Respect for Autonomy has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility (...) of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons. (shrink)

This article summarizes some of the results of the BIOMED II project “Basic Ethical Principles in European Bioethics and Biolaw” connected to a research project of the Danish Research Councils “Bioethics and Law”. The BIOMED project was based on cooperation between 22 partners in most EU countries. The aim of the project was to identify the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four important ideas or values for a European bioethics and biolaw. The research concluded (...) that the basic ethical principles cannot be understood as universal everlasting ideas or transcendental truths but they rather function reflective guidelines and important values in European culture. The method of the research was conceptual, philosophical analysis of the cultural background of the four values or normative ideas that people use and find important in their existence. Moreover, this was combined with analysis of empirical legal material and policy documents. Also, a number of qualitative interviews with relevant experts were carried out. Another important result of the BIOMED project was the partner's Policy Proposals to the European Commission, the Barcelona Declaration, unique as a philosophical and political agreement between experts in bioethics and biolaw from many different countries. The Policy Proposals are reprinted here at the end of the article. (shrink)

This article examines the relationship between women entrepreneurs’ job autonomy and work–life balance, with a particular focus on how this relationship might be augmented by environments that discriminate against women, whether socio-economically, institutionally, or culturally. Multisource data pertaining to 5334 women entrepreneurs from 37 countries indicate that their sense of job autonomy increases the likelihood that they feel satisfied with their ability to balance the needs of their work with those of their personal life. This process is particularly prominent when (...) they operate in countries characterized by discriminatory socio-economic and institutional conditions, though a mitigating instead of invigorating effect arises in culturally discriminatory settings. For business ethics scholars and practitioners, these findings indicate how the extent to which women entrepreneurs, seeking to combine professional and private responsibilities, derive benefits from initiatives aimed at enhancing their job-related freedom critically depends on whether they operate in adverse external environments. (shrink)

Part of what makes the environment valuable is its autonomy. There are some who think that any human influence on an environment is necessarily autonomy-compromising because it is a form of human control. In this article, I will assume human influence on the environment necessarily undermines autonomy. However, I will argue, even given this assumption, it is still possible for the intervention to enable autonomy in the long run. My focus is on genetic intervention into organisms, because some might think (...) human influence in these cases cannot dissipate. I argue this is mistaken and, borrowing a concept from botany, I argue genes, even genes inserted into a genome by humans, can “naturalize.” Furthermore, they can function in ways that are autonomy-enabling to the individual and to the system to which the organism belongs. (shrink)

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

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

In this paper we criticize the “Ashbyan interpretation” (Froese & Stewart, 2010) of autopoietic theory by showing that Ashby’s framework and the autopoietic one are based on distinct, often incompatible, assumptions and that they aim at addressing different issues. We also suggest that in order to better understand autopoiesis and its implications, a different and wider set of theoretical contributions, developed previously or at the time autopoiesis was formulated, needs to be taken into consideration: among the others, the works of (...) Rosen, Weiss and Piaget. By analyzing the concepts of organization and closure, the idea of components, and the role of materiality in the theory proposed by Maturana and Varela, we advocate the view that autopoiesis necessarily entails self-production and intrinsic instability and can be realized only in domains characterized by the same transformative and processual properties exhibited by the molecular domain. From this theoretical standpoint it can be demonstrated that autopoietic theory neither commits to a sharp dualism between organization and structure nor to a reflexive view of downward causation, thus avoiding the respective strong criticisms. (shrink)

Aulisio and Arora argue that the moral significance of value imposition explains the moral distinction between traditional conscientious objection and non-traditional conscientious objection. The former objects to directly performing actions, whereas the latter objects to indirectly assisting actions on the grounds that indirectly assisting makes the actor morally complicit. Examples of non-traditional conscientious objection include objections to the duty to refer. Typically, we expect physicians who object to a practice to refer, but the non-traditional conscientious objector physician refuses to refer. (...) Aulisio and Arora argue that physicians have a duty to refer because refusing to do so violates the patient’s values. While we agree with Aulisio and Arora’s conclusions, we argue value imposition cannot adequately explain the moral difference between traditional conscientious objection and non-traditional conscientious objection. Treating autonomy as the freedom to live in accordance with one’s values, as Aulisio and Arora do, is a departure from traditional liberal conceptions of autonomy and consequently fails to explain the moral difference between the two kinds of objection. We outline how a traditional liberal understanding of autonomy would help in this regard, and we make two additional arguments—one that maintains that non-traditional conscientious objection undermines society’s autonomy, and another that maintains that it undermines the physician-patient relationship—to establish why physicians have a duty to refer. (shrink)

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?

