In this paper I argue for what I call ‘the inherency thesis’: the thesis that an autonomous choice that succeeds in expressing an agent’s authentic identity is inherently prudentially valuable for the choosing agent. I argue that this is the case because autonomous choice is a vehicle for the expression of authentic identity, the satisfaction of which is intrinsically prudentially valuable. Moreover, I argue that no such inherent relation exists between fulfilled autonomous choice and the exemplification of (...) moral, aesthetic or perfectionist value. These conclusions suggest that accounts of the normativity of personal autonomy should focus on the notion that the demand to respect personal autonomy is grounded on the demand to promote the prudential value – and hence well-being – of others. (shrink)

The present trend toward routine inquiry appears to be based on the false premise that the individual's wishes cannot be known and that, therefore, the family is the only alternative for making donation decisions. The UAGA states that the family should be turned to only when the wishes of the individual are not known.To protect the right of individuals to make their own decision, an effective and efficient process for making the wishes of individuals known should be devised and the (...) UAGA amended accordingly. I have presented the policy of strong required request as the best way to effectively protect the rights that the UAGA ostensibly gives to the individual. This policy ensures that the individual's wishes, both for and against donation, are known. It also alleviates some of the problems in the original approach that hindered the procurement of organs from willing donors. Strong required request saves families from making critical decisions, which may be painful and conflicted for some, at a time of emotional shock and grief. (shrink)

Individuals are owed equal respect. But on the basis of what property of individuals are they owed such respect? A popular Kantian answer —rational agency — appears less plausible in light of the growing psychological evidence that human choice is subject to a wide array of biases (framing, laziness, etc.); human beings are neither equal in rational agency nor especially robust rational agents. Defenders of this Kantian answer thus need a non-ideal theory of equal respect for (...) rational agency, one that takes seriously our characteristic deficiencies of practical rationality without junking the notion that rational agency entitles us to equal respect. This article defends an understanding of respect for rational agency wherein the object of such respect is individuals’ aspiration to rationally govern their lives. This understanding of respect for rational agency retains the core notion of respect as a kind of deference, directs respect at persons, has suitably egalitarian implications, and does not require us to deny the aforementioned psychological evidence regarding the infirmities of human rationality. (shrink)

Human rights have increasingly been put forward as an important framework for bioethics. In this paper, it is argued that human rights offer a potentially fruitful approach to understanding the notion of Respect for Persons in bioethics. The idea that we are owed a certain kind of respect as persons is relatively common, but also quite often understood in terms of respecting people’s autonomous choices. Such accounts do however risk being too narrow, reducing some human beings to a (...) second-class moral status. This paper puts forward a political approach to our standing as persons and a strongly pluralistic account of human rights that lays the ground for a more broadly applicable conception of Respect for Persons. It is further argued that this model also provides an example of a more general approach to philosophical ethics, an approach which is here called taxonomical pluralism. When it comes to Respect for Persons specifically, this principle is developed in terms of five distinct core concerns. (shrink)

This paper explores the value of respect for personal autonomy in relation to clearly immoral and irrational acts committed freely and intentionally by competent people. Following Berlin's distinction between two kinds of liberty and Darwall's two kinds of respect, it is argued that coercive suppression of nonautonomous, irrational, and self-harming acts of competent persons is offensive to their human dignity, but not disrespectful of personal autonomy. Irrational and immoral choices made by competent people may claim only the negative (...) liberty to be left alone. Lives disposed to autonomy are worthy of solidarity and active support in addition to the right of free choice and action. Autonomous premeditated desires (distinguished from mere consent) may embody transcendental choices, which transcend consideration of physical and psychological well-being. Choices made by incompetent persons (e.g., children and the mentally disabled) are not related to autonomy, but to self-directedness. The value of human dignity confers protection to self-directedness, but not at the expense of other vital interests. (shrink)

As liberals, we would like each person to direct her own life in accordance with her will. However, because of the complexities of the human mind, it is very often not clear what a person wills. She may choose one thing though she prefers another, while having false beliefs the correction of which would cause her to prefer some third thing. I propose, against this background, that to respect a person’s will or self-direction is to respect both her (...) choices and her preferences, with some priority given to those preferences that are informed and coherent. This is a pluralist answer to the neglected question, “respect for what?”. (shrink)

