Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since (1) patients guide care in patient-centered care, and (2) respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use (...) of a principle of respect for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Telemedicine is a complex field including various applications and target groups. Especially telehealthcare is seen by many as a means to revolutionize medicine. It gives patients the opportunity to take charge of their own health by using self-tracking devices and allows health professionals to treat patients from a distance. To some, this means an empowerment of patient autonomy as well as an improvement in the quality of care. Others state the dangers of depersonalization of medicine and the pathologization of (...) daily life. This paper examines the ethical implications of telehealthcare, focusing on patient autonomy and quality of care by analyzing metareviews, randomized controlled trials and narrative ethical analyses on the topic. As a result, we conclude that the technically enhanced encounter between patients and health professionals may mean an empowerment of patient autonomy when it goes along with a personal relationship based on trust, assistance and support. When it comes to the quality of care, telehealthcare may lead to an improvement as long it is adopted to the patient’s individual needs. (shrink)

Within Kantian ethics and Kant scholarship, it is widely assumed that autonomy consists in the self-legislation of the principle of morality. In this paper, we challenge this view on both textual and philosophical grounds. We argue that Kant never unequivocally claims that the Moral Law is self-legislated and that he is not philosophically committed to this claim by his overall conception of morality. Instead, the idea of autonomy concerns only substantive moral laws, such as the law that one (...) ought not to lie. We argue that autonomy, thus understood, does not have the paradoxical features widely associated with it. Rather, our account highlights a theoretical option that has been neglected in the current debate on whether Kant is best interpreted as a realist or a constructivist, namely that the Moral Law is an a priori principle of pure practical reason that neither requires nor admits of being grounded in anything else. (shrink)

History's judgment on the success of bioethics will not depend solely on the conceptual creativity and innovation in the field at the level of ethical and political theory, but this intellectual work is not insignificant. One important new development is what I shall refer to as the relational turn in bioethics. This development represents a renewed emphasis on the ideographic approach, which interprets the meaning of right and wrong in human actions as they are inscribed in social and cultural practices (...) and in structures of lived meaning and interdependence; in an ideographic approach, the task of bioethics is to bring practice into theory, not the other way around. The relational turn in bioethics may profoundly affect the critical questions that the field asks and the ethical guidance it offers society, politics, and policy. The relational turn provides a way of correcting the excessive atomism of many individualistic perspectives that have been, and continue to be, influential in bioethics. Nonetheless, I would argue that most of the work reflecting the relational turn remains distinctively liberal in its respect for the ethical significance of the human individual. It moves away from individualism, but not from the value of individuality.In this review essay, I shall focus on how the relational turn has manifested itself in work on core concepts in bioethics, especially liberty and autonomy. Following a general review, I conclude with a brief consideration of two important recent books in this area: Jennifer Nedelsky's Law's Relations and Rachel Haliburton's Autonomy and the Situated Self. (shrink)

This essay* takes two notions of autonomy and two notions of explanation and argues that colours occur in explanations that fall under all of them. The claim that colours can be used to explain anything at all may seem to some people an outrage. But their pessimism is unjustified and the orthodox dispositional view which may seem to support it, I shall argue, itself has difficulties. In broad terms, Section 2 shows that there exist good straight scientific laws of (...) colour, constituting what one might call a phenomenal science. Section 3 offers a larger view of what we are doing when we attribute colours to things, a view which makes it a case of holistic explanation, similar in many ways to psychological explanation. Section 2 emphasizes the model of scientific explanation, and Section 3 the holistic model found in rational explanation; but it will emerge that colour explanation in different ways fits both models, as it also does the two principal notions of autonomy that the first section identifies. (shrink)

