Multiple realization historically mandated the autonomy of psychology, and its principled irreducibility to neuroscience. Recently, multiple realization and its implications for the reducibility of psychology to neuroscience have been challenged. One challenge concerns the proper understanding of reduction. Another concerns whether multiple realization is as pervasive as is alleged. I focus on the latter question. I illustrate multiple realization with actual, rather than hypothetical, cases of multiple realization from within the biological sciences. Though they do support a degree (...) of autonomy for higher levels of explanation and organization, they do not have the dire consequences critics of multiple realization fear. †To contact the author, please write to: Department of Philosophy, University of Cincinnati, P.O. Box 210374, Cincinnati, OH 45221‐0374; e‐mail: [email protected]. (shrink)

Colburn’s ambition in this book is to defend a ‘political morality of autonomy-minded liberalism’. Colburn defines autonomy as the ability to live in accordance with what one has deemed valuable, and to bear responsibility for this decision. There is a traditional debate that forces liberalism either to identify itself as anti-perfectionist and thus as neutral on the question of autonomy’s value , or as pro-autonomy and perfectionist. Colburn alleges that this debate is premised on a logical (...) error. In Chapter 1, Colburn proposes a content-neutral account of autonomy in the tradition of liberal individualism espoused by Wilhelm von Humboldt and John Stuart Mill, and more recently by Joseph Raz and Steven Wall. In Chapter 2, Colburn offers an account of autonomy as a global phenomenon ; lives, rather than episodes of individual choice and action, are at issue. Colburn’s account is an amalgam of ideas defended by Gerald Dworkin, Harry Frankfurt, Mill, and philosophers who defend some form of a social-historical relational account of autonomy. The autonomous agent has values she would hypothetically endorse under conditions of independence, free of factors such as hypnosis or coercion that might derail her critical faculties. Colburn helpfully develops the independence condition by specifying that one’s general commitments to a way of life must be ‘content-sensitive’; they must not ‘depend on something other than the nature of that thing’ deemed valuable. Moreover, the agent must perceive the reasons for her endorsement of a value. The final condition of autonomy might be labelled the relational one of actually ‘living life in accordance with values’ and ‘putting one’s decisions into effect’ . The heart of the book lies in Colburn’s argument for his ‘Equivalence Claim’ in Chapter 3, and in his discussion of the relationship …. (shrink)

In this issue of Clinical Ethics, Jonathan Pugh rejects hypothetical consent-based conceptions of the child’s right to bodily integrity (RBI). Pugh also questions the relevance of adults’ regret of past bodily infringements in evaluating potential violations of children’s RBI. Pugh then argues that autonomy serves as the justification for our power to waive our bodily rights. Finally, Pugh claims that the child’s interest in developing the capacity for autonomy is key to evaluating potential RBI violations. In this (...) article, I challenge each of these arguments. First, I argue that it is the circumstances of parents vis-a-vis their children (rather than the difficulties in determining hypothetical agents' values) that should lead us to reject hypothetical-consent-based conceptions of the child’s RBI in favor of best-interests conceptions. Second, I argue that adults’ regret of childhood bodily interventions is highly relevant for evaluating these interventions’ permissibility. Third, I reject the claim that autonomy is the primary justification for our power to waive our bodily rights. Finally, I argue that Pugh overstates the importance of the child’s interest in developing the capacity for autonomy, at least when it comes to debates in contemporary liberal democracies over interventions in children’s bodies. (shrink)

Hypothetical consent is puzzling. On the one hand, it seems to make a moral difference across a wide range of cases. On the other hand, there seem to be principled reasons to think that it cannot. In this article I put forward reasonably precise formulations of these general suspicions regarding hypothetical consent; I draw several distinctions regarding the ways in which hypothetical consent may make a moral difference; I distinguish between two autonomy-related concerns, nonalienation and sovereignty; (...) and, utilizing these distinctions, I show that—and in a preliminary way, when—the objections to the moral significance of hypothetical consent fail. (shrink)

