Resolved and unresolved bioethical authenticity problems

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 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

Respect the Author: a Research Ethical Principle for Readers

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

Authenticity in Bioethics: Bridging the Gap between Theory and Practice

The aim of this doctoral thesis is to bridge the gap between theoretical ideals of authenticity and practical authenticity-related problems in healthcare. In this context, authenticity means being "genuine," "real," "true to oneself," or similar, and is assumed to be closely connected to the autonomy of persons. The thesis includes an introduction and four articles related to authenticity. The first article collects various theories intended to explain the distinction between authenticity and inauthenticity in a taxonomy that enables oversight and analysis. It is argued that (in-)authenticity is difficult to observe in others. The second article offers a solution to this difficulty in one theory of authenticity. It is proposed that under certain circumstances, it is morally justified to judge that the desires underlying a person's decisions are inauthentic. The third article incorporates this proposition into an already established theory of personal autonomy. It is argued that the resulting conceptualization of autonomy is fruitful for action-guidance in authenticity-related problems in healthcare. The fourth article collects nine cases of possible authenticity-related problems in healthcare. The theory developed in the third article is applied to the problems, when this is allowed by the case-description, to provide guidance with regard to them. It is argued that there is not one universal authenticity-related problem but many different problems, and that there is thus likely not one universal solution to such problems but various particular solutions

The impossibility of reliably determining the authenticity of desires: implications for informed consent

It is sometimes argued that autonomous decision-making requires that the decision-maker’s desires are authentic, i.e., “genuine,” “truly her own,” “not out of character,” or similar. In this article, it is argued that a method to reliably determine the authenticity (or inauthenticity) of a desire cannot be developed. A taxonomy of characteristics displayed by different theories of authenticity is introduced and applied to evaluate such theories categorically, in contrast to the prior approach of treating them individually. The conclusion is drawn that, in practice, the authenticity of desires cannot be reliably determined. It is suggested that authenticity should therefore not be employed in informed consent practices in healthcare.QC 20170612</p

Individualism Under Constraining Social Norms: Conceptualizing the Lived Experiences of LGBT persons

Value conflicts between individualism and collectivism are common. In philosophy, such conflicts have been conceptualized as conflicts between individuality and conformity, among other things. This article develops a more detailed conceptual framework by combining philosophical analysis with empirical observations. The focus is on value conflicts pertaining to LGBT (lesbian, gay, bisexual, and transgender) factors in a non-individualist society (Georgia). Conservative or traditional norms sometimes constrain LGBT individuals by influencing them to adapt to social expectations. The phenomenon is intuitively clear and has been reported on in numerous quantitative investigations. A qualitative study has been conducted on how LGBT individuals in Georgia experience the constraining influence of such norms. Deep interviews (n=8) have clarified how, more precisely, the effects of those influences should be conceptualized. The results indicate that important distinctions between different types of influences, as well as different objects of influence, have been overlooked in previous philosophical inquiries about value conflicts in this context. The conceptual framework developed throughout the article should be of use to philosophers and social scientists studying individualism and collectivism, and to policymakers working with LGBT issues

A Non-Ideal Authenticity-Based Conceptualization of Personal Autonomy

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.QC 20190218</p

What Justifies Judgments of Inauthenticity?

The notion of authenticity, i.e., being “genuine,” “real,” or “true to oneself,” is sometimes held as critical to a person’s autonomy, so that inauthenticity prevents the person from making autonomous decisions or leading an autonomous life. It has been pointed out that authenticity is difficult to observe in others. Therefore, judgments of inauthenticity have been found inadequate to underpin paternalistic interventions, among other things. This article delineates what justifies judgments of inauthenticity. It is argued that for persons who wish to live according to the prevailing social and moral standards and desires that are seriously undesirable according to those standards, it is justified to judge that a desire is inauthentic to the extent that it is due to causal factors that are alien to the person and to the extent that it deviates from the person’s practical identity. The article contributes to a tradition of thinking about authenticity which is known mainly from Frankfurt and Dworkin, and bridges the gap between theoretical ideals of authenticity and real authenticity-related problems in practical biomedical settings.QC 20180822</p

What is Wrong Between Us? : On the problem of circularity in Scanlon's contractualism

In this essay, the Scanlonian contractualist formula will be understood as follows: Within the domain of morality of what we owe to each other, an action is morally wrong if it follows principles that similarly motivated people can reasonably reject. Consequently, the concept of ‘reasonable rejection’ is the operative element in moral valuation, thus begging the question of what it is for a rejection to be reasonable. The problem of circularity in Scanlon’s contractualism builds upon a reading according to which Scanlon’s explanation of what it is to be ‘reasonably rejected’ seems to be understood as ‘when the action is morally wrong’. If this is the case, then Scanlon’s contractualism refers to its own thesis when performing moral valuations: that is wrong which can be reasonably rejected, and for an action to be reasonably rejected it must be morally wrong. The problem of circularity apparently renders Scanlon’s contractualism ‘empty’ as it cannot explain what it is for an action to be morally wrong without referring to its own thesis. In this essay I will try to clarify the difference between welfarist and structural charges of circularity. I will argue that the structural charges of circularity are due to a fallacious constructivist reading of What We Owe to Each Other. As I understand Scanlon, the constructivist reading places Scanlon’s theory too close to the contractualist tradition. I will also argue that critics holding Scanlon’s contractualism to be circular have failed to note that his theory only claims to cover a narrow domain of morality. Where critics hold Scanlon’s contractualism to refer to its own thesis when performing moral valuations I will argue that the theory refers to moral domains outside that of what we owe to each other. Hopefully my discussion on constructivism and circularity will shed some light on the simple brilliance and practical applicability of Scanlon’s contractualism. I will give a brief overview of What We Owe to Each Other before I present the critique put forth by Onora O’Neill, Mark Timmons and Joseph Raz. Then I will show how Scanlon treats the problem of circularity in his book, and how his defense targets substantial and not structural charges of circularity. I will then show that the structural critique is fallacious by analyzing the domain of morality that Scanlon’s contractualism targets. Finally I will try to apply Scanlon’s formula on personal relationships and on environmental issues. As of this point I will refer to Scanlon’s thesis as ‘contractualism’ while other theories following the contractualist tradition will be referred to as ‘contractarian’