When our choice affects some other person and the outcome is unknown, it has been argued that we should defer to their risk attitude, if known, or else default to use of a risk‐avoidant risk function. This, in turn, has been claimed to require the use of a risk‐avoidant risk function when making decisions that primarily affect future people, and to decrease the desirability of efforts to prevent human extinction, owing to the significant risks associated with continued human survival. (...) I raise objections to the claim that respect for others' risk attitudes requires risk‐avoidance when choosing for future generations. In particular, I argue that there is no known principle of interpersonal aggregation that yields acceptable results in variable population contexts and is consistent with a plausible ideal of respect for others' risk attitudes in fixed population cases. (shrink)

When our choice affects some other person and the outcome is unknown, it has been argued that we should defer to their risk attitude, if known, or else default to use of a risk avoidant risk function. This, in turn, has been claimed to require the use of a risk avoidant risk function when making decisions that primarily affect future people, and to decrease the desirability of efforts to prevent human extinction, owing to the significant risks associated with continued (...) human survival. I raise objections to the claim that respect for others’ risk attitudes requires risk avoidance when choosing for future generations. In particular, I argue that there is no known principle of interpersonal aggregation that yields acceptable results in variable population contexts and is consistent with a plausible ideal of respect for others’ risk attitudes in fixed population cases. GPI Working Paper No. 20-2022. (shrink)

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it (...) is argued that O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)

Can a state seek to promote a thick conception of the good (such as fostering a kind of meaning or excellence in people's lives) without treating its citizens disrespectfully? The predominant answer among friends of the principle of respect for persons is "no." The most powerful Kantian objection to non-liberalism or perfectionism is the claim that citizens who do not share the state's conception of the good would be wronged in that the state would treat a certain way of (...) life as more important than its citizens' capacities to choose their own ways of life. I sketch a new non-liberal principle for political decision-making and show that, unlike other forms of non-liberalism, it is not vulnerable to this major respect-based objection. 'Open perfectionism' is the view that state enforcement of a conception of the good favoured by the majority is permissible if and only if the minority has the substantial ability to avoid the territory in which the conception of the good is enforced. I argue that it is a realistic possibility for some non-liberal states to provide a fair opportunity to their dissenters to avoid the imposition of non-liberal policies and that the Kantian liberal's central complaint would not apply to non-liberal states if they were to provide such an opportunity. The principle of respect for persons grounds the most influential argument for liberalism, and so showing that open perfectionism is consistent with liberal intuitions about free choice promises to help to transcend the long-standing conflict between non-liberalism and Kantian liberalism. (shrink)

The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. It then considers whether a switch to the rational autonomy view would lead to overriding more patient decisions but concludes that this should not be the case. Rather, a determination of whether individual patient decisions are autonomous is much less relevant than (...) usually considered in determining whether health care providers must abide by these decisions. Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy. (shrink)

Rival causal and interpretive approaches to explaining social phenomena have important ethical differences. While human actions can be explained as a result of causal mechanisms, as a meaningful choice based on reasons, or as some combination of the two, it is morally important that social scientists respect others by recognizing them as persons. Interpretive explanations directly respect their subjects in this way, while purely causal explanations do not. Yet although causal explanations are not themselves expressions of (...) class='Hi'>respect, they can be used in respectful ways if they are incorporated into subjects’ self-directed projects. This can occur when subjects correctly understand and freely adopt researchers’ goals through a process of informed consent. It can also occur when researchers correctly understand and adopt their subject’s goals, using their research to empower those they study. (shrink)

An important approach to game theory is to examine the consequences of beliefs that rational agents may have about each other. This paper considers respect for public preferences. Consider an agent A who believes that B strictly prefers an option a to an option b. Then A respects B’s preference if A considers the choice of a “infinitely more likely” than the choice of B; equivalently, if A assigns probability 1 to the choice of a given (...) that B chooses a or b. Respect for public preferences requires that if it is common belief that B prefers a to b, then it is common belief that all other agents respect that preference. Along the lines of Blume, Brandenburger and Dekel [4] and Asheim [1], I treat respect for public preferences as a constraint on lexicographic probability systems. The main result is that if respect for public preferences and perfect recall obtains, then players choose in accordance with Iterated Backward Inference. Iterated Backward Inference is a procedure that generalizes standard backward induction reasoning for games of both perfect and imperfect information. From Asheim’s characterization of proper rationalizability [1] it follows that properly rationalizable strategies are consistent with respect for public preferences; hence strategies eliminated by Iterated Backward Inference are not properly rationalizable. (shrink)