Living kidney transplantation offers the best treatment in terms of life-expectancy and quality of life for those with end-stage renal disease. The long-term risks of living donor nephrectomy, although real, are very small, with evidence of good medium-term outcomes. Who should be entitled to donate, and in which circumstances, is nevertheless a live question. We explore the ethical dimensions of a request by an individual to donate both of their kidneys during life: ‘dual living kidney donation’. Our ethical analysis is (...) tethered to a hypothetical case study in which a father asks to donate a kidney to each of his twin boys. We explore the autonomy of the protagonists, alongside different dimensions of the public interest, such as the need to protect not only the recipients, but also the donor and even the wider community. Whilst acknowledging objections to ‘dual-donation’, not least by reference to the harms that the donor might be expected to endure, we suggest there is a prima facie case for permitting this, provided that both donor and recipients are willing and that due attention is paid to such considerations as the autonomy and welfare of all parties, as well as to the wider ramifications of acting on such a request. We argue for broader interpretations of the concepts of autonomy and welfare, recognizing the importance of relationships and the relevance of more than merely physical well-being. Equipped with such a holistic assessment, we suggest there is a prima facie case for allowing ‘dual living kidney donation’. (shrink)

The patient preference predictor is a computer-based algorithm devised to predict the medical treatment that decisionally incapacitated patients would have preferred. The target paper argues against various criticisms to the effect that the use of a PPP is inconsistent with proper respect for patient autonomy.1 In this commentary, I aim to add some clarifications to the complex relationship between autonomy and the PPP. First, I highlight one way in which the decision of a surrogate designated by the patient (...) realises respect for patient autonomy in a way that PPP cannot realise by introducing the idea of shared agency. Second, I show how the attempt to predict someone’s hypothetical choice can be disrespectful to her autonomy. Following the treatment decision of a surrogate designated by the patient counts as a way of respecting the patient’s own autonomy. Designating someone as one’s surrogate is a case of entrusting her with the task of making important life decisions on one’s behalf. To entrust someone with a certain matter is to assign her the responsibility for that matter based on the trust that she will take a good care of it. When a patient entrusts a surrogate decision-maker, what is the matter that she is trusted to take a good care of? In many contexts, the surrogate is r egarded as an epistemic proxy, one who is likely to know the patient’s preferences the best. It is often thought that the point of practising surrogate decision making is to respect the patient’s autonomy by following what the patient most likely would have preferred. Using a PPP in the decision-making process has the same goal of making a more accurate prediction of the patient’s treatment preference. However, at least in some cases, designating the patient’s intimates or ones she loves and cares …. (shrink)

The concept of autonomy has assumed increasing importance in contemporary political philosophy. Philosophers such as Rawls, Wolff, Scanlon, Raz and Hurley have employed the concept to ground principles and illuminate issues such as the choice of principles of justice, the justification of political authority, the limits of free speech, the nature of the liberal state and the justification of democracy.

Psychologists and neuroscientists often struggle to integrate findings in their respective domains, a problem due partly to implicitly and explicitly held philosophical positions on issues of reduction and autonomy across these domains. The present article reviews how reduction and autonomy have been used in philosophical arguments regarding how macro-scale findings relate to micro-scale findings across various scientific disciplines. The present article demonstrates how macro findings are indispensable to explanations of phenomena of interest by (a) providing information regarding higher (...) levels of organization in mechanisms, (b) including information not contained within certain micro explanations that (c) provides more general and stable causal explanations relative to micro explanations in certain situations. The purpose of presenting these analyses and recommendations is to disabuse psychologists and neuroscientists of pervasive assumptions that psychology is reducible to biology and that lower level phenomena (molecular) should be prioritized as somehow more explanatory than higher level phenomena (behavioral). The article concludes with 3 hypothetical scenarios from clinical psychology and psychiatry illustrating this critique and providing a pragmatic approach to clarify the relative roles, and importance, of biological and psychological data in service of general and stable explanations that are tailored to the kind of intervention desired. (shrink)