It was something of a dogma for much of the twentieth century that one cannot validly derive an ought from an is. More generally, it was held that non-normative propositions do not entail normative propositions. Call this thesis about the relation between the natural and the normative Natural-Normative Autonomy. The denial of Autonomy involves the entanglement of the natural with the normative. Naturalism entails entanglement—in fact it entails the most extreme form of entanglement—but entanglement does not entail naturalism. (...) In a ground-breaking paper “The autonomy of ethics” Arthur Prior constructed some intriguing counterexamples to Autonomy. While his counterexamples have convinced few, there is little agreement on what is wrong with them. I present a new analysis of Autonomy, one which is grounded in a general and independently plausible account of subject matters. While Prior’s arguments do establish shallow natural-normative entanglement, this is a consequence of simple logical relationships that hold between just about any two subject matters. It has nothing special to do with the logical structure of normativity or its relation to the natural. Prior’s arguments leave the fundamental idea behind natural-normative Autonomy intact. I offer a new argument for deep entanglement. I show that in any framework adequate for dealing with the natural and the normative spheres, a purely natural proposition entails a purely normative proposition, and vice-versa. But this is no threat to non-naturalist moral realism. In fact it helps ameliorate the excesses of an extreme non-naturalism, delivering a more palatable and plausible position. (shrink)

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

Integrates Spinoza's thought into the contemporary debate on interpersonal relationships and individual autonomy The question of how to understand autonomy has emerged as a critical issue in contemporary political philosophy. Feminists and others argue that autonomy cannot be adequately conceived without taking into consideration the ways in which it is shaped by our relationships with others. This collection of 13 new essays shows what Baruch Spinoza can add to our understanding of the relational nature of autonomy. (...) By offering a relational understanding of the nature of individuals centred on the role played by emotions, Spinoza offers not only historical roots for contemporary debates but also broadens the current discussion. At the same time, reading Spinoza as a theorist of relational autonomy underscores the consistency of his overall metaphysical, ethical and political project, which has been clouded by the standard rationalist interpretation of his works. (shrink)

Although prior research has demonstrated that switching schools poses a risk for academic and behavioral functioning among adolescents, relatively little is known about their emotional adjustment, or how it affects emotional well-being. Moreover, the cumulative effects of multiple risk and protective factors on their emotional well-being are even less covered in the existing literature. Guided by a risk and resilience ecological framework, the current study compared emotional well-being, operationalized as positive affect and negative affect, between Chinese adolescents who had switched (...) schools and their non-switch counterparts, and examined the direct and interactive effects of teacher autonomy support and two facets of grit (i.e., perseverance and consistency) on emotional well-being in both groups. A propensity score matching analysis was used to balance the two groups in terms of sociodemographic characteristics (i.e., age, gender, and socioeconomic status). A total of 371 adolescents who had switched schools and 742 non-switch counterparts aged from 13 to 18 years were involved in this study. Results indicated that adolescents who had switched schools reported higher levels of negative affect than their non-switch counterparts. Moreover, for adolescents who had switched schools, those who possessed higher levels of perseverance had a significantly negative association between teacher autonomy support and negative affect; however, the corresponding association was independent of perseverance for their non-switch counterparts. The current findings indicate that switching schools is a disadvantage for adolescents’ emotional states. However, teacher autonomy support and perseverance can protect adolescents who switch schools as critical stress-buffering factors against these negative feelings. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall stipulate a (...) definition of care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ‘relational autonomy’ can be applied fruitfully in the practice of psychiatric care. (shrink)

The principle of autonomy is widely recognized to be of utmost importance in bioethics; however, we argue that this principle is often misapplied when one fails to distinguish two different contexts in medicine. When a particular patient is offered treatment options, she has the ultimate say in whether to proceed with any of those treatments. However, when deciding whether a particular intervention should be regarded as a form of medical treatment in the first place, it is the medical community (...) who has the ultimate say. Some argue that particular interventions should be allowed by virtue of the fact that they are autonomously requested. But making such an argument fails to distinguish between these two contexts and misapplies the principle of autonomy, ultimately having the potential to instigate problematic changes in the practice of medicine. (shrink)

While care ethics has frequently been criticized for lacking an account of autonomy, this paper argues that care ethics' relational model of moral agency provides the basis for criticizing the philosophical tradition's model of autonomy and for rethinking autonomy in relational terms. Using Diana Meyers's account of autonomy competency as a basis, a dialogical model of autonomy is developed that can respond to internal and external critiques of care ethics.

