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Abímbọ́lá, Kọ́lá, , . Culture and the Principles of Biomedical Ethics
2013, Journal of Commercial Biotechnology, 19 (3): 31-39.
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Abstract: This paper examines the roles of culture in the principles of biomedical ethics. Drawing on examples from African, Navajo and Western cultures, the paper maintains that various elements of culture are indispensable to the application of the principles of biomedical ethics.

Comment: This text presents a clear introduction to questions about the application of biomedical ethical principles outside of Western medical contexts. It contains a good overview of the Western interpretation and application of autonomy, as well as other, culturally specific, interpretations of autonomy in medical contexts. This makes it useful as a text to introduce students to the way in which conflicts occur over the application of medical ethical principles in context prior to looking at specific cases (such as Jehovah’s Witnesses refusal to accept blood transfusions or the well known case of the Hmong medical culture).

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Barclay, Linda, , . Genetic Engineering and Autonomous Agency
2003, Journal of applied philosophy 20(3): 223–236.
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Abstract: In this paper I argue that the genetic manipulation of sexual orientation at the embryo stage could have a detrimental effect on the subsequent person’s later capacity for autonomous agency. By focussing on an example of sexist oppression I show that the norms and expectations expressed with this type of genetic manipulation can threaten the development of autonomous agency and the kind of social environment that makes its exercise likely.

Comment: Useful mainly in the context of (the limitations of) reproductive rights and as a further reading on the ethics of genetic engineering and human enhancement.

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Bortolotti, Lisa, , Daniela Cutas. Reproductive and Parental Autonomy: An Argument for Compulsory Education
2009, Reproductive Biomedicine Online, 19 (Ethics Supplement): 5-14.
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Added by: Rochelle DuFord, Contributed by:

Abstract: In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not believe that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.

Comment: This text provides a clear overview of debates about reproductive autonomy and compulsory education. It also contains responses to well known criticisms of compulsory parental education. It would be best used in a course dealing with issues of parenthood and procreation, reproduction, or autonomy in a medical context.

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Conly, Sarah, , . One Child: Do We Have a Right to More?
2016, Oxford: Oxford University Press.
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Added by: Rochelle DuFord, Contributed by:

Summary: A compelling argument for the morality of limitations on procreation in lessening the harmful environmental effects of unchecked population. We live in a world where a burgeoning global population has started to have a major and destructive environmental impact. The results, including climate change and the struggle for limited resources, appear to be inevitable aspects of a difficult future. Mandatory population control might be a possible last resort to combat this problem, but is also a potentially immoral and undesirable violation of human rights. Since so many view procreation as an essential component of the right to personal happiness and autonomy, the dominant view remains that the government does not have the right to impose these restrictions on its own citizens, for the sake of future people who have yet to exist. Sarah Conly is first to make the contentious argument that not only is it wrong to have more than one child in the face of such concerns, we do not even retain the right to do so. In One Child, Conly argues that autonomy and personal rights are not unlimited, especially if one’s body may cause harm to anyone, and that the government has a moral obligation to protect both current and future citizens. Conly gives readers a thought-provoking and accessible exposure to the problem of population growth and develops a credible view of what our moral obligations really are, to generations present and future.

Comment: This book would be an excellent resource for an upper-division course on population ethics, ethcs of reproduction, autonomy, or human rights. It would also serves as a good overview of positions in population ethics or as a supplement to a class on environmental ethics and future generations.

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Etieyibo, Edwin, , . The Case of Competancy and Informed Consent
2013, Journal of Clinical Research and Bioethics, 4 (2): 1-4.
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Added by: Rochelle DuFord, Contributed by:

Abstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.

Comment: This text presents an introduction to the relationship between competance, informed consent, and autonomy in medical contexts through the use of a case study. As such, it would be a good text for an introductory course in health care ethics or biomedical ethics within a unit on autonomy or culturally-specific applications of medical ethical principles.