It is argued that expressivists can solve their problems in accounting for the unity and autonomy of logic – logic is topic independent and does not derive from a general ‘logic’ of mental states – by adopting an analysis of the logical connectives that takes logically complex sentences to express complex combinations of simple attitudes like belief and disapproval and dispositions to form such simple attitudes upon performing suppositional acts, and taking acceptance and rejection of sentences to be the (...) common mental denominator in descriptive and evaluative discourse, and structural requirements governing these to be the basis for logic. Such an account requires that attitudes like belief, intention and disapproval can come in hypothetical mode – plausibly linked to the capacity to mentally simulate or emulate one's own attitudes – and, if correct, suggests that these form the basic building blocks for our capacity to understand logically complex sentences. (shrink)

In Territorial Sovereignty: A Philosophical Exploration, Anna Stilz argues that legitimate political authority requires the actual—rather than hypothetical—consent of the governed. I argue, however, that her analysis of that consent is inconsistent, in the weight it ascribes to the felt desire to refrain from doing politics with some particular group of people. In the context of secession and self-determination, the lack of actual consent to shared political institutions is weighty enough to render such institutions presumptively illegitimate. In the context (...) of migration, however, a lack of actual consent to the presence of newcomers is ascribed nearly no weight, and instead is taken as evidence of irrationality or immoral preferences. I argue that this apparent contradiction must be clarified before Stilz's overall account of self-governance can be accepted. (shrink)

ObjectiveWhile nudges are increasingly utilized in public policy settings, their potential threat to autonomous choice is the topic of heated debate. Regardless of the actual effects of nudges on autonomy, the mere perception of nudges as autonomy threatening by the general public or policy makers could negatively influence nudge acceptability. The present online studies examined how people expect nudges to affect their perception of autonomy.MethodsIn the first study, participants were presented with a hypothetical choice that employed (...) either a default nudge, direct persuasion, or no persuasion, to steer to the desired choice. The presented influence technique was explained before participants reported their expected autonomy, as well as their expected choice satisfaction. Study 2 involved a replication of Study 1 with an additional social norm nudge condition. In Study 3, the explanation of how choice had been influenced was omitted.ResultsWhile participants expected the default nudge to violate autonomy, they had no such expectations for social norm nudges. Omitting the explanation that most people are unaware of nudges influencing their choice, reduced the negative impact of nudges on expected autonomy.ConclusionEffects of nudges on expectations of autonomy differ by type of nudge. Negative expectations are primarily driven by the explanation that decision makers are often unaware of nudges. (shrink)

The categorical imperative inherent in Kant’s ethics has had indubitable historical influence on societies worldwide whether in the form of laws, democracy or public deliberation. The Toronto Van Attack of 2018 and its subsequent legal trial is a case example that shows how the categorical imperative can be applied to assist in understanding the reasoning for the case’s guilty verdict. This paper will convey the applicability of the categorical imperative for examining criminal case studies by closing the gap between ethical (...) theory and practice. Such closure will be shown to assist in understanding why a perpetrator of a crime can be found guilty of following a hypothetical imperative to base their actions. The rationale for the verdict in this case will be shown to be based on the perpetrator’s responsibility in the form of maintaining autonomy despite having an autism diagnosis. The perpetrator will be shown to have acted on an irrational will and yet was treated in the legal sense as a rational individual. Such rationality was maintained despite complications with their autonomy in the form of relativism and ethical solipsism. (shrink)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (shrink)

Decisions about how and where they deliver their baby are extremely important to pregnant women. There are very strong ethical norms that women’s autonomy should be respected, and that plans around birth should be personalised. However, there appear to be profound challenges in practice to respecting women’s choices in pregnancy and labour. Choices carry risks and consequences—to the woman and her child; also potentially to her caregivers and to other women.What does it mean for women’s autonomy to be (...) respected in obstetrics? How should health professionals respond to refusals of treatment or requests for care outside normal guidelines? What are the ethical limits to autonomy? In this clinical ethics round table, service users, midwives, obstetricians, philosophers and ethicists respond to two hypothetical cases drawn from real-life scenarios. (shrink)

