Autonomy,constraining options,and organ sales

Although there continues to be a chronic shortage of transplant organs the suggestion that we should try to alleviate it through allowing a current market in them continues to be morally condemned, usually on the grounds that such a market would undermine the autonomy of those who would participate in it as vendors. Against this objection Gerald Dworkin has argued that such markets would enhance the autonomy of the vendors through providing them with more options, thus enabling them to exercise a greater degree of control over their bodies. Paul Hughes and T. L. Zutlevics have recently criticized Dworkin's argument, arguing that the option to sell an organ is unusual in that it is an autonomy–undermining "constraining option" whose presence in a person's choice set is likely to undermine her autonomy rather than enhance it. I argue that although Hughes' and Zutlevics' arguments are both innovative and persuasive they are seriously flawed — and that allowing a market in human organs is more likely to enhance vendor autonomy than diminish it. Thus, given that autonomy is the preeminent value in contemporary medical ethics this provides a strong prima facie case for recognizing the moral legitimacy of such markets.     

Ambivalence,Autonomy, and Organ Sales

Recent philosophical arguments in favor of legal markets in human organs such as kidneys claim that respect for autonomy justifies such markets. I argue that these arguments fail to establish the moral permissibility of commercialized organ sales because they do not show that those most likely to serve as vendors would choose to sell autonomously. Pro‐market views utilize hierarchical theories of autonomy to demonstrate that potential organ vendors may autonomously consent to selling their organs even in the absence of any practical alternative to doing so. But central to hierarchical accounts of autonomy is the idea that persons my experience volitional ambivalence, a condition in which the will is irreconcilably conflicted. Because commercialized organ sales would create volitional ambivalence in many of those who opt to sell an organ, the choice to sell an organ would not be an autonomous one.     

Why the ‘Black Market’ Arguments against Legalizing Organ Sales Fail

One of the most widespread objections to legalizing a market in human organs is that such legalization would stimulate the black market in human organs. Unfortunately, the proponents of this argument fail to explain how such stimulation will occur. To remedy thus, two accounts of how legalizing markets in human organs could stimulate the black market in them are developed in this paper. Yet although these accounts remedy the lacuna in the anti-market argument from the black market neither of them provide reason to believe that legalizing an organ markets would stimulate the black market in organs. Despite its prevalence, then, the argument from the black market should be rejected.     

Autonomy,Vote Buying,and Constraining Options

A common argument used to defend markets in ‘contested commodities’ is based on the value of personal autonomy. (1) Autonomy is of great moral value; (2) removing options from a person's choice set would compromise her ability to exercise her autonomy; (3) hence, there should be a prima facie presumption against removing options from persons’ choice sets; (4) thus, the burden of proof lies with those who wish to prohibit markets in certain goods. Christopher Freiman has developed a version of this argument to defend markets in votes. I argue that Freiman's argument fails, and that its failure illustrates the falsity of the widespread claim that the more options a person has available to her the better able she will be to exercise her autonomy. In Part 1, I outline Freiman's argument from ‘the presumption of voter liberty’ for legalising markets in votes. In Part 2, I argue that the option to sell one's vote in a legal market for them would be a ‘constraining option’ – an option which, if chosen, would be likely to lead to a diminution in a person's future ability to exercise her autonomy. In Part 3, I respond to objections to my arguments.     

Markets and The Needy: Organ Sales or Aid?

As organ shortages have become more accute, support for a market in organs has steadily increased. Whilst many have argued for such a market, it is Gerald Dworkin who most persuasively defends its ethics. As Dworkin points out, there are two possibilities here--a futures market and a current market. I follow Dworkin in focusing on a current market in the sale of organs from living donors, as this is generally considered to be the most difficult to justify. One of the most pressing concerns here is that such a market will exploit the poor. I outline this concern and scrutinize Dworkin's and others' rejection of it. Briefly, I argue that the arguments Dworkin employs for allowing the poor to sell their organs fail, and in fact better support an argument for increasing aid to the needy.     

Marketing human organs: The autonomy paradox

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a “gift of life” and a “commodity exchange.” The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources.     

Body parts and the market place: insights from Thomistic philosophy.

With rare exceptions, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often oversimplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas' (1224-1274) understandings of embodiment and moral uses of the body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas' principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas' texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God's dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation.     

