Precedent Autonomy and Subsequent Consent

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her “precedent autonomy” by giving her what she used to want? There is a similar problem with “subsequent consent”: How can we justify interfering with someone's autonomy on the grounds that she will later consent to the interference, if she refuses now? Both problems arise on the assumption that, to respect someone's autonomy, any preferences we respect must be among that person's current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone's wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference.     

The Anarchist's Myth: Autonomy,Children, and State Legitimacy

Philosophical anarchists have made their living criticizing theories of state legitimacy and the duty to obey the law. The most prominent theories of state legitimacy have been called into doubt by the anarchists' insistence that citizens' lack of consent to the state renders the whole justificatory enterprise futile. Autonomy requires consent, they argue, and justification must respect autonomy. In this essay, I want to call into question the weight of consent in protecting our capacity for autonomy. I argue that if we care about all of the preconditions for autonomy, then we have good reasons to leave the state of nature. This leaves the philosophical anarchist with a dilemma. If she truly cares about autonomy, then she must welcome the state. But if she wants to deny the legitimacy of the state because of the value of consent, then she needs to downplay the moral significance of autonomy in people's lives. If autonomy matters, the state does too. If it doesn't, then consent doesn't. The philosophical anarchist can't have it both ways.     

Do we image God on-line? The opportunities and challenges for authentic relationships in cyberspace

ABSTRACT

Genesis 1 states that we are created in the image of God. While Biblical scholars have taken a performative approach, viewing God's image in our actions, systematic theologians have viewed God's image in relational terms. Thus, the quality of our relationships is crucial, not only for the health of our day to day lives but for our very identity. What makes a relationship authentic? Karl Barth suggests four criteria: that we look the other in the eye, speak to and hear the other, aid the other, and do it gladly. We look ?rst at how our authentic relationships function to make God present among us and then use Barth's criteria to examine the quality of relationships that exist primarily in cyberspace. Social media, in particular, present unique opportunities and challenges for forming authentic relationships and raise fundamental questions about who we are and where God is found among us.     

Interests without history? Some difficulties for a negative Aristotelianism

This paper focuses on 3 features of Freyenhagen's Aristotelian version of Adorno. (a) It challenges the strict negativism Freyenhagen finds in Adorno. If we have morally relevant interests in ourselves, it is implicit that we have a standard by which to understand what is both good and bad for us (our interests). Because strict negativism operates without reference to what is good, it seems to be detached from real interests too. Torture, it is argued, is, among other things, a violation of those interests. (b) Freyenhagen identifies the “impulse” in Adorno as an untutored yet moral reaction to morally demanding situations. The plausibility of this primitivism and its compatibility with Adorno's general worries about immediacy are considered. (c) The disruptive character of Adorno's version of the categorical imperative, its willingness to complicate action through wholesale reflection on the norms of what we are committing ourselves to, is set in contrast with Freyenhagen's Aristotelian claim that certain notions, such as “humanity,” cannot be intelligibly questioned.     

Un mineur peut-il consentir à un parcours de transition médicale?

As hundreds of so-called transgender children and teenagers enter “medical transition” processes with serious consequences, the relevance of the application of the rules of the Public Health Code relating to patient information and consent must be questioned : to what extent are these young minors capable of understanding the information provided and giving free and informed consent to these programmes?The medical controversies that have arisen concerning the consequences of the medical transition processes, the experimental nature of which has been pointed out, raise serious doubts about the quality, reliability and fairness of the information given. Furthermore, is the complexity of the information communicated to minors who have no life experience, the eagerness of young patients, the influence of social networks, and the censure attached to possible therapeutic alternatives compatible with the capacity to give free and informed consent?Finally, if it is not a question of treating a pathology but of “concretising the right to self-determination”, can we still claim the application of rules specific to the medical field? If there is no medical necessity or very serious medical reason, is it legitimate to accede to a minor's request to irreversibly damage his or her body?In the UK, a thousand families are reportedly preparing to take legal action for medical negligence, alleging that their vulnerable children have been misdiagnosed and placed on a damaging medical transition course. Yet these minors had been found to be ‘consenting’.It is time to weigh up the relevance of the sacredness of the minor's consent.     

A Goodness-of-Fit Approach to Informed Consent for Pediatric Intervention Research

As children and adolescents receive increased research attention, ethical issues related to obtaining informed consent for pediatric intervention research have come into greater focus. In this article, we conceptualize parent permission and child assent within a goodness-of-fit framework that encourages investigators to create consent procedures “fitted” to the research context, the child's cognitive and emotional maturity, and the family system. Drawing on relevant literature and a hypothetical case example, we highlight four factors investigators may consider when constructing consent procedures that best reflect participants' rights, concerns, and well-being: (a) the child's current assent capacity and the likely impact of study information on the child's mental and physical development, (b) parents' understanding of their child's treatment needs and distinctions between treatment and clinical trials research, (c) the family's history of shared decision making, and (d) the child's strivings for autonomy within the context of their parents' duty to make decisions in the child's best interest.     