The so-called Substituted Judgment Standard is one of several competing principles on how certain health care decisions ought to be made for patients who are not themselves capable of making decisions of the relevant kind. It says that a surrogate decision-maker, acting on behalf of the patient, ought to make the decision the patient would have made, had the latter been competent. The most common way of justifying the Substituted Judgment Standard is to maintain that this standard protects patients’ right (...) to autonomy, or self-determination, in the situation where they are no longer able to exercise this right on their own. In this paper we question this justification, by arguing that the most commonly suggested moral reasons for allowing and encouraging people to make their own choices seem not to apply when the patient’s decision-making is merely hypothetical. We end with some brief sketches of possible alternative ways of justifying the Substituted Judgment Standard. (shrink)

This book argues for the explanatory autonomy of the biological sciences. It does so by showing that scientific explanations in the biological sciences cannot be reduced to explanations in the fundamental sciences such as physics and chemistry and by demonstrating that biological explanations are advanced by models rather than laws of nature. To maintain the explanatory autonomy of the biological sciences, the author argues against explanatory reductionism and shows that explanation in the biological sciences can be achieved without (...) reduction. Then, he demonstrates that the biological sciences do not have laws of nature. Instead of laws, he suggests that biological models usually do the explanatory work. To understand how a biological model can explain phenomena in the world, the author proposes an inferential account of model explanation. The basic idea of this account is that, for a model to be explanatory, it must answer two kinds of questions: counterfactual-dependence questions that concern the model itself and hypothetical questions that concern the relationship between the model and its target system. The reason a biological model can answer these two kinds of questions is due to the fact that a model is a structure, and the holistic relationship between the model and its target warrants the hypothetical inference from the model to its target and thus helps to answer the second kind of question. The Explanatory Autonomy of the Biological Sciences will be of interest to researchers and advanced students working in philosophy of science, philosophy of biology and metaphysics. (shrink)

This chapter focuses on how Kierkegaard criticizes both eudaimonism and Kantian autonomy for failing to account for unconditional obligations and genuine other-regard. Like Kant, Kierkegaard argues that eudaimonism makes moral virtue contingent on prudence. Kierkegaard views eudaimonism as an anthropocentric and self-regarding doctrine, which he contrasts not with Kantian autonomy but with theocentrism and proper other-regard. Kierkegaard then criticizes Kantian autonomy in much the same way as he criticizes eudaimonism. Whereas eudaimonism makes morality contingent on prudence, (...) class='Hi'>autonomy makes morality contingent on decisions that may be revoked, he argues. As a result, human autonomy can account for hypothetical imperatives but not categorical imperatives. This line of reasoning seems problematic, however, since Kierkegaard takes Kantian autonomy to not only represent a form of moral constructivism, but also a form of moral relativism and decisionism. Still, Kierkegaard’s critique of autonomy indicates that morality and practical rationality need unconditional commitment towards what is objectively good. (shrink)

This paper explores the extent to which behavioral public policies can be both efficient and democratic by reflecting on the conditions under which individuals could rationally consent to them. Consent refers to a moral requirement that a behavioral public policy should respect what I call a person’s value autonomy and conception of the good. Behavioral public policies can take many forms. Based on a social choice framework, I argue that fully paternalistic and prudential behavioral public policies are unlikely to (...) trigger a hypothetical form of rational consent. Non-fully paternalistic behavioral public policies with partially non-prudential motivations are less problematic in this perspective. In any case, a public deliberative stage preceding the implementation of policies seems to be the best democratic way to justify them. (shrink)

Agency and identity -- Necessitation -- Acts and actions -- Aristotle and Kant -- Agency and practical identity -- The metaphysics of normativity -- Constitutive standards -- The constitution of life -- In defense of teleology -- The paradox of self-constitution -- Formal and substantive principles of reason -- Formal versus substantive -- Testing versus weighing -- Maximizing and prudence -- Practical reason and the unity of the will -- The empiricist account of normativity -- The rationalist account of normativity (...) -- Kant on the hypothetical imperative -- Against particularistic willing -- Deciding and predicting -- Autonomy and efficacy -- The function of action -- The possibility of agency -- Non-rational action -- Action -- Attribution -- The psychology of action -- Expulsion from the garden : the transition to humanity -- Instinct, emotion, intelligence, and reason -- The parts of the soul -- Inside or outside -- Pull yourself together -- The constitutional model -- Models of the soul -- The city and the soul -- Platonic virtues -- Justice : substantive, procedural, and platonic -- Kant and the constitutional model -- Defective action -- The problem of bad action -- Being governed by the wrong law -- Or five bad constitutions -- Conceptions of evil -- Degrees of action -- Integrity and interaction -- Deciding to be bad -- The ordinary cases -- Dealing with the disunified -- Kant's theory of interaction -- My reasons -- Deciding to treat someone as an end in himself -- Interacting with yourself -- How to be a person -- What's left of me? (shrink)