Peter-Paul Verbeek elaborates on the concept of “relational freedom” in Moralizing Technology (2011). In this paper, I propose to extend and reinterpret it as a concept of personal autonomy. Generally, studies of autonomy do not examine the use of technology thoroughly, because these studies mainly focus on an individual’s mental process regarding reasons or motives. Consequently, these studies fail to understand technological aspects that contribute to the agent’s actions and decisions. When we take into consideration that our autonomous behaviors and (...) lives are highly intertwined with technologies, it becomes necessary to clarify the aspect of autonomy that relates to the use of technology. This is where Verbeek’s relational freedom comes into play. This is because it refers to the set of capacities to constitute one’s subjectivity in the process of deliberately using technological means. However, some conceptual analysis and critical discussion are necessary. The former includes whether it is a procedural or substantive notion. The latter consists of the problem concerning the correspondence between human participant(s) and a hybrid agent, and the difference between the hybrid agent and a moral subject. (shrink)

Has the renewal of interest in the ostensible agency of living beings signaled an advance from a merely heuristic Kantian sense of purposiveness to an unequivocally, empirically grounded research program or are there as yet hidden tensions or contradictions in, for example, the organizational autonomy approach to natural agency? Can normativity be found to be immanent in nature but only beginning with the living cell or must a thoroughgoing naturalism find the seeds of normativity immanent throughout abiotic as well as (...) biotic nature? Beginning with a brief exposition of Kant´s influential treatment and recommendation for how to methodologically combine what he took to be the inevitable epistemological limit to explaining the origins of ostensible biotic purposefulness with the legitimate intentions of scientific research and explanation, this essay will critically engage with three recent essays that attempt to grapple with the preceding questions. Having putatively raised questions about the consistency and adequacy of each of the individual positions, the essay will attempt to move synthetically, drawing upon aspects of all three contributions, in the direction of a “cooperativity theoretic” approach to incipient natural normativity and agency. (shrink)

As patient autonomy expands, a highly controversial issue has emerged. Should the advance directives of refusing life-saving treatments or requesting euthanasia of persons with dementia who express changed minds or are often in a happy state be fulfilled? There are two autonomy-related positions. The mainstream position in philosophical discussions supports the priority of ADs based on precedent autonomy. Buchanan and Brock, and Dworkin represent this view. The other position supports the priority of PWDs’ current wishes based on minimal autonomy represented (...) by Jaworska. By rethinking the theoretical and practical challenges of the two positions and their arguments respectively, the paper concludes that in such a scenario, the priority of ADs is morally indefensible, and it is also challenging to establish minimal autonomy defend the moral priority of PWDs’ current wishes. For PWDs whose past values, beliefs, and preferences fade away but who retain apparent intrinsic sentience of well-being, a modified defined quality-of-life approach serves as another reasonable basis in their medical decision-making, and the ADs and the QoL should be further merged to reduce the uncertainty of the grey zone. (shrink)

No descriptive material is available for this title.

International institutions are facing increasing criticism of the legitimacy of their authority. But what does it mean for an international institution to be legitimate? Arthur Applbaum’s latest book provides a convincing new concept of legitimacy, namely, the power-liability view, and a new normative conception, the free group agent account. However, it is not clear how they can be applied to the international level. First, this paper examines how different concepts of legitimacy can be applied to international institutions. Second, it assesses (...) three different conceptions of legitimacy, namely, the service conception, Applbaum’s free group agent account and the autonomy-based conception for the international level. It outlines how on the last conception, international institutions’ legitimacy depends on three different aspects required to protect autonomy: the political power of the institution; its purpose; and its relation to other institutions. Finally, the paper argues that the creation of an international institution should be seen as part of relational legitimacy and that state consent plays an important role to protect the political autonomy of peoples. (shrink)

Volume 24, Issue 5, May 2024, Page 25-27.

Journal of Social Philosophy, EarlyView.

There has been renewed interest in whether we should understand standards of decision-making capacity (DMC) to be risk-relative. Critics of risk-relative standards often highlight a puzzling asymmetry that they imply; a patient may have the requisite DMC to consent to a treatment that is in their best interests, whilst lacking the requisite DMC to refuse that same treatment, given the much higher risk that this would entail. Whilst some have argued that this asymmetry suggests that risk-relative standards are nonsensical, in (...) this paper I defend a ‘quality of evidence’ view of such standards. I begin by outlining DMC’s purported gate-keeping role in medical ethics, and identifying three key normative claims that undergird this role. I then explain how two competing theories of risk-relative standards are incompatible with at least one of these claims. Drawing on Douglas’ distinction between standards of ‘true capacity’ and standards invoked in the ‘test’ for capacity, I then outline my ‘quality of evidence’ view. I explain how the view is compatible with the aforementioned normative claims, and outline the nature of the asymmetry it implies. I conclude by responding to the objection that there is no meaningful distinction between ‘true capacity’ and the ‘test’ for capacity. (shrink)

This article examines the impact of gender on the relative economic success of microentrepreneurs, their contributions to family income, and the impact of gender ideology and income on household decision making. The concept of economic success is problematized by examining how these businesses, even those of limited assets and income generation, offer women increased autonomy in household budgetary matters and decision making. The analysis draws on data from a representative survey of 201 male and female microentrepreneurs in the Dominican Republic. (...) The findings show that household decision making is influenced by variations in economic power but that gender ideologies structure the direction and extent of this influence, reflected in distinct “gender thresholds,” or the point at which income contributions start to matter. (shrink)

In Scepticism, Freedom and Autonomy, Araujo argues against this interpretation, asserting that we retain control over our opinions only through selective ...