such interdisciplinary problems. This makes possible to theoretically correctly connect technological and socio-humanitarian descriptions in a single conceptual structure and to analyze main socio-humanitarian criteria for evaluating digital innovations. The article discusses in detail the main provisions of the information approach and its application for the development of AGI systems, the socio-humanitarian assessment of AI autonomous development, and the resolution of security issues. (shrink)

We all want things. And although we might disagree on just how significant our wants, desires, or preferences are for the matter of how well we fare in life, we would probably all agree on some of them having some significance. So any reasonable theory about the human good should in some way acknowledge this. The theory that most clearly meets this demand is of course preferentialism, but even pluralist theories can do so. However, then they will at the same (...) time bring aboard a classical problem for preferentialism, namely that of discriminating among preferences. Not all preferences would seem to make contributions to our well-being and there should be some set of criteria which at least makes it intelligible why there is such a difference and that perhaps can even be used in order to evaluate hard cases. (shrink)

L’objectif de cet article est d’exposer certains éléments de la théorie hiérarchique de l’autonomie personnelle développée par Harry G. Frankfurt, en mettant l’accent sur son interprétation de l’activité évaluative impliquée dans la délibération pratique. Selon le philosophe, les questions relatives à la manière dont je dois mener ma vie ne sont pas à proprement parler des questions normatives, mais se déterminent sur la base du critère subjectif et empirique que sont les intérêts de l’agent. Nous voulons montrer, d’une part, que (...) ce critère n’est pas le seul pertinent pour le type de questions relevant du domaine de l’autonomie personnelle et, d’autre part, que les intérêts de l’agent peuvent eux aussi, dans une certaine mesure, être évalués sur la base de critères extérieurs à la subjectivité. Nous voulons affirmer d’une manière générale que les questions concernant le comment vivre sont aussi des questions normatives.The aim of this article is to expose some elements of the hierarchical theory of personal autonomy developped by H. G. Frankfurt, stressing on his interpretation of the evaluative activity implied in pratical deliberation. According to the philosopher, the questions concerning how we should live are not normative questions ; they are determined by a subjective and empirical criteria, namely the agent’s interests . We want to show, on one side, that this subjective criteria is not the only one relevant for the type of questions belonging to the field of personal autonomy and, on the other side, that the interests can also, to a certain extent, be criticised on the basis of normative criterias external to the subjectivity. To put it briefly, we want to assert here that, according to us, questions about how we should live are also normative questions. (shrink)

The categories and contours of a normative social theory are prefigured by its ‘anthropological’ presuppositions. The discourse/communicative-theoretic basis of Habermasian theory was prefigured by a strong anthropological demarcation between an instrumentally structured realm of science, technology and labor versus a normatively structured realm of social interaction. An alternative anthropology, bolstered by current work in the empirical sciences, finds fundamental normative needs for orientation and ‘compensation’ also to be embedded in embodied material practices. An emerging anthropologically informed concept of skill that (...) goes beyond old manual versus intellectual dichotomies and brings forth internal criteria of autonomy and authenticity can serve as a new bridge between categories of social justice, such as Sen and Nussbaum’s basic human ‘capabilities’, and new cutting-edge work in the empirical human sciences and thereby provide Critical Theory with a renewed point of departure that is both normatively and descriptively rich, for advancing its dialectical, historical mission. (shrink)