Advances in brain–brain interface technologies raise the possibility that two or more individuals could directly link their minds, sharing thoughts, emotions, and sensory experiences. This paper explores conceptual and ethical issues posed by such mind-merging technologies in the context of clinical neuroethics. Using hypothetical examples along a spectrum from loosely connected pairs to fully merged minds, the authors sketch out a range of factors relevant to identifying the degree of a merger. They then consider potential new harms like loss (...) of identity, psychological domination, loss of mental privacy, and challenges for notions of autonomy and patient benefit when applied to merged minds. While radical technologies may seem to necessitate new ethical paradigms, the authors suggest the individual-focus underpinning clinical ethics can largely accommodate varying degrees of mind mergers so long as individual patient interests remain identifiable. However, advanced decisionmaking and directives may have limitations in addressing the dilemmas posed. Overall, mind-merging possibilities amplify existing challenges around loss of identity, relating to others, autonomy, privacy, and the delineation of patient interests. This paper lays the groundwork for developing resources to address the novel issues raised, while suggesting the technologies reveal continuity with current healthcare ethics tensions. (shrink)

Research into human ageing is a growing field of research with two central foci: geriatric medicine works to reduce the incidence and severity of age-related diseases and disabilities by devising adequate therapeutic and preventive strategies. A second focus, this time in the emerging field of biogerontology, is to bring about a general retardation of the ageing process and by this increase the average and maximum human lifespan. This contribution looks into the second focus, i.e. the possibility of age retardation which, (...) for the time being, is merely hypothetical. After outlining research strategies studying age retardation in animal experiments, it will ask how extending human life by technological interventions might play out on the individual, familial and social level. The central concern here will be autonomy-linked issues, seeing that in debates concerning the ethical implications of age-retarding techniques the argument from autonomy is one of the main arguments in favour of the prolongation of human life. In particular, this contribution will assess whether the argument from autonomy does, in fact, unequivocally support the recourse to age-retarding techniques. (shrink)

The concept of autonomy was and still is one of the central notions of practical philosophy. The current discussion often identifies autonomy with free or rational self-determination of a person. But a person must always be seen as being integrated in social and institutional contexts. Therefore the concept of autonomy has to be developed from an integrative perspective which includes both perspectives: the individual and the institutional one. Moreover, this integration cannot be constituted by shared affects and (...) feeling of individuals, but has to refer to the idea of “lawfulness” and guiding norms and orientations. This essay tries to show that Hermann Cohen′s understanding of “autonomy as a task” is a theory worthy of being followed, as it develops the principles as well as the concrete conditions of an integrative concept of autonomy on the basis of a “hypothetical” method which is both: critical and dynamical. (shrink)

Uterine transplantation could give women who suffer from uterine factor infertility the possibility of experiencing gestation. Much of the ethical discussion about uterine transplantation has focused on whether research on it should even be pursued, but researchers are nevertheless moving forward with several uterine transplant research protocols. Scholars should therefore already be identifying and engaging in an intimate examination of the ethical realities of offering uterine transplantation in a clinical setting. Given the potential for the procedure to expand reproductive options (...) for women, reproductive autonomy has been a primary principle underlying much of the ethical discourse about the hypothetical impact of uterine transplantation. Yet the factors that will affect whether uterine transplants promote or undermine a patients’ reproductive autonomy if the procedure is integrated into clinical practice have yet to be rigorously explored. Focusing on the clinical realities of patient autonomy, I argue that empirical data exploring prospective recipients’ motivations and their perceptions of the benefits of the procedure in the context of their lived experiences are critical to a robust analysis of the ethical dimensions of uterine transplantation. (shrink)