Justice in the Family: A Defence of Feminist Contractarianism

ABSTRACT Jean Hampton argues that we can detect exploitation in personal relationships by thinking about what we would agree to were we to set aside the emotional benefits we receive from those relationships. Hampton calls her account “feminist contractarianism,” but it has recently been critiqued as decidedly un‐feminist, on the grounds that it is hostile to women's interests and women's values. Furthermore, Hampton's requirement that we imaginatively distance ourselves from our emotional connections to our loved ones — the key element in her contractarian test — is simply ad hoc. In this essay, I will evaluate these objections and offer a new justification for Hampton's test. I conclude that feminist contractarianism is not only a useful tool for detecting exploitation in the family, it is also deserving of its feminist label.     

Intuitive Political Theory: People's Judgments About How Groups Should Decide

Societies must make collective decisions even when citizens disagree, and they use many different political processes to do so. But how do people choose one way to make a group decision over another? We propose that the human mind contains an intuitive political theory about how to make collective decisions, analogous to people's intuitive theories about language, physics, number, minds, and morality. We outline a simple method for studying people's intuitive political theory using scenarios about group decisions, and we begin to apply this approach in three experiments. Participants read scenarios in which individuals in a group have conflicting information (Experiment 1), conflicting interests (Experiment 2), and conflicting interests between a majority and a vulnerable minority who have more at stake (Experiment 3). Participants judged whether the group should decide by voting, consensus, leadership, or chance. Overall, we find that participants prefer majority‐rule voting over consensus, leadership, and chance when a group has conflicting interests or information. However, participants' support for voting is considerably diminished when the group includes a vulnerable minority. Hence, participants showed an intuitive understanding of Madison's concerns about tyranny of the majority.     

Customary Trade and the Complications of Consent

Global justice theorists have given much attention to corporations' purchases of state‐owned natural resources controlled by dictators. These resources, the common argument goes, belong to the people rather than to those who exercise effective political power. Dictators who rely on violence to secure their political power and who sell state‐owned natural resources without authorisation from their people, or from their people's elected delegates, are therefore violating their peoples' property rights. But many dictatorships also distribute natural resource revenue to the population, and stopping to purchase natural resources from them is therefore likely to produce relative deprivation for the people, even while increasing the chances of the people gaining control over their property. Given these circumstances, can corporations buying the people's natural resources from a distributive dictatorship appeal to the people's consent as justification for such purchases? I consider this question by inspecting three types of consent to which resource corporations might appeal. I show that, under the circumstances of natural resource trade with distributive dictatorships, none of these types of consent can obtain. Hence, resource corporations cannot appeal to popular consent to defend their transactions with distributive dictatorships.     

Children with AIDS in the public schools: The ethical issues

The question of whether to allow children with AIDS to attend public school generates explosive emotions and has wide-reaching consequences. This paper focuses on the perspective of parents of well children who may be asked to attend school with children who have AIDS. These parents are poised at the heart of the dilemma: they are the ethical “bottom line,” and an argument that fails to satisfy them ought not to satisfy anyone. The conflicting commitments these parents face are first to the parentchild covenant which requires them to act in their child's best interests, and second, to the principles of beneficence and justice, which require them not to further burden a sick child with ostracism and isolation. Almost exact parallels exist between this issue and that of proxy consent by parents for children's participation in low-risk, non-therapeutic research. The lengthy and important debate between Paul Ramsey and Richard McCormick on this question is analyzed, concluding that McCormick's position in favor of thoughtful proxy consent is the more compelling. Returning to the question of allowing children with AIDS to attend school, the essay shows why the parallels are persuasive. On the ethical level, the apparent conflict of obligations is almost exactly the same; on the pragmatic level, the essay shows why sharing a classroom with a child who has AIDS is comparable to the “low-risk” category that the National Commission for the Protection of Human Subjects found acceptable in its 1978 guidelines. The essay concludes that parents of healthy childrenmay and ought to accept the presence of children with AIDS in the public school.     

Does executive control relate to sacrificial behavior during conflicts of interests?

Why is it that some people are better able to sacrifice their own immediate interest for the sake of their partner than others? We conducted two studies to test whether an individual's level of executive control plays a role in answering this question. Study 1 demonstrated that executive control is related to the tendency to continue a frustrating task to benefit one's partner. Study 2 replicated this effect by using two different indicators of sacrifice: a behavioral sacrifice measure and a questionnaire on the intention to make major sacrifices for one's partner. Together, our findings suggest that higher levels of executive control facilitate prorelational behavior when facing various conflicts of interests in a romantic relationship.     