Following the argument proposed by Tschudin in 1986 that many nurses do not have the skills for ethical decision-making, this article identifies and discusses one ethical prob lem from practice. The problem concerns an extremely obese patient who refuses to be moved by a hoist. The nurses acquiesce to the patient's wishes and she is moved manually by four mem bers of staff. The issues identified for discussion are: the paramountcy of the principle of respect for the patient's autonomy; (...) the rights and obligations of the nurses; and the jus tification for influencing patient choice. The approach used by the ward nurses is analysed and the value of using an ethical decision-making model is considered. (shrink)

The paper considers acts of private (in the sense of individually motivated and extra-legal) revenge, and draws attention to a special kind of judgement we may make of such acts. While endorsing the general view that an act of private revenge must be morally wrong, it maintains that under certain special conditions (which include its being just) it is susceptible of a rational respect from others which is based on its standing outside morality, as a choice by the (...) revenger not to act morally but to obey other compelling motives. This thesis is tested against various objections, notably those which doubt the intelligibility or application of such non-moral respect, or would assimilate it to moral approval; and it is distinguished from various positions with which it might be confused, such as the 'admirable immorality' of Slote, or the Nietzschean critique of morality. (shrink)

How ought we respond to advance directives that appear to fly in the face of a severely mentally impaired patient's quality of life? An advance directive is a legal instrument wherein a person records instructions regarding the medical treatment that she is to receive in the event that she becomes persistently incapable of refusing or giving informed consent to treatment. Where these instructions are legally binding, they enable a person to exercise control over her future medical treatment. This has been (...) welcomed by some on the grounds that it increases patient autonomy, but there has also been concern that in cases in which a patient is left conscious but severely mentally impaired, the person's advance .. (shrink)

This essay explores three issues in respect for autonomy that pose unfinished business for the concept. By this, I mean that the dialogue over them is ongoing and essentially unresolved. These are: whether we ought to respect persons or their autonomous choices; the role of relational autonomy; and whether nonhuman animals can be autonomous. In attending to this particular set of unfinished business, I highlight some critical moral work left aside by the concept of respect for autonomy (...) as understood in Beauchamp and Childress’ Principles of Biomedical Ethics. Specifically, while significant pragmatic traction is gained by the authors’ focus on autonomous choice, carving such a focus out from the broader questions of moral respect and the autonomy of the person leaves aside a number of questions that we might have thought a view about respect for autonomy in biomedicine ought to answer. These include: How should physicians respond when autonomous patients make decisions that appear nonautonomous? What is the impact of the view that autonomy is “relational” for cross-cultural differences in how autonomy is respected? If chimpanzees can be autonomous, what does that mean for how they should be treated? (shrink)

The traditional liberal view on conflicts between care for wellbeing and respect for choice and desire is that we should look to degrees of competence and voluntariness to determine which moral imperative should take priority. This view has likely influenced the common view that children’s choices should be considered only to the extent that this promotes their future autonomy and helps us determine their best interests. I reject both the general traditional liberal view and its application to children. (...) Competence and voluntariness, as well as maturity, are at best proxies for what really matters, which is wellbeing, choice and desire. We typically have reason to respect children’s choices, irrespective of any further positive consequences. If we should more often make children do what they do not want to do, this is mainly because, though we should care about respecting their choices, we should care even more about their wellbeing and future autonomy. (shrink)

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental (...) importance of understanding persons within the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging. (shrink)