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their (...) requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

This article describes the relatively new technology of freezing human eggs and examines whether egg freezing, specifically when it is used by healthy women as 'insurance' against age-related infertility, is a legitimate exercise of reproductive autonomy. Although egg freezing has the potential to expand women's reproductive options and thus may represent a breakthrough for reproductive autonomy, I argue that without adequate information about likely outcomes and risks, women may be choosing to freeze their eggs in a commercially exploitative (...) context, thus undermining rather than expanding reproductive autonomy. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, such as the USA, (...) Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

In this paper, I show how a novel treatment of speech acts can be combined with a well-known liberal argument for multiculturalism in a way that will justify claims about the preservation, protection, or accommodation of minority languages. The key to the paper is the claim that every language makes a distinctive range of speech acts possible, acts that cannot be realized by means of any other language. As a result, when a language disappears, so does a class of speech (...) acts. If we accept that our social identities are in large part constituted by the decisions we make about how to speak, language loss, then, will amount to a substantial infringement on our autonomy in a particularly important domain. (shrink)

European Journal of Philosophy, EarlyView.

Antidepressant medication and evidence-based psychotherapy have largely equivalent efficacy in the management of the common, less severe grades of depression. As a result, several national guidelines recommend that either can be used in the treatment of this disorder. Psychotherapy, however, differs in that it assists insight into how the depressed person appraises and manages the stressors that frequently trigger depressive episodes. I argue that the self-knowledge achieved through psychotherapy has moral value in that it promotes the autonomy of stressor-related (...) decisions. I further argue that such an effect comprises a compelling moral reason for doctors to see evidence-based psychotherapy not as merely optional, but as a necessary treatment for their patients with depression. (shrink)

Katerina Deligiorgi offers a contemporary defence of autonomy which is Kantian but engages closely with recent arguments about agency, morality, and practical reasoning.

A rich philosophical examination of why it matters to live an autonomous life.

Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute (...) autonomy is impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites. Methods: In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today’s medicine. Results and Conclusions: Autonomy may and should be a shared target in today’s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy. (shrink)

According to the High Court in England and Wales, the primary purpose of legal interventions into the lives of vulnerable adults with mental capacity should be to allow the individuals concerned to regain their autonomy of decision making. However, recent cases of clinical decision making involving capacitous vulnerable adults have shown that, when it comes to medical law, medical ethics and clinical practice, vulnerability is typically conceived as opposed to autonomy. The first aim of this paper is to (...) detail the problems that arise when the courts and health care practitioners respond to the vulnerability of capacitous adults on the basis of such an opposition. It will be shown that not only does the common law approach to vulnerability fail to adequately capture the autonomy of capacitous vulnerable adults, the conception of vulnerability and autonomy in oppositional terms leads to objectionably paternalistic health care responses that undermine the autonomy of vulnerable patients as well as clinical and legal interventions that violate their autonomy. In response, the second aim of this paper is to show that the concepts of autonomy and vulnerability are necessarily entwined and, on that basis, the focus should be on promoting the autonomy of capacitous vulnerable adults where possible. In order to make this case, the paper explains the limitations of standard approaches to the autonomy of vulnerable adults and, in their place, offers a conception of legitimate, self-authorised autonomy that is fundamentally dependent on intersubjective practices of recognition. (shrink)

ABSTRACT We argue that in societies like our own the prevailing view that parents have both special responsibilities for and special rights over their children fails to give a proper understanding of the autonomy both of parents and of children. It is our claim that there is a logical priority of the separable interests of a child over the autonomy of its parents in the fulfilment of their special responsibilities for and the exercise of their special rights over (...) their children. However, we believe that in acknowledging the child as a distinct locus of interests appropriate weight can still be given to parental autonomy. In particular, since raising a child is a long‐term commitment which plays a central role in the life‐plans of many adults it will be a legitimate exercise of an adult's autonomy strongly to influence the future of any children involved in such a plan. Such influence will be quite separate from paternalistic concern for those children. But the logical priority of the child's interests will at the same time show why parents are not entitled to behave proprietorially toward their children, even when paternalistic concern is called for. (shrink)