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Heal, Jane, , . Mental disorder and the value(s) of ‘autonomy’
2012, In Autonomy and Mental Disorder, Lubomira Radoilska (ed.). New York: Oxford University Press, 3-25.
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Added by: Jamie Robertson, Contributed by:

Summary (from Introduction of Autonomy and Mental Disorder, Radoilska ed.): In ‘Mental disorder and the value(s) of autonomy’, Jane Heal identifies and critically examines a form of thought which is implicit in discussions about what we, as a society, owe to people with mental disorder. This form of thought builds upon intuitions which link respect for a person with respect for a person’s autonomy. In light of these intuitions, the issue of how to treat a person with mental disorder may seem to revolve around the question whether or not this person has the capacity for autonomy. However, Heal argues, inquiries that share this logical form are methodologically inappropriate and potentially unhelpful in answering either of the questions they put together: what we owe to people with mental disorder and what is involved in autonomy as a capacity. The reason for this is twofold.
Firstly, the apparent consensus about autonomy as a capacity for self-determination that ought to be protected from interference by a corresponding right to self-determination is too shallow to ground a coherent course of action in terms of respect for autonomy. Even if we work with the assumption that autonomy is part of the Enlightenment project, we face an important dilemma since we have to choose between a Kantian or rationality oriented and a Millian or well-being oriented take on the nature and significance of autonomy. Secondly, even if we were to reach a substantive consensus on the concept of autonomy, it would arguably require an intricate array of mental capacities, outside the reach of at least some people with mental disorder. Getting clearer on what autonomy is will not help us find out what it means to treat these people respectfully.

Comment: This text would be a good candidate for inclusion in a course about autonomy, philosophy of disability, or the ethics or political philosophy of mental health or aging (due to discussion of dementia). If assigned as part of a course on autonomy, students will benefit from considering Heal’s approach to breaking down the logical components of the concept and her nuanced discussion of the limitations of autonomy as a moral principle for understanding our obligations toward people with mental disorders. This second element is the central question of the paper and would be of interest when examining disability or mental health from a philosophical perspective.

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Jackson, Jennifer, , . Truth, trust and medicine
2001, London: Routledge.
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Publisher: Truth, Trust and Medicine investigates the notion of trust and honesty in medicine, and questions whether honesty and openness are of equal importance in maintaining the trust necessary in doctor-patient relationships. Jackson begins with the premise that those in the medical profession have a basic duty to be worthy of the trust their patients place in them. Yet questions of the ethics of withholding information and consent and covert surveillance in care units persist. This book boldly addresses these questions which disturb our very modern notions of a patient’s autonomy, self-determination and informed consent.

Comment: This text is best used as a further reading in medical, professional and applied ethics courses. It is very detailed and thorough in its approach, but some chapters can be used as more introductory standalone texts. In particular, chapters 3 and 4 offer a good discussion on ‘Why truthfulness matters’ and ‘What truthfulness requires’, and chapters 2 and 9 look critically at lying or withholding information for the benefit of the patient.

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O’Neill, Onora, , . Autonomy and Trust in Bioethics
2002, Cambridge University Press.
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Added by: Chris Howard, Contributed by: Simon Fokt

Publisher’s Note: Onora O’Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.

Comment: Parts of this book are an excellent supplement to units on autonomy and informed consent in an intermediate-advanced level medical ethics course. In particular, chapters 1, 2, and 4 would be excellent additions to a unit on autonomy, and chapter 7 would be a similarly excellent addition to a unit on informed consent.