That Jehovah’s Witnesses may refuse lifesaving blood transfusions is a morally accepted feature of contemporary medical practice. The principle of respect for autonomy supports this, and there is seldom reason to interfere with this choice because it rarely harms another individual. Advances in surgical technique have made it possible for transplant surgeons to perform bloodless organ transplant, enabling Jehovah’s Witnesses to benefit from this treatment. When the transplant organ is a directed donation from a family member or friend, (...) no ethical dilemma arises. However, when a Jehovah’s Witness cannot identify a living donor and wishes to be listed for organ transplant, the transplant team may face an ethical dilemma. On the one hand, it wishes to provide care to the patient that is compatible with her or his preferences. On the other hand, the team may wonder if it is fair to other patients who need an organ and will accept blood transfusion to include the Jehovah’s Witness patient on a waiting list for a donated organ. If the Jehovah’s Witness patient is listed and receives an organ, then a patient who also needs an organ, and who is willing to accept all care to optimize the success of the transplant, may be denied an organ.To frame the ethical dilemma outlined above we present an anonymized case of a Jehovah’s Witness woman in urgent need of a kidney, who was referred to one of the authors’ institution’s transplant center. We review the evolution of the Jehovah’s Witness position on blood transfusion and the medical community’s efforts to provide care that accommodates this religious commitment. If Witnesses are to be denied transplant in the name of justice, there must be an ethically sound reason. We identify two rationales in the literature: (1) this allocation is unacceptable because it will cost lives; (2) resources should be allocated to patients who comply with the standard of care. We argue that neither apply to this dilemma. We also emphasize the importance of examining the data on outcomes of transplant with and without transfusion. Our interpretation of the published data on transplant without transfusion is that the outcomes are similar. We conclude that, in the absence of data that resources are risked, it is not ethical to refuse to include a Jehovah’s Witness patient on a waiting list for an organ. Finally, we reflect on the heterogeneity in transplant institutes’ polices for accepting Jehovah’s Witness patients. (shrink)

The aim of the study was to understand the development of professional identity of prospective teachers, their ideals and experiences during interactions with their surrounding learning environment, including university studies and pedagogical placement during their 5-year studies. We also aimed at understanding how students with different motivational pathways to teacher education may be supported to explore teaching as a possible career choice. The findings reported in this article emerged primarily from interviews with 13 student teachers at the end of (...) their teacher education programme. Survey responses collected during earlier stages of the study were utilised to provide data about the student teachers’ professional development prior to the point of the interviews. The findings of the study point to various concerns and dilemmas, which in turn suggest that student teachers take different identity development routes. The study identified four possible “identity routes” to becoming a teacher. Th... (shrink)

Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. (...) I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows. (shrink)

In this paper, I appeal to two aspects of Immanuel Kant’s philosophy – his metaphysics and ethics – in defense of abortion rights. Many Kantian pro-life philosophers argue that Kant’s second principle formulation of the categorical imperative, which proscribes treating persons as mere means, applies to human embryos and fetuses. Kant is clear, however, that he means his imperatives to apply to persons, individuals of a rational nature. It is important to determine, therefore, whether there is anything in Kant’s philosophy (...) that permits regarding embryos and fetuses as persons, since they lack the capacity for sentience (at least until mid-gestation), let alone rational thought. In the first part of the paper, I will illustrate why there are difficulties maintaining, from a Kantian perspective, that conception marks the genesis of a new person. Even granting that embryos and fetuses are persons, however, this alone would not entail the moral impermissibility of abortion rights, mainly because prohibiting abortion, and compelling women to gestate, violates the formula of humanity against them. Developing this thesis encompasses the second part of my essay. Finally, although I argue that Kant’s philosophy lends strong support to abortion rights, this does not thereby entail that it allows for the complete dehumanization of the human fetus. By appealing to the writings of Kantian scholar Allen Wood, I will argue that a fetus’ status as a potential person does render it worthy of some degree of respect and moral value. (shrink)

