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Ashley, Florence. Gatekeeping Hormone Replacement Therapy for Transgender Patients is Dehumanising
2019, The Journal of Medical Ethics. 45: 480-482.
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Added by: Chris Blake-Turner
Abstract: Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.

Comment: Ashley draws on their own experiences as a trans person, as well as that of the trans community more broadly, to argue against assessment and referral requirements for hormone-replacement therapy (HRT). Ashley argues instead for an informed consent model, on which providers of HRT are not gatekeepers of transness, but facilitators of thoughtful decision-making.

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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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Begon, Jessica. Paternalism
2016, Analysis 76(3): 355-373.
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Added by: Carl Fox
Summary: Analysis review article of recent work on the topic of paternalism. Discusses different ways in which the term is defined, reviews the debate between 'paternalists' and 'anti-paternalists', and presents soft paternalism.

Comment: Could be used as an introductory reading to the topic of paternalism, or a further reading to provide a comprehensive background to recent work in the area.

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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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Buss, Sarah. Personal autonomy
2008, Stanford Encyclopedia of Philosophy.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Abstract: To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems that when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question.

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

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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.

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

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Corrigan, Oonagh. Empty Ethics: The Problem with Informed Consent
2003, Sociology of Health & Illness, 25 (3): 768-792.
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Added by: Rochelle DuFord
Abstract: Informed consent is increasingly heralded as an ethical panacea, a tool to counter autocratic and paternalistic medical practices. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic practice that negates individual choice. A bioethical framework, based on a principle-led form of reductive/deductive reasoning, dominates the current model of informed consent. Such a model tends to abstract the process of consent from its clinical and social setting. By fleshing out the social process involved when patients and healthy volunteer subjects consent to take part in clinical drug trials, this paper attempts to address the problem arising from the current 'empty ethics' model. My arguments are substantiated by qualitative interview data drawn from a study I conducted on the process of consent as experienced by participants in clinical drug trials.

Comment: This text is a clear critique of the use of informed consent as a medical-ethical panacea (it could be taught alongside O'neill's "Paternalism and Partial Autonomy" for a more accessible and applied look at the problem of informed consent). It would be useful as a contrast at the end of a unit on informed consent for medical treatment or a unit on clinical research ethics. It is especially good for use in a biomedical ethics or research ethics course aimed at students interested in the health professions.

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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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Friedman, Marilyn. Autonomy, Social Disruption, and Women
2000, in Mackenzie, C. and Stoljar, N. (Eds.) Relational Autonomy: Feminst Perspectives on Autonomy, Agency, and the Social Self. Oxford: Oxford University Press. 35-51.
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Added by: Carl Fox
Abstract: This chapter develops a point made in preceding chapters that autonomy, although socially grounded, has an individualizing dimension — a dimension that is defend against the worries of critics. The main thesis is that: at the same time that we embrace relational accounts of autonomy, we should also be cautious about them. Autonomy increases the risk of disruption in interpersonal relationships. While this is an empirical and not a conceptual claim about autonomy, nevertheless, the risk is significant and its bearing on the value of autonomy is therefore empirically significant. It makes a difference in particular to whether the ideal of autonomy is genuinely hospitable to women.

Comment: This chapter presents an account of autonomy that sits between highly relational and highly individual accounts of autonomy.

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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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Hurd, Heidi. The Moral Magic of Consent
1996, 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 others

Comment: 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.

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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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Jaworska, Agnieszka. Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value
1999, 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.

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