Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp and Childress’s theory, this article develops a non-ideal authenticity-based conceptualization of personal autonomy. Factors that indicate inauthentic decision-making are explicated, and the full concept is defended from three expected objections. The theory is then tested on a paradigm case which has concerned theorists and practitioners for some time, namely the possible inauthenticity of anorexia nervosa patients’ decision-making. It is concluded that the theory seems to be fruitful in analyses of the degree of autonomy of patients’ decision-making, and that it succeeds in providing reliable action-guidance in practical contexts.
Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being "real," "genuine," "true to oneself," or similar, is crucial to a person's autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when (decision-competent) anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine.
The opposing views in the scholarly debate on evidence-based policy (EBP) have recently been labeled ‘rationalist’ and ‘constructivist’, where the former are positive to EBP and the latter are not. This framing of the debate is suboptimal, as it conflates critical positions that should be kept separate. This article suggests that the debate should be understood as one between idealists, realists, and counter-idealists about EBP. The realist position, that is, that EBP is difficult or impossible to achieve in practice, has already been treated at length in the debate. The conflict between idealism and counter-idealism, to the contrary, has been neglected. This article aims to stimulate the scholarly debate on EBP by initiating a principled discussion between idealism and counter-idealism about EBP, which should motivate proponents of EBP to formulate their ideal with substantial moral arguments. This places the debate on EBP in the context of normative political theory, where it rightfully belongs.<br /><br />Key messages<br /><ul><li>The scholarly debate on evidence-based policy (EBP) has been framed as one between ‘rationalists’ and ‘constructivists’</li><br /><li>It is better understood as one between idealists, realists, and counter-idealists</li><br /><li>The principled conflict between idealism and counter-idealism is treated at length</li><br /><li>The discussion should motivate proponents of EBP to formulate their ideal with substantial moral arguments</li></ul>
Much of contemporary research ethics was developed in the latter half of the twentieth century as a response to the unethical treatment of human beings in biomedical research. Research ethical considerations have subsequently been extended to cover topics in the sciences and technology such as data handling, precautionary measures, engineering codes of conduct, and more. However, moral issues in the humanities have gained less attention from research ethicists. This article proposes an ethical principle for reading for research purposes: Respect the author.
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