Among the numerous conceptions of autonomy, three are particularly important: Kant's notion of humans' being subject, and subject only, to moral laws they gave themselves, Frankfurt's idea of persons' willing and acting deriving from the essential character of their wills, and the popular conception of persons' being master over whether others do or do not certain things to them. Kant's moral conception of autonomy, it is argued, is untenable because the moral character of a law and its self-givenness (...) are incompatible. Frankfurt's idea suffers from the fact that we cannot give substance to talk of the essential character of one's will. The third conception is practically irrelevant: there is no principle requiring people to be master over what others do to them. Thus autonomy may have to be dropped from our self-conception. To some this will appear a grave loss. In fact it is not. (shrink)

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon (...) demonstration of competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to acquire knowledge, use instrumental rationality, and form and revise a life plan. (shrink)

Paul Benson and Andrea C. Westlund have proposed conceptualising personal autonomy in terms of the readiness to respond to criticism that targets the agent’s actions and intentions (Benson) or commitments (Westlund). While incorporating this dialogical facet into a theory of personal autonomy is a step in the right direction, a theory of personal autonomy that is exclusively construed in terms of this facet and that posits discursive accountability as the sole criterion against which actions, choices, and commitments (...) can be judged as autonomous or not is too restrictive and entails counterintuitive ideas. In this article, an alternative conceptualisation is proposed, one that avoids reductively construing personal autonomy exclusively in terms of the discursive and communicative facet and that conceptualises this facet in terms of communicative spaces which agents can claim authority over and in which and through which they can take ownership of claims, actions, and commitments. This alternative conceptualisation is initially formulated – by way of analogy – in terms of the normative requirement to respect the physical space of individuals. The article also outlines a set of conditions which indicate when one should claim authority over communicative spaces and the manner in which one takes ownership of claims, actions, and commitments in order to be autonomous. (shrink)

When are soldier enhancements permissible in so far as they affect moral autonomy? This question is answered via the setting out of an important condition for moral autonomy: the capacity agents have for appropriating actions and experiences into a unified morally coherent self-conception.

The relationship between adults and children in liberal democracies is based on two flawed assumptions that are widespread: first, that childhood is an impediment, a passing phase of impaired maturity; and second, that children benefit from the proliferation of rights ascribed to them. Social institutions, and particularly the education system, are correspondingly misconstrued. This article focuses on the combined effect of vulnerability and autonomy as they construct contemporary childhood. I conclude that adults' obligations rather than children's rights are the (...) appropriate social, political and educational basis for adult society's relations with children. (shrink)

Individual autonomy is a concept highly appreciated in modern Western societies. Its significance is reflected by the central importance and broad use of the model of informed consent in all fields of medicine. In predictive genetic testing, individual autonomy gains particular importance, for what is in focus here is not so much a concrete medical treatment but rather options for taking preventive measures and the influence that the test results have on long-term lifestyle and preferences. Based on an (...) analysis of autonomy-related issues in predictive genetic diagnosis and genetic screening programmes, this contribution stresses the central relevance of a broad notion of autonomy for the discussion of ethical issues raised in connection with predictive genetic testing and genetic screening programmes. Only against the background of such a broad notion of autonomy, which stresses not only free and informed decision-making but also the relevance of long-term prospects for leading a self-determined life in familial and social contexts, can the manifold autonomy-related issues linked to predictive genetic testing be given adequate consideration. (shrink)

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, (...) in which actions are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training. (shrink)

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

Within the western health-care context autonomyis a central value. Still, as it is used withinthis context it is far from clear what we areactually talking about. In this article theauthor outlines four different uses or aspectsof autonomy: self-determination, freedom,desire-fulfilment and independence. Oneimportant conclusion will be that in order tobe able to respect autonomy in a way thatactually brings value to the patient’s life weneed to clearly assess what aspect of autonomythe patient values and for what reason it isvalued (...) by the patient. (shrink)