Directed Organ Donation: Discrimination or Autonomy?

abstract   Numerous measures have been proposed to change the collection procedure in order to increase the supply of organ donations. One such proposal is to give the candidate donors the right to direct their organs to groups of recipients characterised by specific features like sex, age, disease and geographic location. Four possible justifications for directed donation of organs are considered: the utilitarian benefit, the egalitarian principle of justice, the maximin principle of justice and the autonomy principle. It is concluded that none of these principles justifies the acceptance of designated donations. When potentially life-saving resources are distributed, only a pure egalitarian distribution is in agreement with the principle of justice.s     

AGENCY,AUTONOMY, AND SOCIAL INTELLIGIBILITY

Popular Frankfurt‐style theories of autonomy hold that (i) autonomy is motivation in action by psychological attitudes that have ‘authority’ to constitute the agent's perspective, and (ii) attitudes have this authority in virtue of their formal role in the individual's psychological system, rather than their substantive content. I pose a challenge to such ‘psychologistic’ views, taking Frankfurt's and Bratman's theories as my targets. I argue that motivation by attitudes that play the roles picked out by psychologistic theories is compatible with radically unintelligible behavior. Because of this, psychologistic views are committed to classifying certain agents as ‘autonomous’ whom we intuitively find to be dysfunctional. I then argue that a necessary condition for autonomy is that an agent's behavior is intelligible in a particular way: autonomy necessarily involves acting from a subjective practical perspective that is, in principle, minimally comprehensible to others – not simply in a causal sense, but in a substantive, socio‐cultural sense.     

Oppression,Autonomy and the Impossibility of the Inner Citadel

This paper argues for a conception of autonomy that takes social oppression seriously without sapping autonomy of its valuable focus on individual self-direction. Building on recent work in relational accounts of autonomy, the paper argues that current conceptions of autonomy from liberal, feminist and critical theorists do not adequately account for the social features of belief formation. The paper then develops an alternative conception of relational autonomy that focuses on how autonomy contains both individualistic and social epistemic features. Rather than consider autonomy to reside in an impenetrable inner citadel, a place immune from external influences, the paper argues that we must acknowledge the hermeneutic relationship between individual and social processes of belief adjudication. Taking such an argument seriously results in the need to alter our conception of autonomy and the schooling needed to foster its growth.     

Religious Belonging,Religious Agency,and Women's Autonomy in Mozambique

Women's autonomy has frequently been linked with women's opportunities and investments, such as education, employment, and reproductive control. The association between women's autonomy and religion in the developing world, however, has received less attention, and the few existing studies make comparisons across major religious traditions. In this study, we focus on variations in levels of female decision‐making autonomy within a single religious tradition—Christianity. Using unique survey data from a predominantly Christian area in Mozambique, we devise an autonomy scale and apply it to compare women affiliated with different Christian denominations as well as unaffiliated women. In addition to affiliation, we examine the relationship between autonomy and women's religious agency both within and outside their churches. Multivariate analyses show that women belonging to more liberal religious traditions (such as Catholicism and mainline Protestantism) tend to have higher autonomy levels, regardless of other factors. These results are situated within the cross‐national scholarship on religion and women's empowerment and are interpreted in the context of gendered religious dynamics in Mozambique and similar developing settings.     

The Market for Bodily Parts: a response to Ruth Chadwick

ABSTRACT  Largely as a result of public outcry, legislation has recently been passed in the UK prohibiting the sale of bodily parts. This topic was the focus of a recent article in Journal of Applied Philosophy by Ruth Chadwick, which acknowledged that difficulties might exist in trying to distinguish between the selling of one's bodily organs and the selling of one's labour. The position argued for, in the ensuing discussion, is that there is no relevant moral difference between the two acts. Furthermore it contests the view that the sale of bodily organs should necessarily be prohibited. The assertion is made that the legislation does little to prevent the general exploitation of the type of person likely to be involved in such transactions, places unnecessary restrictions on the autonomy of individuals, and does nothing to promote an enhanced moral attitude by health professionals.     

自主支持、基本心理需要满足对一年级职高生内外化问题的影响机制

对1137名一年级职高生实施问卷调查,探讨感知教师和父母自主支持、基本心理需要满足与内外化问题的关系。结果表明：（1）一年级职高生在抑郁问题上女生更严重,在外化问题上男生更严重;（2）教师、父母自主支持与基本心理需要满足呈显著正相关,教师、父母自主支持、基本心理需要满足与一年级职高生内外化问题呈显著负相关;（3）一年级职高生基本心理需要满足在教师、父母自主支持与内化问题的关系中起完全中介作用,在教师、父母自主支持与外化问题的关系中起部分中介作用;（4）教师自主支持对一年级职高生外化问题的影响受父母自主支持的调节作用,对于感知父母自主支持较高的学生,教师自主支持对外化问题的影响呈较为明显的下降趋势。     

Religion,Inclusive Individualism,and Volunteering in Europe

A well supported finding in social science is that religiosity is associated with pro-social behaviours such as volunteering, but the religious decline in Europe characterising the latter part of the twentieth century has not been accompanied by decline in voluntary participation. This period is also associated with a sharp increase in the moral emphasis on individual autonomy and inclusiveness over social norms and traditions. In this analysis of the European Values Study (2008–2010), I examine the relationship between religion and volunteering, taking both individual values and aggregate norms into account. Religious attendance is found to be associated with volunteering at the individual level. However, the average citizen’s likelihood of volunteering is lower in more religious countries. This could be due in part to secular countries’ high levels of inclusive individualism (autonomy values and generalised trust) which are positively associated with volunteering among both religious and non-religious respondents.     