The fair transaction model of informed consent: an alternative to autonomous authorization

The doctrine of informed consent in bioethics has relied on the view that consent is valid when it represents a patient or research subject's autonomous authorization. In this article we challenge this reigning conception of the validity of informed consent in clinical research, focusing in particular on the problem of the therapeutic misconception. We argue that the autonomous authorization model of informed consent suffers from four defects: (1) it fails to do justice to the relevance of risk-benefit considerations in shaping the criteria for the validity of consent, (2) it compromises the interests of subjects by preventing them from consenting to research participation with less than substantial understanding when doing so would likely be consistent with their preferences and beneficial to them or at least be unlikely to cause them harm, (3) it jeopardizes the interests of investigators by denying them fair notice regarding when the consent of research subjects can be considered valid and thus make it permissible for them to be enrolled in research, and (4) it threatens the reasonable limits on the responsibility of investigators to assure the adequacy of subjects' understanding of what research participation involves. In place of the autonomous authorization model, we present and defend a fair transaction model of informed consent, which better reflects the values served by consent.     

Frankl, Newman and the Meaning of Suffering

How can we find meaning in the suffering in our lives? What alternatives does our tradition offer to those who reject the “abuse excuse” and the “feel-good” mentality? This article contrasts the “feel-good” therapeutic model with Viktor Frankl's logotherapy and John Henry Newman's theology of the cross.     

The wonder of our complex enterprise: Steps enabled by attachment and the effects of relationships on relationships

John Bowlby's legacy encourages our exploration well beyond the child's attachment to a primary caregiver. A wide variety of family relationships contribute to child development, and the effects of relationships on other relationships are in particular need of investigation. The complexities of relationship influences seem mind-boggling as we array them, but both the researcher and the working clinician are guided by a number of principles in the search for meaning. These are described in terms of polarities that frame our interests and in terms of our human capacities for empathy and pattern recognition.     

酒依赖与酒文化

在医疗过程中,无法取得患者的同意时,通常由他人代其做出同意。但是,代为同意人在代为做出同意时,必须以患者本人的最佳利益为原则。在判断患者的最佳利益时,可以借鉴英国《心智能力法2005》的规定,通过对诸因素的评估,来综合决定何谓患者的最佳利益。我国在制订和修改代为同意的相关规定时,应该考虑如何借鉴英国的规定,制订符合我国国情的代为同意制度。     

Recovered Memories of Child Abuse:

In this paper we exemplify the ongoing and inconclusive nature of empirical research examining the validity of adults' recovered memories of childhood abuse. In view of increasing evidence that the processes underlying traumatic memories differ in fundamental ways from those underlying memories for nontraumatic events, experimental studies of everyday memory processes are likely to have little relevance for our understanding of the memory processes underlying traumatic child abuse. Further, given ethical concerns, it is unlikely that research will ever establish a definitive 'scientific' conclusion regarding the accuracy of recovered memories. Nevertheless, both laypersons and professionals are taking a stand on the recovered memory issue. In this regard, we discuss social psychological research that suggests that people's beliefs about recovered memories and other aspects of child abuse are tied to their personal needs and sociopolitical interests rather than to science or social values. These personal needs and interests include people's inability to acknowledge the injustice of child abuse and their opposition to women's equality, both of which vary as a function of people's authoritarian inclinations. The implications of these findings for social action, as opposed to social research, are discussed.     

Democratic Control of Information in the Age of Surveillance Capitalism

Carol Gould's article offers a powerful argument against the sufficiency of informed consent in an age of surveillance capitalism. In this review, I assess the three main claims that Gould makes in her article, namely that (1) democratic control is required by the all‐affected principle; (2) democratic control is a means of ensuring that surveillance corporations and governments track public, rather than merely private, interests; and (3) democratic control is constitutive of freedom as self‐development and self‐transformation.     

From Classroom to Controversy: Conflict in the Teaching of Religion

What happens when a class assignment becomes a source of controversy? How do we respond? What do we learn? By describing the controversy surrounding an assignment on religion and representation, this article examines conflict's productive role in teaching about New Religious Movements (NRMs) and religion. It suggests that we consider how our personal and institutional dispositions toward conflict influence our pedagogies. Moreover, it urges us to consider how teaching conflicts within and/or between disciplines can enhance our learning objectives and stimulate students' ability to think critically.     

Family coercion and valid consent

Coercion is commonly said to invalidate consent, and that is always true if the source of the coercion is the physician. However, if it is a family member who coerces the patient to consent, the resultant consent may be quite valid and treatment should proceed.