Nicholas Makins makes a valuable contribution to the literature on medical decision-making, highlighting the role that risk attitudes play in deliberation and subsequently arguing that, in medical choices under uncertainty, if considerations of autonomy and beneficence support deference to patient values and outcome preferences then they also support deference to patients’ attitudes to risk.1 Crucially, however, Makins suggests that it is not simply first-order risk attitudes that are the appropriate target of deference but, rather, patients’ higher-order risk attitudes. In other (...) words, Makins argues that if considerations of autonomy and beneficence support deference in medical decision-making, this deference should include the risk attitudes that individuals desire to have or reflectively endorse. This commentary draws out a morally relevant and overlooked distinction between: (1) deferring to patients’ higher-order attitudes that endorse the first-order risk attitudes they currently hold. and (2) deferring to patients’ higher-order attitudes that endorse risk attitudes that are at odds with the first-order risk attitudes they currently hold (which equates to a higher-order desire to change one’s first-order risk-attitudes). I agree with Makins that if respect for autonomy and beneficence support deference to patient preferences, then these considerations may also support deference to at least some higher-order risk attitudes, namely, those of type (1). But I think that whether they support deference to those of type (2) is less clear. In particular, it does not …. (shrink)

Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this (...) context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making. (shrink)

Turkey has a complex character, which has differences from the Western world or Eastern Asia as well as common points. Even after more than a century of efforts to modernise and integrate with the West, Turkish society has values that are different from those of the West, as well as having Western values. It is worth questioning whether ordinary Turkish people show an individualistic character. The principle of respect for individual autonomy arises from a perception of oneself as an (...) individual, and the person’s situation may affect the applicability of the principle. Patients who perceive themselves to be members of a community rather than free persons and who prefer to participate in the common decisions of the community and to consider the common interest and the common value system of the community concerning problems of their life rather than to decide as independent, rational individuals may not be competent to make an autonomous choice. Expectations that such patients will behave as autonomous individuals may be unjustified. The family, rather than the patient, may take a primary role in decisions. A flexible system considering cultural differences in the concept of autonomy may be more feasible than a system following strict universal norms. (shrink)

Abstract Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of (...) human persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity. (shrink)

Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of human (...) persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity. (shrink)

Under current UK law, an embryo cannot be transferred to a woman's uterus without the consent of both of its genetic parents, that is both of the people from whose gametes the embryo was created. This consent can be withdrawn at any time before the embryo transfer procedure. Withdrawal of consent by one genetic parent can result in the other genetic parent losing the opportunity to have their own genetic children. We argue that offering couples only one type of consent (...) agreement, as happens at present, is too restrictive. An alternative form of agreement, in which one genetic parent agrees to forego the right to future withdrawal of consent, should be available alongside the current form of agreement. Giving couples such a choice will better enable them to store embryos under a consent agreement that is appropriate for their circumstances. Allowing such a choice, with robust procedures in place to ensure the validity of consent, is the best way to respect patient autonomy. (shrink)

The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio‐circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions—first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid‐twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or functioning lungs. In (...) Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on “what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed.” We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach. (shrink)

In this paper, I examine the conflicts between autonomy and justice. The problem of justice in healthcare concerns both micro-allocation and macro-allocation. The latter has to do with distributive justice: who should get what healthcare resources at whose expense. The current debate about healthcare reform brings up two competing models of distributive justice from political philosophy. The libertarian theory holds to the ideal of individual responsibility and choice, viewing taxation for the purpose of providing goods to those who cannot (...) afford them as a form of unjustified coercion. The liberal theory holds that society should ensure that all members are provided with basic goods that correct for inequalities that deprive them of human dignity. Even though both theories value individual choice, these theories provide opposing answers to the question of whether taxes should be collected and used for the purpose of ensuring universal access to healthcare. In my paper, I show that neither theory can respect patient choice in healthcare and achieve distributive justice. Libertarians ignore the realities of the healthcare system and why a free market where patients choose and pay for what they want cannot exist. Liberals face the problem that the choices that patients make can lead to over-consumption of healthcare at the expense of other goods important to society. (shrink)

P. van Inwagen famously offered three precise versions of the so-called Consequence Argument for incompatibilism. The third of these essentially employs the notion of an agent’s having a choice with respect to a proposition. In this paper, I offer two intuitively attractive accounts of this notion in terms of the explanatory connective ‘because’ and explore the prospects of the third argument once they are in play. Under either account, the argument fails.

