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Added by: Jamie RobertsonAbstract:
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.Huang, Pei-hua. Moral Enhancement, Self-Governance, and Resistance2018, 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 HuangAbstract:
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.
Hurd, Heidi. The Moral Magic of Consent1996, Legal Theory 2(2): 121-146.-
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Added by: Carl Fox
Abstract: We regularly wield powers that, upon close scrutiny, appear remarkably magical. By sheer exercise of will, we bring into existence things that have never existed before. With but a nod, we effect the disappearance of things that have long served as barriers to the actions of others. And, by mere resolve, we generate things that pose significant obstacles to others' exercise of liberty. What is the nature of these things that we create and destroy by our mere decision to do so? The answer: the rights and obligations of others. And by what seemingly magical means do we alter these rights and obligations? By making promises and issuing or revoking consent When we make promises, we generate obligations for ourselves, and when we give consent, we create rights for others. Since the rights and obligations that are affected by means of promising and consenting largely define the boundaries of permissible action, our exercise of these seemingly magical powers can significantly affect the lives and liberties of othersComment: Good introduction to the topic of consent as it makes clear both how strange it is as a power and how pervasive it is in our moral practices. Goes on to provide an interesting argument for consent as a subjective mental state and offers an account of what that might be. Could support a lecture or seminar on consent, or would make good further reading if the topic is only touched on briefly.
Jackson, Jennifer. Truth, trust and medicine2001, 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.
Jaworska, Agnieszka. Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value1999, Philosophy and Public Affairs 28(2): 105–138.-
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Added by: Simon Fokt
Introduction: Dworkin puts forth two main arguments to justify adhering to the wishes the patient expressed before becoming demented. As he sees it, this course of action both promotes the patient’s well-being and is required in order to respect the patient’s autonomy. In each argument, while I consider most of the ideas well-founded, I challenge the crucial premise. In the argument focused on the patient’s well-being, I dispute the claim that demented patients are no longer capable of generating what Dworkin calls “critical interests.” In the argument concerning autonomy, I question the premise that demented patients no longer possess the “capacity for autonomy.”7 In each case, I will trace how the problematic premise arises within Dworkin’s argument and then develop an alternative account of the relevant capacity.Comment: Jaworska asks: 'Should we, in our efforts to best respect a patient with dementia, give priority to the preferences and attitudes this person held before becoming demented, or should we follow the person’s present preferences?' (p. 108). The article offers a useful critical overview of the views expressed by Rebecca Dresser and Ronald Dworkin. It is best used as a primary reading in ethics classes focusing directly on medical ethics or autonomy, or as further reading in general ethics teaching on autonomy.
Kittay, Eva Feder. Forever Small: The Strange Case of Ashley X2011, Hypatia, 26 (3): 610-631.-
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Added by: Rochelle DuFord
Abstract: I explore the ethics of altering the body of a child with severe cognitive disabilities in such a way that keeps the child 'forever small.' The parents of Ashley, a girl of six with severe cognitive and developmental disabilities, in collaboration with her physicians and the Hospital Ethics Committee, chose to administer growth hormones that would inhibit her growth. They also decided to remove her uterus and breast buds, assuring that she would not go through the discomfort of menstruation and would not grow breasts. In this way she would stay 'forever small' and be able to be carried and handled by family members. They claimed that doing this would ensure that she would be able to be part of the family and of family activities and to have familial care. But the procedure has raised thorny ethical questions. I wish to explore these questions philosophically by bringing to bear my own experiences as a mother of a grown daughter with severe cognitive impairments.Comment: This reading both introduces the controversial case of Ashley X and also provides a set of ethical considerations concerning altering the bodies of persons with severe cognitive disabilities. It would serve as an excellent introduction to a unit on disability, a unit on the ethics of care, or concerning the limits of parental paternalism.
Mackenzie, Catriona (ed.), Stoljar, Natalie (ed.). Relational Autonomy: Feminist Perspectives on Automony, Agency, and the Social Self2000, Oxford University Press.-
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Added by: Clotilde Torregrossa
Publisher's Note: This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including self-conception, self-worth, memory, and the imagination.Comment: All but one of the papers in this volume are writtn by underrepresented authors.
Nussbaum, Martha. Objectification1995, Philosophy and Public Affairs 24(4): 249-291.-
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Added by: Simon Fokt
Introduction: Sexual objectification is a familiar concept. Once a relatively technical term in feminist theory, associated in particular with the work of Catharine MacKinnon and Andrea Dworkin, the word "objectification" has by now passed into many people's daily lives. It is common to hear it used to criticize advertisements, films, and other representations, and also to express skepticism about the attitudes and intentions of one person to another, or of oneself to someone else. Generally it is used as a pejorative term, connoting a way of speaking, thinking, and acting that the speaker finds morally or socially objectionable, usually, though not always, in the sexual realm. Thus, Catharine MacKinnon writes of pornography, "Admiration of natural physical beauty becomes objectification. Harmlessness becomes harm."' The portrayal of women "dehumanized as sexual objects, things, or commodities" is, in fact, the first category of pornographic material made actionable under MacKinnon and Dworkin's proposed Minneapolis ordinance.2 The same sort of pejorative use is very common in ordinary social discussions of people and events.Comment: Seminal paper distinguishing seven features of sexual objectification. An excellent introduction to any class on feminism.
O'Neill, Onora. Some limits of informed consent2003, 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.
O'Neill, Onora. Autonomy and Trust in Bioethics2002, 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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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.
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.