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

We analyzed stable patients’ views regarding synthetic biology in general, the medical application of synthetic biology, and their potential participation in trials of synthetic biology in particular. The aim of the study was to find out whether patients’ views and preferences change after receiving more detailed information about synthetic biology and its clinical applications. The qualitative study was carried out with a purposive sample of 36 stable patients, who suffered from diabetes or gout. Interviews were transcribed verbatim, translated and fully (...) anonymized. Thematic analysis was applied in order to examine stable patients’ attitudes towards synthetic biology, its medical application, and their participation in trials. When patients were asked about synthetic biology in general, most of them were anxious that something uncontrollable could be created. After a concrete example of possible future treatment options, patients started to see synthetic biology in a more positive way. Our study constitutes an important first empirical insight into stable patients’ views on synthetic biology and into the kind of fears triggered by the term “synthetic biology.” Our results show that clear and concrete information can change patients’ initial negative feelings towards synthetic biology. Information should thus be transmitted with great accuracy and transparency in order to reduce irrational fears of patients and to minimize the risk that researchers present facts too positively for the purposes of persuading patients to participate in clinical trials. Potential participants need to be adequately informed in order to be able to autonomously decide whether to participate in human subject research involving synthetic biology. (shrink)

In the mid to late 1980s a debate arose over the moral and legal authority of advance medical directives. At the center of this debate were two point-counterpoint law journal articles by Rebecca Dresser and Nancy Rhoden. What appeared to have the makings of an ongoing critical dialogue ended with the untimely death of Nancy Rhoden. Rebecca Dresser, however, has continued her challenge of advance directives in numerous publications, most recently in a critique of Ronald Dworkin's Life's Dominion. Like Rhoden, (...) Dworkin has been a staunch advocate of advance directives as an exercise of what has come to be referred to as prospective or precedent autonomy. In this paper I will consider a number of the issues that Dresser has repeatedly raised about the infirmities of advance directives, and suggest that it is from an understanding of and appreciation for the narrative dimension of the life of a person that advanced directives draw one of their most powerful justifications. (shrink)

Reflecting Subjects offers a bold and original reading of Book 2 of the Treatise, and presents a problem that has been little explored by Hume scholarship. Jacqueline Taylor's book argues that we can reconstruct what she calls a "social theory" out of Book 2 of the Treatise. Based on a detailed account of the passions that constitute social selves, the social theory of the Treatise offers, according to Taylor, rich and fine-grained explanations of the causes of difference and inequality among (...) human beings, based on understanding the characters of individuals, their social statuses, and their differences in power. However—and this is one of the central problems that Reflecting Subjects seeks to tackle—in Book 3 of... (shrink)

Gambling self-exclusion agreements enable a person to have themselves prevented from gambling for some future period. In light of evidence of their effectiveness in helping problem gamblers manage their addiction, these agreements enjoy growing popularity. In particular, several jurisdictions now oblige gambling operators to offer self-exclusion to their clientele. If self-exclusion has a unique value that is distinct from paternalistic measures, such as forced exclusion, it is surely because it prizes the gambler’s autonomy. In this article, however, I will (...) argue that self-exclusion’s theoretical basis cannot, in fact, be found in a procedural theory of autonomy that only regards agents’ own values and decisions. Rather, I will contend that if agents may bind their future selves in only some ways—for example, by preventing themselves from gambling but not preventing themselves from self-excluding or selling themselves into slavery—it can only be because of a normative, substantive claim. (shrink)

Recent philosophy has developed an overblown concept of autonomy. In fact we do not have moral autonomy, and personal autonomy we only have in the sense of being able to decide some things that affect the course of our lives, not in the sense of shaping these lives and being master over them; nor ought we to have autonomy in the latter sense, or come closer to having it. As for our political institutions, they do not (...) presuppose, as prevailing doctrines claim they do, citizens’ autonomy in a more demanding sense. Freedom and democracy as understood for instance in the German constitution only assume subordinates capable of deciding some matters on their own. Current talk of autonomy is just gilding people’s real dependence. (shrink)

Respect for autonomy is a key concept in contemporary bioethics and in ethics at the end of life in particular. An individualistic interpretation of autonomy may not incorporate the aspects of consideration that patients may have for their wider construct of personhood, which includes their love and consideration for their families. This anonymous case describes the intricacies of a patient’s decision making at the end of life, the choices she made, and how her decisions changed as her situation (...) evolved. The tension this produced within the medical team is unpacked using a lens of compassionate care in the intensive care unit. (shrink)