James Stacey Taylor

For almost the past three decades the model of autonomy which has dominated philosophical discussion of this concept has been the "hierarchical" model, which has been independently developed and defended by Harry Frankfurt, Gerald Dworkin and John Christman, and which is primarily concerned with what makes a person autonomous with respect to her first-order desires. It is argued that all versions of the hierarchical model of personal autonomy are based upon a theoretical mistake, and so should be rejected. This mistake is to focus upon the person's attitude towards the desire in question. Such attitude-based approaches will be mistaken because it is always possible to raise the question as to whether the person is autonomous with respect to this attitude itself. With this rejection of the hierarchical analyses of autonomy in hand it is argued that a person is autonomous with respect to her first-order desires to the extent that she has critically reflected upon the beliefs which lead her to have them. This belief-based approach to autonomy enjoys several advantages over its attitudebased rivals. It avoids all of the problems that are faced by the attitude-based models offered by Frankfurt et al., and it is also able to recognize a richer taxonomy of desire than they are. Moreover, this account of autonomy is not committed to either a Humean or an anti-Humean model of motivation. ;With the defense of the belief-based model of autonomy in hand, it is then applied to three distinct debates within applied ethics; social ethics , business ethics , and medical ethics' focus on the Principle of Respect for Autonomy. This part of the dissertation concludes by observing that in all three of these particular debates it is not autonomy that is of primary concern, but well-being, subjectively understood

A standard objection to a market in political votes is that it will enable the rich politically to dominate the poor. If a market in votes was allowed then the poor would be the most likely sellers and the rich the most likely buyers. The rich would thus accumulate the votes of the poor, and so the candidates elected and the policies passed would represent only their interests and not those of the electorate as a whole. To ensure that the poor do not become de facto disenfranchised, then, markets in votes should be disallowed. This objection seems so straightforward and compelling that it has received almost no critical scrutiny. This is unfortunate, for close examination reveals that this argument is not as straightforward as it initially appears. Indeed, there are four different ways of understanding this objection. It could be understood as expressing: the concern that markets in votes would enable candidates to win elections who would otherwise lose them; the concern that they would enable the election of candidates opposed by the majority of the electorate; the concern that they would lead to the poor having disproportionately low political influence; and the concern that they would lead to the rich having disproportionately high political influence. I will argue in this paper that only and could plausibly ground objections to markets in votes. Moreover, these will only plausibly ground objections to unrestricted markets in votes; they will not ground objections to markets in votes per se. Thus, if we are to continue to object to markets in political votes we will have to do this on grounds other than that were they to be allowed the rich will politically dominate the poor.

The papers in this special thematic issue of HEC Forum critically and carefully explore key issues at the intersection of patient privacy and commodification. For example, should hospitals be required to secure a person’s consent to any possible uses to which his discarded body parts might be put after his treatment or should it only be concerned with securing his informed consent to his treatment? Should a hospital be required to raise the possibility of the commodification of such body parts, or should it only be required to address this issue if the patient asks about it? Should persons be paid to engage in medical research, or should they only be compensated for their time, on the grounds, perhaps, that such payment would be coercive or exploitative, for it might move some persons to agree to participate in research who otherwise would not have done? This number of HEC Forum illustrates the widespread implications of these issues upon which healthcare ethics committees are called to deliberate.

The Affordable Care Act has been touted as a long‐overdue remedy for what is perceived to be the chronic problem of large numbers of Americans living without adequate health insurance. While much of the discussion of the ACA has focused on its legality, it should also be assessed on the basis of its economic implications and its moral acceptability. On its face, the ACA appears to do well on both counts. Given that the uninsured often secure their health care from expensive emergency room treatment (from which they cannot be excluded and whose cost is often borne by third parties), expanding insurance to cover them (and hence to give them access to less expensive treatments) appears to make economic sense. Similarly, it might appear that providing access to insurance for people who otherwise could not afford it, or who would be denied it as a result of having medical conditions that they are not responsible for, would be morally laudable. But these appearances deceive: The ACA is neither economically sound nor morally acceptable. To paraphrase Oscar Wilde, to fail on one of these criteria may be misfortune; to fail on both looks like carelessness.

Schweda and Schicktanz argue that the debate over the ethics of using financial incentives to procure human transplant organs rests on socioempirical premises that need to be critically assessed. They contend that once this is achieved a completely new perspective on the debate should be adopted, with organ donation being viewed primarily as a reciprocal social interaction between donor and recipient. This paper challenges this conclusion, arguing that rather than supporting a new perspective on the debate over the commercial procurement of organs, the observations of Schweda and Schicktanz support the view that human organs should be commercialized

Teck Chuan Voo and Soren Holm argue that “organs should be inheritable if they were to be socially and legally recognised as tradable property.”1 To support this view they first observe that “…legal recognition of objects as property… opens up the possibility of the legal recognition of the survival of the property rights and their inheritability after the death of the source/owner, even if those rights are intimately bound with the person.”1 They also note that if organs are tradable property then they could be sold by their current owners for removal by the buyer after the original owner dies. Having established that a person's property rights in her organs should be respected in this way if organs are tradable property, Voo and Holm hold that “[p]rima facie, organs should be disposable by testation”.1 They believe that this claim is supported by the same consequentialist reasons that support organs being recognised as tradable property: that this increases persons’ freedom and control over their organs, and increases transfers of transplantable organs to persons who need them. But while these reasons support recognising organs as tradable property, they do not support their being …

In recent years a concern with the value of personal autonomy has come to dominate discussions in medical ethics. This emphasis on autonomy has naturally led to discussions of what criteria must be met for a person to be autonomous, or to be autonomous with respect to her decisions, her actions, or those of her desires that motivate her to make or to perform the decisions or the actions that she makes or does. It has also led to discussions of whether autonomy is valuable in itself, instrumentally valuable, or whether its value is a combination of the two: that a person’s autonomy is valuable to her not merely as a means to securing something else that she finds valuable, but is valuable as its possession is part of what makes her life go well.Questions that concern the value of autonomy are necessarily linked to the prior question of the precise nature of autonomy. There are two main approaches to answering this question within the Western philosophical tradition. The first is Kantian ..

Markets have long had a whiff of sulphur about them. Plato condemned innkeepers, whose pursuit of profit he believed led them to take advantage of their customers, Aristotle believed that the pursuit of profit was indicative of moral debasement, and Cicero held that retailers are typically dishonest as this was the only path to gain. And even those who are more favorably disposed towards markets in general are frequently inclined to be suspicious of markets in medical goods and services. For example, Margaret Thatcher supported the legal prohibition of markets in kidneys despite being arguably the most pro-market Prime Minister the United Kingdom saw in the 20th century.