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O’Neill, Onora, , . Constructions of Reason: Explorations of Kant’s Practical Philosophy
1989, Cambridge University Press.
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Publisher’s Note: Two centuries after they were published, Kant’s ethical writings are as much admired and imitated as they have ever been, yet serious and long-standing accusations of internal incoherence remain unresolved. Onora O’Neill traces the alleged incoherences to attempts to assimilate Kant’s ethical writings to modern conceptions of rationality, action and rights. When the temptation to assimilate is resisted, a strikingly different and more cohesive account of reason and morality emerges. Kant offers a “constructivist” vindication of reason and a moral vision in which obligations are prior to rights and in which justice and virtue are linked. O’Neill begins by reconsidering Kant’s conceptions of philosophical method, reason, freedom, autonomy and action. She then moves on to the more familiar terrain of interpretation of the Categorical Imperative, while in the last section she emphasizes differences between Kant’s ethics and recent “Kantian” ethics, including the work of John Rawls and other contemporary liberal political philosophers

Comment: [This is a stub entry. Please add your comments to help us expand it]

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O’Neill, Onora, , . Some limits of informed consent
2003, Journal of Medical Ethics 29 (1):4-7
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Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.

Comment: A great introductory text offering a short overview of the problems related to consent. The point regarding the intransitivity of consent is likely to inspire interesting discussions. As the paper is quite short, it can easily be used in conjunction with other texts.

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Oshana, Mariana, , . Autonomy and the Partial-Birth Abortion Act
2011, Journal of Social Philosophy, 42 (1): 46-60.
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Summary: In this paper, Oshana argues that the U.S. Supreme Court’s decision to affirm the Partial-Birth Abortion Act was mistaken. She claims that the Partial-Birth Abortion Act cannot withstand the test of strict scrutiny, that the Act fails to respect the privacy rights of individuals, and that there are compelling reasons (based in autonomy) to allow partial-birth abortion up until the point of fetal viability. As such, she claims, the Act violates the integrity of law.

Comment: This text would be excellent to use in a course focused on abortion, any course that covers the suite of U.S. Supreme Court cases involving the right to privacy, or a course that wishes to discuss and apply the doctrine of strict scrutiny. While it requires a significant amount of background knowledge (concerning the legislative history on abortion in the United States), it provides an excellent example of applying both the principle of autonomy and the principle of strict scrutiny.

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Oshana, Marina, , . Personal Autonomy and Society
1998, Journal of Social Philosophy 29(1): 81–102.
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Content: Oshana argues against ‘internalist’ theories of autonomy that focus exclusively on psychological conditions internal to the agent – what goes on inside her head – and suggests instead that certain social relations must obtain between the agent and those around her for genuine autonomy to be possible.

Comment: Oshana argues that personal autonomy is a socio-relational phenomenon partially constructed by external, social relations. She also offers an interesting and detailed critique of internalist accounts, which makes the text very useful in teaching on autonomy and free will in general. The text is best used as a further reading in undergraduate and a more central required reading in postgraduate teaching. It offers a good synopsis of Gerald Dworkin’s influential conception of autonomy.

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Seavilleklein, Victoria, , . Challenging the Rhetoric of Choice in Prenatal Screening
2009, Bioethics 23(1): 68-77.
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Added by: Simon Fokt, Contributed by:

Abstract: Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women’s choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women’s autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women’s autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.

Comment: The text introduces the notion of relational autonomy and argues that an increase in pre-natal screening can in fact act so as to restrict the autonomy of pregnant women. It is best used in teaching applied ethics modules on procreation and autonomy, and as a further reading offering a critique of approaches which do not take into account contextual features of particular situations in their moral assessment.

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Walker, Rebecca L., , . Medical Ethics Needs a New View of Autonomy
2009, Journal of medicine and philosophy 33: 594-608.
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Added by: Simon Fokt, Contributed by:

Abstract: The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order.

Comment: Walker argues against the Black Box view advocated by Beauchamp and Childress. The text is most useful when discussing principlism in biomedical ethics and more general issues related to autonomy and consent. The text works well when read alongside’s Onora O’Neill’s “Some limits of informed consent.”

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Warwick, Sarah Jane, , . A vote for no confidence
1989, Journal of Medical Ethics 15 (4):183-185.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt

Abstract: This paper considers the justifications for adhering to a principle of confidentiality within medical practice. These are found to derive chiefly from respect for individual autonomy, the doctor/patient contract, and social utility. It is suggested that these will benefit more certainly if secrecy is rejected and the principle of confidentiality is removed from the area of health care

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