Happiness,Rationality, Autonomy and the Good Life

The paper starts with a general discussion of the concepts of happiness and the good life. I argue that there is a conceptual core of happiness which has to do with one’s life as a whole. I discuss affective and attitude or life satisfaction views of happiness and indicate problems faced by those views. I introduce my own view, the life plan view, which sees happiness as the ongoing realizing of global desires of the person. I argue that on such a view one’s life could be happy without a high level of rationality or a high level of autonomy; such rationality and autonomy are not built into the concept of happiness. So while happiness is a final value, and good for the person, it is not the only final value. Rationality and autonomy are also final values and, where they exist, are good as ends for the person, part of the good life.     

行为自主决策、亲子亲合与个体主观幸福感的关系:留守与非留守青少年的比较

以374名农村青少年为被试,基于留守青少年和非留守青少年的比较,探讨了个体行为自主决策、亲子亲合与主观幸福感之间的关系,并检验了亲子亲合与性别的调节作用。结果表明：（1）行为自主决策能够显著正向预测农村留守和非留守青少年的生活满意度;父子亲合和母子亲合能显著正向预测两类青少年的积极情绪和生活满意度,负向预测其消极情绪。（2）对于非留守青少年,行为自主决策与母子亲合对主观幸福感的预测作用存在性别差异：行为自主决策仅能够显著正向预测非留守男生的积极情绪和生活满意度,母子亲合则显著负向预测非留守女生的消极情绪;但是,这种性别差异不存在于留守青少年之中。（3）对于非留守青少年,母子亲合在其行为自主决策与生活满意度之间关系中的调节作用显著：低母子亲合水平下,行为自主决策能够显著正向预测其生活满意度;高母子亲合水平下,行为自主决策与其生活满意度之间不存在关联。     

Proximal Job Characteristics,Feelings of Empowerment,and Intrinsic Motivation: A Multidimensional Model1

We examined relations between job characteristics, empowerment, and intrinsic motivation among technical and telemarketing workers. Empowerment was conceptualized as a gestalt of 4 psychological dimensions: autonomy, competence, meaningfulness, and impact. It was hypothesized that the various dimensions of empowerment would mediate the relationship between job characteristics, such as feedback and autonomy support, and intrinsic motivation at work. A path analysis supported the hypothesis, revealing that different job characteristics were predictive of different aspects of empowerment, and that aspects of empowerment differentially affected intrinsic motivation. The results point to the value of considering empowerment as a multidimensional construct.     

Autonomy,Sanity and Moral Theory

The concept of autonomy plays atleast two roles in moral theory. First, itprovides a source of constraints upon action:because I am autonomous you may not interferewith me, even for my own good. Second, itprovides a foundation for moral theory: humanautonomy has been thought by some to producemoral principles of a more general kind.This paper seeks to understand what autonomyis, and whether the autonomy of which we arecapable is able to serve these roles. We wouldnaturally hope for a concept of autonomy thatis value-neutral rather than value-laden. Thatis to say, we would want the judgement that Iam autonomous to depend wholly on, say,structural features of my psychology, and in noway to require us to make ethical judgements, orother value judgements. Being value-neutral isperhaps desirable in a concept of autonomyserving the first role, and plausiblyindispensible in one playing the second. Ishall argue, however, that value-neutral conceptionsof autonomy are impoverished and out of linewith our intuitions; set out and defendan explicitly value-laden conception ofautonomy; and explore the implications of such a view for theability of autonomy to play the rolesmentioned above.     

Endorsement and Autonomous Agency

We take self-governance or autonomy to be a central feature of human agency: we believe that our actions normally occur under our guidance and at our command. A common criticism of the standard theory of action is that it leaves the agent out of his actions and thus mischaracterizes our autonomy. According to proponents of the endorsement model of autonomy, such as Harry Frankfurt and David Velleman, the standard theory simply needs to be supplemented with the agent's actual endorsement of his actions in order to make room for our autonomy. I argue that their proposal fails and that a more substantive enrichment of the standard theory is called for.