Kant's Imperatives -- Imperatives in Kant's metaphysics of morals -- Imperatives in the critique of judgment -- The role of reason and freedom in Kant's doctrine -- Contemporary phenomenology's response to Kant's Imperatives -- Imperatives in Merleau-Ponty's Phenomenology of perception -- Merleau-Ponty and Kant's Imperatives -- Imperative style and levels -- Imperatives in Levinas's doctrines of sensibility and alterity -- Sensation and sensibility -- Alterity, infinity, exteriority, and asymmetry -- Alterity and language -- Privileged heteronomy versus autonomy -- Alphonso (...) Lingis : between categorical and hypothetical imperatives -- Lingis as kantian phenomenologist : imperative necessity -- Force and form -- Kant's typology : illustrations of imperative force -- Lingis's critique of Kant -- Lingis's critique of phenomenology via the imperative -- Elemental and sublime imperatives -- Conclusion: Subjectivity and subjection. (shrink)

This paper draws upon a research study of accountants and HR specialists. The study eschewed hypothetical scenarios and focused upon those situations and scenarios that the interviewees defined as causing them ethical concerns. There are two distinct but related issues arising from the paper. The first is that the singular categorisations of moral reasoning attributed to individuals when faced with hypothetical scenarios by many who write on the issue of moral reasoning, did not correspond to the fluidity in (...) moral choices faced by the interviewees as they experienced their unfolding moral dilemmas. The second issue relates to the unwillingness of the interviewees to give voice to their concerns, not only externally, but also within their employing organisations. The tensions within the two cases featured were held in check only by the diminution of the autonomy of the two principal actors. As a consequence, the exercise of moral agency was denied. (shrink)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort (...) and a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician‐assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging (...) in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses’ moral well‐being. (shrink)

A questionnaire survey was conducted at the annual meeting of the Japanese Society for Hospice and Home Care to study attitudes toward euthanasia. Respondents were asked how they agreed with the doctor's decision regarding several forms of euthanasia in hypothetical clinical situations dealing with terminal and non-terminal patients. Their acceptance of euthanasia was correlated with respect to patient's autonomy. Results showed 54% and 62% of respondents agreed with voluntary and non-voluntary passive euthanasia at the terminal stage, respectively. Indirect (...) euthanasia was accepted by 71%. In voluntary active euthanasia, 21% agreed with the doctor's act. In non-voluntary active euthanasia, 13% and 37% agreed with the use of potassium chloride and sedative, respectively. In dealing with a quadriplegic patient, 18% and 37% agreed with voluntary active euthanasia with a sedative and voluntary passive euthanasia. Voluntary passive euthanasia in the terminal stage and voluntary active and passive euthanasia and mercy killing were more likely to be favoured by the respondents who respected patient's autonomy than those who did not. (shrink)

The concept of the ‘well-being of the child’ (like the ‘child’s welfare’ and ‘best interests of the child’) has remained underdetermined in legal and ethical texts on the needs and rights of children. As a hypothetical construct that draws attention to the child’s long-term welfare, the well-being of the child is a broader concept than autonomy and happiness. This paper clarifies some conceptual issues of the well-being of the child from a philosophical point of view. The main question (...) is how well-being could in practice acquire a concrete meaning and content for a particular issue or situation. A phenomenological-hermeneutic research perspective will be outlined that allows the child’s well-being to be elucidated and specified as an anthropological and ethical idea. It is based on a contextual understanding of generative relationships, a combination of the theory and practice of making sense, here described as ‘generative insight’, which could provide ethical guidance for decision making in families, legal practice, medicine or biomedical research. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical (...) patients who differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