This book investigates the relationship between our present and future selves. It focuses specifically on diachronic self-regarding decisions: choices involving our earlier and later selves, in which the earlier self makes a decision for the later self. The author connects the scientific understanding of the neurobehavioral processes at the core of individuals' perceptions of their future selves with the philosophical reflection on individuals' moral relationship with their future selves. She delineates a descriptive theory of the perception of the future self (...) that is based on empirical evidence and that systematizes and integrates the current theoretical literature. She then argues for the morality of prudence and interprets diachronic self-regarding decisions as decisions between two agents-the earlier and later selves-that belong to the realm of intergenerational ethics, which regulates the relationship between contemporary people and future generations. Finally, the author provides a moral theory of prudence based on respect for one's agency. This theory identifies what the present and the future selves owe to one another in diachronic self-regarding decisions. Moral Choices for Our Future Selves will be of interest to researchers and students working in ethics, moral psychology, philosophy of mind, and cognitive science. (shrink)

Parental decision making is necessary for contracting medical interventions that require personal risk–benefit evaluation, and for overseeing matters of education. In the nineteenth century, exemptions from obligatory vaccination were granted for religious and conscientious reasons. Then and today, religion and moral values play marginal roles in vaccine hesitancy and denialism. Rather, the key values invoked by vaccine hesitants and denialists are liberty and pluralism. Neither is compatible with limiting adolescents’ choice. Because vaccination does not require assessment of personal medical (...) risks, because it does not need to occur within the sphere of the doctor–patient relationship, and because the risk involved is within the range of their daily activities, adolescents have the right to free access to vaccination without legal requirement of parental involvement. Drawing on the development of Common Law, and on the development of respect for personal conscience in the history of ideas, this paper does not promote an argument that grants public health an overriding moral power. Rather, this paper rejects the presumption that vaccination of adolescents might involve a conflict between parental authority and public health. Free access to vaccination is compatible with the law and ethics of adolescents’ evolving autonomy in relation to healthcare. (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be (...) respected. (shrink)

Decision theory is a theory of rationality, but the concept of rationality has several different dimensions. Making decision theory more realistic with respect to one dimension may well have the result of making it less realistic in another dimension. This paper illustrates this tension in the context of sequential choice. Trying to make decision theory more realistic by accommodating resoluteness and commitment brings the normative assessment dimension of rationality into conflict with the action-guiding dimension. In the case of (...) resolute choice the conflict comes because of a clash of perspectives. The perspective from which resolute choice seems normatively compelling is not the perspective from which it can serve the purpose of guiding action. (shrink)

L’émergence des marchés en Europe de l’Est, en Asie et celle du cyber-espace ne se fait pas avec la rapidité que beaucoup d’observateurs voudraient. La lenteur de ce développement provient de l’environnement institutionnel : les systèmes législatifs ne soutiennent pas les droits de propriété privée et ne font pas plus respecter les contrats. Ainsi, beaucoup soutiennent que les Etats doivent intensifier leurs efforts pour établir un droit commercial. En réalité, il faut réclamer un désengagement de l’Etat dans le droit commercial. (...) Tout au long de l’histoire, le recours efficace de l’activité commerciale est toujours provenu d’un système polycentrique de droit coutumier avec des querelles résolues par le biais de cours de commerce ou d’arbitrage eux-mêmes appuyés par des sanctions d’ostracisme imposées de façon privée, et il en est de même pour le droit commercial international aujourd’hui. Nous proposons une description des institutions et des processus du droit commercial international, suivie de discutions sur la nécessité d’un droit polycentrique et des caractéristiques du droit coutumier. Finalement, nous expliquons pourquoi nous devrions compter sur un système de droit coutumier polycentrique sans Etat pour l’émergence récente des marchés.The emergence of markets in Eastern Europe, Asia, and cyberspace is no occurring as rapidly as many observers would like. Slow development is a function of the institutional environment: legal systems do not support private property rights or enforce contracts. Thus, many contend that states must step up their efforts to establish commercial law. In reality, less state involvement in commercial law is called for. Throughout history effective recourse for commercial activity has been produced through a polycentric system of customary law with disputes resolved through merchant courts or arbitration backed by privately imposed ostracism sanctions, and the same is true for international commercial law today. A description of the institutions and processes of international commercial law is provided, followed by discussions of the desirability of polycentric law and the characteristics of customary law. Finally, an explanation is provided for why a stateless system of polycentric customary law should be relied upon in modern emerging markets. (shrink)

