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Autonomy

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National Oxford Uehiro Prize in Practical Ethics: Undisclosed Conversational AIs: A Threat to Users’ Autonomy

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This article received an honourable mention in the graduate category of the 2024 National Oxford Uehiro Prize in Practical Ethics. Written by Beatrice Marchegiani. Introduction Recent advancements in Large Language Models have enabled AI systems to engage in conversations with users that are virtually indistinguishable from human interactions. The proliferation of advanced Conversational AIs (CAIs)1… Read More »National Oxford Uehiro Prize in Practical Ethics: Undisclosed Conversational AIs: A Threat to Users’ Autonomy

Expertise and Autonomy in Medical Decision Making

Written by Rebecca Brown.

This is the fourth in a series of blogposts by the members of the Expanding Autonomy project, funded by the Arts and Humanities Research Council.

This blog is based on a paper forthcoming in Episteme. The full text is available here.

Imagine you are sick with severe headaches, dizziness and a nasty cough. You go to see a doctor. She tells you you have a disease called maladitis and it is treatable with a drug called anti-mal. If you take anti-mal every day for a week the symptoms of maladitis should resolve completely. If you don’t treat the maladitis, you will continue to experience your symptoms for a number of weeks, though it should resolve eventually. In a small number of cases, maladitis can become chronic. She also tells you about some side-effects of anti-mal: it can cause nausea, fatigue and an itchy rash. But since these are generally mild and temporary, your doctor suggests that they are worth risking in order to treat your maladitis. You have no medical training and have never heard of maladitis or anti-mal before. What should you do?

One option is that you a) form the belief that you have maladitis and b) take the anti-mal to treat it. Your doctor, after all, has relevant training and expertise in this area, and she believes that you have maladitis and should take anti-mal.Read More »Expertise and Autonomy in Medical Decision Making

Stoicism as a Foundational Component of Ethics and Existentialism

The Flammarion engraving, unknown artist

Provided my eyes are not withdrawn from that spectacle, of which they never tire; provided I may look upon the sun and the moon and gaze at the other planets; provided I may trace their risings and settings, their periods and the causes of their travelling faster or slower; provided I may behold all the stars that shine at night – some fixed, others not travelling far afield but circling within the same area; some suddenly shooting forth, and others dazzling the eye with scattered fire, as if they are falling, or gliding past with a long trail of blazing light; provided I can commune with these and, so far as humans may, associate with the divine, and provided I can keep my mind always directed upwards, striving for a vision of kindred things – what does it matter what ground I stand on?  

Seneca, Consolation to Helvia, translated by C. D. N. Costa

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Nudges and Incomplete Preferences

Written by Sarah Raskoff

(Post is based on my recently published paper in Bioethics

Nudges are small changes in the presentation of options that make a predictable impact on people’s decisions. Proponents of nudges often claim that they are justified as paternalistic interventions that respect autonomy: they lead people to make better choices, while still allowing them to choose for themselves. A classic example is changing the location of food items in a cafeteria so that healthier choices are more salient. The salience of healthy foods predictably leads people to select them, even though they are still free to select the unhealthy options, too.

Nudges have become increasingly popular, but there are many objections to their widespread use. Some allege that nudges do not actually benefit people, while others suspect that they do not really respect autonomy. Although there are many ways of making sense of this latter concern, in a recent paper, I develop a new version of this objection, which takes as its starting point the observation that people often have incomplete preferences.Read More »Nudges and Incomplete Preferences

Protecting Children or Policing Gender?

Laws on genital mutilation, gender affirmation and cosmetic genital surgery are at odds. The key criteria should be medical necessity and consent.

By Brian D. Earp (@briandavidearp)

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In Ohio, USA, lawmakers are currently considering the Save Adolescents from Experimentation (SAFE) Act that would ban hormones or surgeries for minors who identify as transgender or non-binary. In April this year, Alabama passed similar legislation.

Alleging anti-trans prejudice, opponents of such legislation say these bans will stop trans youth from accessing necessary healthcare, citing guidance from the American Psychiatric Association, the American Medical Association and the American Academy of Pediatrics.

Providers of gender-affirming services point out that puberty-suppressing medications and hormone therapies are considered standard-of-care for trans adolescents who qualify. Neither is administered before puberty, with younger children receiving psychosocial support only. Meanwhile genital surgeries for gender affirmation are rarely performed before age 18.

Nevertheless, proponents of the new laws say they are needed to protect vulnerable minors from understudied medical risks and potentially lifelong bodily harms. Proponents note that irreversible mastectomies are increasingly performed before the age of legal majority.

Republican legislators in several states argue that if a child’s breasts or genitalia are ‘healthy’, there is no medical or ethical justification to use hormones or surgeries to alter those parts of the body.