What should Japanese doctors do when asked by a patient for active voluntary euthanasia, when the family wants aggressive treatment to continue? In this paper, we present the results of a questionnaire survey of 366 Japanese doctors, who were asked how they would act in a hypothetical situation of this kind, and how they would justify their decision, 23% of respondents said they would act on the patient’s wishes, and provided reasons for their view; 54% said they would not (...) practice VE, either because they were opposed to VE as such, or because they believed that the wishes of the patient’s family should be respected.Analysis of these responses yielded the following results: Doctors willing to respect the patient’s wishes defended their decision by highlighting the significance of patient autonomy and the patient’s exclusive ownership of his or her life; doctors unwilling to act on the patient’s wishes fell into two broad categories — those who based their reasoning on the family’s objections, and those who provided other reasons for refusing VE. Respondents who said they would not comply with the patient’s wishes because of family objections provided the following kinds of rationale: doctors have serious responsibilities not only to the patient, but also to the patient’s family; the importance of the family-doctor relationship; fear of lawsuits for murder and related criminal offences; the need for agreement among all those affected by the decision, and the belief that the patient’s life is not his or her own, but the family’s. Respondents who gave non-family centred reasons for not complying with the patient’s wishes pointed to values such as the sanctity of life, or the importance of a natural deathIn the remainder of this paper, we discuss the implications of a family-centred approach to VE. (shrink)

Objectives: To explore mental health service users’ views of existing and proposed compulsory powers.Design: A qualitative study employing in-depth interviews. Participants were asked to respond to hypothetical questions regarding the application of compulsory powers under the Mental Health Act 1983 for people other than themselves.Setting: Community setting in Southeast England.Participants: Mental health service users subject to Supervised Discharge/Guardianship.Results: Participants considered that the use of compulsory powers was justified if there were some ultimate benefit, and if there was evidence of (...) mental health problems, dangerousness, or a lack of insight. However, participants rejected intrusions into their autonomy and privacy.Conclusions: This paper’s participants indicated that the proposed CTO may be unacceptable because it would threaten service users’ autonomy. Service users’ acceptance of proposed changes is conditional and they emphasised the importance of consent; there is no suggestion that consent will be required for the CTO. The findings also have implications for the exploration of mental health service users’ views and how they might contribute to policy, service planning, and research. (shrink)

On the basis of the characterization of autonomy set out by Beauchamp and Childress in Principles of Biomedical Ethics, we first explore some of the parameters along which autonomy may vary in degree through a series of hypothetical examples drawn from various settings; and, second and in more detail, we examine how the range of autonomy is affected through informed consent to various medical diagnostic tests. Our conclusions are (1) that there are significant implications for patient (...) autonomy inherent in new and forthcoming diagnostic modalities, and (2) that attention should be paid to these implications in formulating policies for both clinical practice and research. We close with (a) some specific policy recommendations for clinical practice and research, and (b) some metaphysical speculations raised by our explorations. (shrink)

Lady Lovelace’s notes on Babbage’s Analytical Engine never refer to the concept of surprise. Having some pretension to ‘originate’ something—unlike the Analytical Engine—is neither necessary nor sufficient to being able to surprise someone. Turing nevertheless translates Lovelace’s ‘this machine is incapable of originating something’ in terms of a hypothetical ‘computers cannot take us by surprise’ objection to the idea that machines may be deemed capable of thinking. To understand the contemporary significance of what is missed in Turing’s ‘surprise’ translation (...) of Lovelace’s insight, one needs to distinguish between trivial surprises and those events, propositions or encounters that lead us to question our understanding of ourselves or what surrounds us. Only some of these non-trivial surprises are the product of originality endeavours. Not only is it uncommon for surprises to track such endeavours, the type of autonomy that would be required on the part of ‘digital computers’ for originality and surprise to intersect in that way goes far beyond the operational autonomy that can be achieved by ‘learning machines’. This paper argues that a salient translation of Lovelace’s originality insight—for contemporary and future ‘learning machines’—is an upside-down version of Turing’s surprise question: can computers be surprised by us in a non-trivial, ‘co-produced’ way? (shrink)