Registered nurses in psychiatric-mental health nursing continuously balance the ethical principles of duty to do good (beneficence) and no harm (non-maleficence) with the duty to respect patient choices (autonomy). However, the problem of nurses’ level of control versus patients’ choices remains a challenge. The aim of this article is to discuss how nurses accomplish their simultaneous responsibility for balancing patient safety (beneficence and non-maleficence) with patient choices (autonomy) through the theory of protective empowering. This is done by reflecting on (...) interview excerpts about caring from 17 registered nurses taking part in a grounded theory study conducted in three acute urban psychiatric hospital settings in Canada. The interplay between the protective and empowering dimensions of the theory of protective empowering was found to correspond with international, national, and local nursing codes of ethics and standards. The overall core process of protective empowering, and its associated reflective questions, is offered as a new lens for balancing patient safety with choices. (shrink)

Fundamentals -- Beginning-of-life issues -- Reproductive technologies -- Contraception, sterilization, and natural family planning -- End-of-life issues -- Cooperation with evil -- Respect for the body -- The ten commandments for health care professionals and patients.

In medical practice, the doctrine of informed consent is generally understood to have priority over the medical practitioner’s duty of care to her patient. A common consequentialist argument for the prioritisation of informed consent above the duty of care involves the claim that respect for a patient’s free choice is the best way of protecting that patient’s best interests; since the patient has a special expertise over her values and preferences regarding non-medical goods she is ideally placed to (...) make a decision that will protect her interests. In this paper I argue against two consequentialist justifications for a blanket prioritisation of informed consent over the duty of care by considering cases in which patients have imperfect access to their overall best interests. Furthermore, I argue that there are cases where the mere presentation of choice under the doctrine of informed consent is detrimental to patient best interests. I end the paper by considering more nuanced approaches to resolving the conflict between informed consent and the duty of care and consider the option of permitting patients to waive informed consent. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary (...) medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

To nudge is to design choice contexts in order to improve choice outcomes. Richard Thaler and Cass Sunstein emphatically endorse nudging but reject more restrictive means. In contrast, I argue that the behavioral psychology that motivates nudging also motivates what may be called jolting — i.e. the design of choice content. I defend nudging and jolting by distinguishing them from the sometimes oppressive means with which they can be implemented, by responding to some common arguments against nudging, (...) and by showing how respect for preferences over option sets and their aggregate properties may require the trimming of option sets, as well as helpful choice contexts. (shrink)

Animals are usually considered to lack the status of autonomous agents. Nevertheless, they do appear to make ostensible choices. This article considers whether, and how, I should respect animals' choices. I propose a concept of volitionality which can be respected if, and insofar as, doing so is in the best interests of the animal. Applying that concept, I will argue that an animals' choices be respected when the relevant human decision maker's capacities to decide are potentially challenged or compromised. (...) For example, it will be best to respect the animals' choice when the human decision maker: lacks accurate knowledge of the animal's subjective experiences; does not know what will lead to desirable experiences or allow for the avoidance of undesirable ones; is biased; is less aware of the animal's specific situation; cannot appreciate all elements comprehensively, including considering any value to the animal being allowed to make and implement a choice, such as where a lack of control or liberty would be unpleasant or where an animal would usefully learn from the process of choice-making; and when the animal's choice is achievable. This additionally suggests that we may often beneficially choose to set up situations that empower animals to make better choices. (shrink)

On the face of it, the perspective that Casper puts forward in his paper (Chap. 2) and the one I offer in mine (Chap. 4)are completely at odds with each other. He sees the current diversity of explanations, theories and methods in embodied cognitive science as problematic and calling for some kind of integration, whereas I defend an extreme pluralist stance and don’t see the diversity as a problem. Not only that, but while he argues for coordination between the disparate (...) approaches, I propose that expecting such coordination is in many cases unrealistic and moreover that, even when it’s possible, it might be counterproductive. The straightforward thing to do now would be for me to double down and use this space to try to show why I’m right and Casper is wrong. But I don’t think he’s wrong. He and I do disagree, but I don’t think it’s that sort of disagreement where only one side can be right and the other must be wrong. In particular, I don’t think that focusing on the different conclusions he and I draw in our respective chapters is a fruitful way to understand the nature of our disagreement. My goal in this commentary will be to explain why. I don’t know if Casper will agree with my assessment or not, but I won’t be surprised if he doesn’t—in fact, as I will suggest, this would make perfect sense given what I propose in my chapter. Still, my hope is that, by clarifying how (from my perspective) our different views relate to each other, I can help some readers better appreciate both his proposal and mine. (shrink)

