Thick (Concepts of) Autonomy: Personal Autonomy in Ethics and Bioethics

Description

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” (concepts of) autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, biographical and social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations (both positive and negative) between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics. Preface Contents Chapter 1: What Moral Responsibility is Not 1.1 Introduction 1.2 Frankfurt 1.3 Other Theorists: Taylor, Watson, and Velleman 1.3.1 Taylor 1.3.2 Watson 1.3.3 Velleman and Bratman 1.4 Conclusion: What Moral Responsibility is Not References Chapter 2: The Passivity of Self-Satisfaction: A Critical Re-appraisal of Harry Frankfurt’s Normatively Thin Ontology of Autonomy 2.1 Re-booting the Debate Over Second-Order Desires 2.2 The Problem Our Desires Pose 2.3 Passive Failures to Face the Predicament of Volitional Reflexivity 2.4 Facing the Predicament and Resolving One’s Will: Structural Hierarchicalism of the Will 2.5 How Critical Must Volitional Reflexivity Be? 2.6 Self-Opacity and the Importance of Understanding What We Care About 2.7 Frankfurt’s Hermeneutically Impoverished Ontology of the Will 2.8 The Costs of Frankfurt’s Commitments to Thinness References Chapter 3: Determining Oneself and Determining One’s Self 3.1 Introduction 3.2 Self-Actualisation and Self-Formation 3.3 Self-Identification: Harry Frankfurt’s Theory of Voluntarist Self-Actualisation 3.4 Self-Realisation: Thomas Hill Green’s Ideal of Perfectionist Self-Formation 3.5 Self-Development: John Stuart Mill’s Conception of Perfectionist Self-Actualisation 3.6 Conclusion References Chapter 4: Self-Confidence, Self-Assertiveness, and Self-Esteem: The Triple S Condition of Personal Autonomy 4.1 The Standard Model for Autonomous Action 4.2 Affirmation, Position, Evaluation 4.3 The Genesis of Autonomy 4.4 The Vulnerability of Autonomy 4.5 Conclusion References Chapter 5: Autonomy, Respect, and Joint Deliberation 5.1 Autonomy, Respect, and Joint Deliberation 5.2 The General Contours of Autonomy 5.3 The Liberal Sensibility 5.4 Partnerships 5.5 The Challenge for the Liberal Sensibility References Chapter 6: Autonomy and Beliefs 6.1 Autonomous and Nonautonomous Actions: Setting Things Up 6.2 Sorting Through Cases References Chapter 7: How Much Understanding Is Needed for Autonomy? 7.1 Autonomy and Informed Consent 7.2 Defending the Thin View of How Much Understanding is Needed for Autonomy 7.2.1 The Objection from the Best Intensional Description 7.2.2 Agency, Autonomy, and Understanding 7.2.3 Maclean’s Objections 7.3 Conclusion References Chapter 8: Is “Autonomy Talk” Misleading? 8.1 A Functional Approach 8.2 ‘Thick’ Concepts of Autonomy as Concepts of the Good Life 8.3 The Good and the Right 8.4 Ideal and Threshold Concepts of Autonomy: Equality and Inclusion 8.5 Interrelations and Disruptions 8.6 The Form of Autonomy Rights References Chapter 9: Respecting Personal Autonomy in Bioethics: Relational Autonomy as a Corrective? 9.1 Crisis of Autonomy and Respect for Autonomy in Bioethics 9.2 The Principle of Respect for Autonomy (PRA) 9.3 Complexities in Respecting Autonomous Choices: A Difficult Case 9.3.1 Case: Death of 14-Year-Old Jehovah’s Witness 9.3.2 Steps in Respecting Autonomous Choices 9.4 Relational Autonomy: A Thicker, Richer Conception 9.4.1 Components of Relational Autonomy 9.4.2 Relationally Responsible Choices: A Necessary Condition of Autonomy? 9.4.3 Respect for an Individual’s Social-Cultural Beliefs and Values 9.4.4 Respect for Temporally Extended Selves 9.5 Conclusions References Chapter 10: Patients’ Decision-Making Competence: Discontents with a Risk-Relative Conception 10.1 Introduction 10.2 Decision-Making Competence: Preliminary Aspects 10.2.1 A Precondition for Valid Authorization 10.2.2 A Set of Abilities 10.2.3 Competence and Rationality 10.2.4 Task-Specificity 10.2.5 The Idea of a Risk-Related Concept of Competence 10.3 Arguments from Conceptual Grammar 10.3.1 Externalism and Normativity 10.3.2 Asymmetrical Risk-Related Competences? 10.3.3 Asymmetrical Decisional Competences? 10.4 Arguments from the Task at Stake 10.4.1 Making Treatment Preferences Decisive 10.4.2 The Ordinary-Person Standard 10.4.3 Complex Versus Risky Decisions 10.5 Arguments from Protection 10.5.1 Fallibilism: Raising Standards of Evidence or of Substance? 10.5.2 Over-Exclusiveness: Hidden Paternalism 10.5.3 Over-Inclusiveness: Devaluating Authorization 10.6 Conclusions References Chapter 11: Vulnerability, Exploitation and Autonomy 11.1 Introduction 11.2 Vulnerability and Corrosive Disadvantage 11.3 Exploitation and Injustice 11.4 Autonomy and Paternalism 11.5 Conclusion References Chapter 12: Outlook 12.1 Other Philosophical Traditions 12.2 Changing Environments 12.3 Intra- and Interdisciplinary Contexts Index