-
Expand entry
-
Added by: Rochelle DuFordAbstract: 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.
-
Expand entry
-
Added by: Clotilde TorregrossaPublisher'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.
-
Expand entry
-
Added by: Simon FoktIntroduction: 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.
-
Expand entry
-
Added by: Chris Howard, Contributed by: Simon FoktPublisher'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.
-
Expand entry
-
Added by: Simon FoktAbstract: 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.
-
Expand entry
-
Added by: Rochelle DuFordSummary: 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.
-
Expand entry
-
Added by: Simon FoktContent: 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.
-
Expand entry
-
Added by: Simon FoktAbstract: 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.
-
Expand entry
-
Added by: Clotilde Torregrossa, Contributed by: Simon FoktAbstract: This article is about the description of all the situations in which clinician find difficult to tell the truth to patients regarding their condition. Moral importance of telling the truth is recognized in both moral theory and in the practical reality of everyday living. However, empirical studies continue to show that health- care professional identify the question of truth-telling and disclosure as a source of moral and psychological discomfort in many situations. Other situation creating difficulties for clinicians are not related directly to the patient's wants or needs regarding their illness but to wider issues such as disclosure of medical error and identifying poor performance in colleagues.
Comment:
-
Expand entry
-
Added by: Carl FoxAbstract: While the concept of adaptive preferences is an important tool for criticizing injustice, it is often claimed that using the concept involves showing disrespect for persons judged to have adaptive preferences. In this paper, I propose an account of adaptive preferences that does the relevant political work while still showing persons two centrally important kinds of respect. My account is based in what I call an indirect substantive account of autonomy, which places substantive requirements on the options available to a person, rather than on the option that she ultimately prefers. This allows us to pinpoint cases in which a person's circumstances have rendered her insufficiently autonomous, without saying that any conception of the good must be non-autonomous tout court.
Comment: This article would make good recommended reading for a session taking an in-depth look at adaptive preferences, or further reading if the topic was autonomy and the session broached questions about preference formation.
-
Expand entry
-
Added by: Erich Hatala MatthesSummary: Todd (Métis) situates contemporary acts of cultural appropriation in the colonial appropriation of indigenous land. She offers a normative definition of cultural appropriation according to which it is understood as the opposite of cultural autonomy. In the course of her discussion, she responds to a number of defenses of cultural appropriation that, she argues, fail to recognize the asymmetries of power in which appropriation from indigenous communities is embedded.
Comment: This is an excellent text to use in order to present students with a conception of the wrong of cultural appropriation that is firmly rooted in the context of colonial power dynamics. It is short, and can be usefully compared and contrasted with the arguments presented by James O. Young in "Profound Offense and Cultural Appropriation.".
-
Expand entry
-
Added by: Carl FoxContent: Tsai argues that offering another agent reasons can sometimes count as paternalism when it is motivated by distrust of the other's agency, conveys this lack of confidence, and intervenes in the target's sphere of agency.
Comment: Best suited as further or specialised reading on paternalism and agency.
-
Expand entry
-
Added by: Björn Freter
Abstract: Certain descriptions of personhood imbue an individual with a particular kind of moral status. There are different person-making capacities that are generally laid out as central to the idea of personhood. Some of the person-making capacities are what people generally refer to as the grounding of certain normative requirements that enable us to respond to individuals as entities with a moral status. Herein personhood is a matter of certain capacities that create one’s moral status. These descriptions of personhood bring about a specific structure of identification that has implications for moral accountability. In this paper I aim to interpret the person-making capacities and argue that they can, in some sense, be limiting, and this may be the case in relation to women as a gender group whose personhood has not always been fairly recognized. I will argue that a view of personhood whose person-making capacities exclude a gender group can have negative implications, and I will explore two implications that I think have this negative attitude. On the one hand, a conception of personhood, especially in the descriptive sense that prioritizes rationality and free will above all else, could imply that women, by virtue of lacking such capacities, are not to be considered as individuals with a moral status, wherein society cannot hold them accountable for their actions, nor would they be able to hold others morally accountable. On the other hand, and this second implication relates to difference in the sense of uniqueness, which is grounded on personhood – if women are denied the status of a person, then they would also be excluded from exploring their uniqueness qua radical difference.
Comment:
-
Expand entry
-
Added by: Simon FoktAbstract: 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."
-
Expand entry
-
Added by: Chris Blake-Turner, Contributed by: Jojanneke VanderveenPublisher's Note: In Freedom Within Reason, Susan Wolf charts a course between incompatibilism, or the notion that freedom and responsibility require causal and metaphysical independence from the impersonal forces of nature, and compatibilism, or the notion that people are free and responsible as long as their actions are governed by their desires. Wolf argues that some of the forces which are beyond our control are friends to freedom rather than enemies of it, enabling us to see the world for what it is. The freedom we want is not independence from the world, but independence from the forces that prevent us from choosing how to live in the light of a sufficient appreciation of the world.
Comment:
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.