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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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Added by: Rochelle DuFord
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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Added by: Simon Fokt
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
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
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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Cordova, Viola. Ethics: The We and the I
2004, In: American Indian Thought: Philosophical Essays. Anne Waters (ed.), Blackwell (Oxford).
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Added by: Sonja Dobroski and Quentin Pharr
Abstract: This book brings together a diverse group of American Indian thinkers to discuss traditional and contemporary philosophies and philosophical issues. The essays presented here address philosophical questions pertaining to knowledge, time, place, history, science, law, religion, nationhood, ethics, and art, as understood from a variety of Native American standpoints. Unique in its approach, this volume represents several different tribes and nations and amplifies the voice of contemporary American Indian culture struggling for respect and autonomy. Taken together, the essays collected here exemplify the way in which American Indian perspectives enrich contemporary philosophy.

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Cordova, Viola. How It Is: The Native American Philosophy of V. F. Cordova
2007, Kathleen Dean Moore, Kurt Peters, Ted Jojola & Amber Lacy (eds.), University of Arizona Press.
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Added by: Sonja Dobroski and Quentin Pharr
Publisher’s Note: Viola Cordova was the first Native American woman to receive a PhD in philosophy. Even as she became an expert on canonical works of traditional Western philosophy, she devoted herself to defining a Native American philosophy. Although she passed away before she could complete her life’s work, some of her colleagues have organized her pioneering contributions into this provocative book. In three parts, Cordova sets out a complete Native American philosophy. First she explains her own understanding of the nature of reality itself—the origins of the world, the relation of matter and spirit, the nature of time, and the roles of culture and language in understanding all of these. She then turns to our role as residents of the Earth, arguing that we become human as we deepen our relation to our people and to our places, and as we understand the responsibilities that grow from those relationships. In the final section, she calls for a new reverence in a world where there is no distinction between the sacred and the mundane. Cordova clearly contrasts Native American beliefs with the traditions of the Enlightenment and Christianized Europeans. By doing so, she leads her readers into a deeper understanding of both traditions and encourages us to question any view that claims a singular truth. From these essays—which are lucid, insightful, frequently funny, and occasionally angry—we receive a powerful new vision of how we can live with respect, reciprocity, and joy

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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
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
Abstract: 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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Huang, Pei-hua. Moral Enhancement, Self-Governance, and Resistance
2018, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 43(5):547-567
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Added by: Sara Peppe, Contributed by: Pei-hua Huang
Abstract: John Harris recently argued that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement that aim to make the enhancement recipients less likely to “fall,” including moral education, are detrimental to moral agency. In this article, I present a new moral agency–based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harm our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, subsequently undermining our moral agency.

Comment: This paper can be assigned as a further reading when teaching the moral enhancement debate. It provides students with a less explored perspective on moral agency in the debate (i.e. the feminist approach to autonomy and Confucianism). Students might find the discussion on the Confucian conception of moral saints in this paper especially interesting when contrasting the conception to the more western ones.

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Jackson, Jennifer. Truth, trust and medicine
2001, London: Routledge.
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Publisher’s Note: 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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Kukla, Quill R.. A Nonideal Theory of Sexual Consent
2021, Ethics, 131(2): 270-292.
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Added by: Emma Holmes, David MacDonald, Yichi Zhang, and Samuel Dando-Moore
Abstract: Our autonomy can be compromised by limitations in our capacities, or by the power relationships within which we are embedded. If we insist that real consent requires full autonomy, then virtually no sex will turn out to be consensual. I argue that under conditions of compromised autonomy, consent must be socially and interpersonally scaffolded. To understand consent as an ethically crucial but nonideal concept, we need to think about how it is related to other requirements for ethical sex, such as the ability to exit a situation, trust, safety, broader social support, epistemic standing in the community, and more.

Comment: Kukla uses this paper to describe a view of consent which is relational. This means that rather than asking questions about what each person individually consented to or not, the question is how the people having sex communicated. If they communicate sufficiently well then the sex is consensual, and if they do not it is not. We can use this to challenge a view of consent which has been implicit in most of the readings so far. This paper is used to discuss blameworthiness and responsibility for wrongful sex, and to ask questions about what the real world obligations of agents are, given their lack of complete information

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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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Added by: Clotilde Torregrossa
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

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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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Added by: Simon Fokt
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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Added by: Rochelle DuFord
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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