However, while trans adolescents struggle to access voluntary services and rarely undergo genital surgeries prior to adulthood, non-trans-identifying children in the United States and elsewhere are routinely subjected to medically unnecessary surgeries affecting their healthy sexual anatomy — without opposition from conservative lawmakers.

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Returning To Personhood: On The Ethical Significance Of Paradoxical Lucidity In Late-Stage Dementia

By David M Lyreskog

Photo by Jr Korpa on Unsplash

About Dementia

Dementia is a class of medical conditions which typically impair our cognitive abilities and significantly alter our emotional and personal lives. The absolute majority of dementia cases – approximately 70% – are caused by Alzheimer’s disease. Other causes include cardiovascular conditions, Lewy body disease, and Parkinson’s disease. In the UK alone, it is estimated that over 1 million people are currently living with dementia, and that care costs amount to approximately £38 billion a year. Globally, it is estimated that over 55 million people live with dementia in some form, with an expected 10 million increase per year, and the cost of care exceeds £1 trillion. As such, dementia is widely regarded as one of the main medical challenges of our time, along with cancer, and infectious diseases. As a response to this, large amounts of money have been put towards finding solutions over decades. The UK government alone spends over £75 million per year on the search for improved diagnostics, effective treatments, and cures. Yet, dementia remains a terrible enigma, and continues to elude our grasp.

Read More »Returning To Personhood: On The Ethical Significance Of Paradoxical Lucidity In Late-Stage Dementia

New Publication: ‘Overriding Adolescent Refusals of Treatment’

Written by Anthony Skelton, Lisa Forsberg, and Isra Black

Consider the following two cases:

Cynthia’s blood transfusion. Cynthia is 16 years of age. She is hit by a car on her way to school. She is rushed to hospital. She sustains serious, life-threatening injuries and loses a lot of blood. Her physicians conclude that she needs a blood transfusion in order to survive. Physicians ask for her consent to this course of treatment. Cynthia is intelligent and thoughtful. She considers, understands and appreciates her medical options. She is deemed to possess the capacity to decide on her medical treatment. She consents to the blood transfusion.

Nathan’s blood transfusion. Nathan is 16 years of age. He has Crohn’s disease. He is admitted to hospital with lower gastrointestinal bleeding. According to the physicians in charge of his care, the bleeding poses a significant threat to his health and to his life. His physicians conclude that a blood transfusion is his best medical option. Nathan is intelligent and thoughtful. He considers, understands and appreciates his medical options. He is deemed to possess the capacity to decide on his medical treatment. He refuses the blood transfusion.

Under English Law, Cynthia’s consent has the power to permit the blood transfusion offered by her physicians. Her consent is considered to be normatively (and legally) determinative. However, Nathan’s refusal is not normatively (or legally) determinative. Nathan’s refusal can be overridden by consent to the blood transfusion of either a parent or court. These parties share (with Nathan) the power to consent to his treatment and thereby make it lawful for his physicians to provide it.

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Compromising On the Right Not to Know?

Written by Ben Davies

Personal autonomy is the guiding light of contemporary clinical and research practice, at least in the UK. Whether someone is a potential participant in a research trial, or a patient being treated by a medical professional, the gold standard, violated only in extremis, is that they should decide for themselves whether to go ahead with a particular intervention, on the basis of as much relevant information as possible.

Roger Crisp recently discussed Professor Gopal Sreenivasan’s New Cross seminar, which argued against a requirement for informational disclosure in consenting to research participation. Sreenivasan’s argument was, at least in its first part, based on a straightforward appeal to autonomy: if autonomy is what matters most, I should have the right to autonomously refuse information.

I have previously outlined a related argument in a clinical context, in which I sought to undermine arguments against a putative ‘Right Not to Know’ that are themselves based in autonomy. In brief, my argument is, firstly, that a decision can itself be autonomous without promoting the agent’s future or overall autonomy and, second, that even if there is an autonomy-based moral duty to hear relevant information (as scholars such as Rosamond Rhodes argue), we can still have a right that people not force us to hear such information.

In a recent paper, Julian Savulescu and I go further into the details of the Right Not to Know, setting out the scope for a degree of compromise between the two central camps.

Read More »Compromising On the Right Not to Know?

‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

by Roger Crisp

At a recent New St Cross Ethics seminar, Gopal Sreenivasan, Crown University Distinguished Professor in Ethics at Duke University and currently visitor at Corpus Christi College and the Oxford Uehiro Centre, gave a fascinating lecture on whether valid informed consent requires that the consenter have understood the relevant information about what they are being asked to consent to. Gopal argued that it doesn’t.Read More »‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

Consent Without Alternatives

Written by Ben Davies and Joshua Parker

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

Read More »Consent Without Alternatives