The article proposes an analysis of imperatives and possibility and necessity statements that (i) explains their differences with respect to the licensing of free choice any and (ii) accounts for the related phenomena of free choice disjunction in imperatives, permissions, and statements. Any and or are analyzed as operators introducing sets of alternative propositions. Free choice licensing operators are treated as quantifiers over these sets. In this way their interpretation can be sensitive to the alternatives any (...) and or introduce in their scope. (shrink)

One of the moral questions concerning autonomous vehicles (henceforth AVs) is the choice between types that differ in their built-in algorithms for dealing with rare situations of unavoidable lethal collision. It does not appear to be possible to avoid questions about how these algorithms should be designed. We present the results of our study of moral preferences (N = 2769) with respect to three types of AVs: (1) selfish, which protects the lives of passenger(s) over any number of (...) bystanders; (2) altruistic, which minimizes the number of casualties, even if this leads to death of passenger(s); and (3) conservative, which abstains from interfering in such situations. We differentiate between scenarios in which participants are to make their decisions privately or publicly, and for themselves or for their offspring. We aim to answer two research questions: (1) whether the public visibility of the choice of an AV type choice make this choice more altruistic and (2) which type of situation makes it more difficult to choose altruistically: when choosing for society as a whole, when choosing only for oneself, or when choosing only for one’s offspring. Our results show that respondents exhibit a preference for an altruistic strategy for AVs and that it is reinforced when signaled to others. The altruistic preference is strongest when applies to everybody else, weaker when it reflects a solely personal choice, and weakest when choosing for one’s own child. We conclude that a public choice is considerably more likely to pressure consumers into accepting a more socially beneficial solution. (shrink)

Focusing mainly on respect for autonomy, particularly autonomous choices and actions in bioethical decisions, I examine several complexities of enacting this respect through the case of a fourteen-year-old boy who died after being allowed to refuse a necessary blood transfusion on religious grounds. I argue that thicker concepts of autonomy, closely connected with relational autonomy, direct our attention to aspects of respect for autonomy that are often neglected or underappreciated in much bioethical theory and practice. In particular, (...) they illuminate the interpretive complexity of respecting autonomous choices by focusing attention on the relational context of individuals’ decisions, on respect for individuals’ social-cultural beliefs and values, and on the temporality of selves, as expressed in their past consent or future consent as well as in—and sometimes in contradiction to—their present consent or dissent. However, it is important not to convert the illuminating and valuable insights from theories of relational autonomy into necessary conditions of autonomous choices and actions and hence of respect for autonomy. (shrink)

Developing ethical standards for clinical use of large-scale genome and exome sequencing has proven challenging, in part due to the inevitability of incidental or secondary findings. Policy of the American College of Medical Genetics and Genomics has evolved but remains problematic. In 2013, ACMG issued policy recommending mandatory analysis of 56 extra genes whenever sequencing was ordered for any indication, in order to ascertain positive findings in pathogenic and actionable genes. Widespread objection yielded a 2014 amendment allowing patients to opt-out (...) from analysis of the extra genes. In 2015, ACMG published the amended policy, providing that patients could opt out of the full set of extra genes, but not a subset. In 2016, ACMG enlarged the set and indicated planned expansion of the roster of extra genes to include pharmacogenetic findings. ACMG policy does not protect the respect for patient choice that prevails in other domains of clinical medicine, where informed consent allows patients to opt in to desired testing. By creating an expanding domain of genomic testing that will be routinely conducted unless patients reject the entire set of extra tests, ACMG creates an exceptional domain clinical practice that is not supported by ethics or science. (shrink)