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

Gratitude has been promoted as a beneficial emotional experience. However, gratitude is not universally experienced as positive. The current work examines whether an autonomous interpersonal style is associated with differential experience of gratitude. Study 1 found an inverse relationship between trait autonomy and both trait gratitude and positivity of response to receiving a hypothetical benefit from a friend. Study 2 replicated the finding that those higher in autonomy report less trait gratitude, and also demonstrated an inverse relationship (...) between autonomy and valuing gratitude. Study 3 found that those higher in autonomy had more self-image goals and reduced compassionate goals in relationships, and that valuing gratitude mediated the relationship between autonomy and relationship goals. These results show a consistent inverse relationship between autonomy and the experience and valuing of gratitude, suggesting that degree of autonomy is one determinant of whether gratitude is experienced as positive. (shrink)

When ethics committees evaluate the research proposals submitted to them by biomedical scientists, they can seek guidance from laws and regulations, their own beliefs, values and experiences, and from the theories of philosophers. The starting point of this paper is that philosophers can only be helpful to the members of ethics committees if they take into account in their models both the basic moral intuitions that most of us share and the consequences of people's choices. A moral view which can (...) be labelled as a consequentialist interpretation of mid-level principlism is developed, defended and applied to some real-life and hypothetical research proposals. (shrink)

I want to get both personal and philosophical in this piece. I want to reflect on how my relationship with Sue Sherwin has fostered my own relational autonomy. At the same time, I want to discuss what theories of relational autonomy, like Sue's, add to the bioethics literature on autonomy. With this second objective, I hope to begin clearing up some confusion that I see in this literature about the nature of relational autonomy.Sue was my PhD (...) supervisor, but more than that, she has been my mentor and my role model. I doubt I would still be part of the discipline of philosophy if it weren't for Sue. I came to Dalhousie University as a PhD student in 1995 with a burning love for philosophy but an intense dislike for... (shrink)

Marshall et al. (2024) identify a potential ethical conflict between the principles of beneficence and respect for patient autonomy when patients refuse to remain in an emergency department (ED) fo...

This paper focuses on a hypothetical case that represents an intervention request familiar to those who work with individuals with intellectual disability. Stacy has autism and moderate intellectual disability. Her parents have requested treatment for her hand flapping. Stacy is not competent to make her own treatment decisions; proxy consent is required. There are three primary justifications for proxy consent: the right to an open future, substituted judgment, and the best interest standard. The right to an open future justifies (...) proxy consent on the assumption of future autonomy whereas substituted judgment justifies proxy consent via reference to past autonomy. Neither applies. Stacy has not been, nor will she be, competent to make her own treatment decisions. The best interest standard justifies proxy consent on the grounds of beneficence. It is unlikely that hand flapping harms Stacy. None of the three primary means of justifying proxy consent apply to Stacy’s case. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows from (...) certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct (...) the PGD procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. (shrink)

Candidate evaluation for breast implantation presents a more important obstacle to the fulfillment of the normative requirements of informed consent than do the social roles of women or cultural norms governing female beauty. I argue that women's decisions to receive breast implants may indeed be informed, competently made, and substantially voluntary, but that the cultural construction of beauty may undermine women's autonomy by influencing the evaluation of surgical candidates and risk disclosure during informed consent.

Although research has examined the role leaders may play in shaping job re-design behaviors among their subordinates, little is known about the way managers craft their jobs as compared to other employees. In two crosssectional studies we tested whether organizational rank affects the frequency of job crafting, and to what extent this relationship is mediated via perceived autonomy. Study 1 demonstrated that managers craft their jobs more frequently than non-managers by increasing structural job resources and seeking challenges at work. (...) We also showed that autonomy explains the relationship between organizational rank and the frequency of increasing structural and social job demands, as well as seeking challenges. However, managers did not craft their jobs by decreasing job demands more often than regular employees. In Study 2 we replicated this pattern of results, subsequently demonstrating that managers with shorter tenure use their autonomy to craft their jobs via decreasing job demands. We discuss the contributions and potential implications of these results. (shrink)

The past few decades have seen patient autonomy ascend to a prime position in health care. Patient consent is seen as a key component to expression of autonomy. Yet, interventions may also be justified without consent because they are deemed to be in the public interest. We observe some subtle shifts in balance in these justifications in health care and illustrate these with a range of examples. We hope thereby to stimulate a more explicit debate so that health-care (...) professionals can manage these competing interests. (shrink)