Andrew Fagan

This article critically re-examines the application of the principle of patient autonomy within bioethics. In complex societies such as those found in North America and Europe health care professionals are increasingly confronted by patients from diverse ethnic, cultural, and religious backgrounds. This affects the relationship between clinicians and patients to the extent that patients' deliberations upon the proposed courses of treatment can, in various ways and to varying extents, be influenced by their ethnic, cultural, and religious commitments. The principle of patient autonomy is the main normative constraint imposed upon medical treatment. Bioethicists typically appeal to the principle of patient autonomy as a means for generally attempting to resolve conflict between patients and clinicians. In recent years a number of bioethicists have responded to the condition of multiculturalism by arguing that the autonomy principle provides the basis for a common moral discourse capable of regulating the relationship between clinicians and patients in those situations where patients' beliefs and commitments do or may contradict the ethos of biomedicine. This article challenges that claim. I argue that the precise manner in which the autonomy principle is philosophically formulated within such accounts prohibits bioethicists' deployment of autonomy as a core ideal for a common moral discourse within multicultural societies. The formulation of autonomy underlying such accounts cannot be extended to simply assimilate individuals' most fundamental religious and cultural commitments and affiliations per se. I challenge the assumption that respecting prospective patients' fundamental religious and cultural commitments is necessarily always compatible with respecting their autonomy. I argue that the character of some peoples' relationship with their cultural or religious community acts to significantly constrain the possibilities for acting autonomously. The implication is clear. The autonomy principle may be presently invalidly applied in certain circumstances because the conditions for the exercise of autonomy have not been fully or even adequately satisfied. This is a controversial claim. The precise terms of my argument, while addressing the specific application of the autonomy principle within bioethics, will resonate beyond this sphere and raises questions for attempts to establish a common moral discourse upon the ideal of personal autonomy within multicultural societies generally

This article identifies and considers the existence of a manifest, though often overlooked, paradox contained within the doctrine of human rights. The principal justifications for human rights are based upon the identification of variously conceived human characteristics, or attributes of human agency. Nevertheless, human rights have all too often been required to protect some human beings from being seriously harmed by other human beings. The justification for human rights envisages a single, universal community of human beings, whereas the actual application of human rights typically testifies to the existence of two, very distinct communities: victims and perpetrators. The single greatest impetus for the drafting of the Universal Declaration of Human Rights was the desire to prevent the re-occurrence of genocide. The modern human rights regime emerged out of mountains of human corpses. One would like to claim that the impetus for human rights became less urgent after the horrors of the Holocaust. Unfortunately, genocide has persisted and gross violations of human rights remain a feature of the geo-political landscape. Our need for protective human rights remains as urgent today as it did fifty years ago. This article accounts for this paradox and answers the question: Why is it that the ultimate justification and application of the doctrine of human rights is frustrated by members of the very species upon which the doctrine is based?

This article traces recent trends in British politics, liberal political theory and human rights law in order to demonstrate why the right of exit – made famous in the political theory of multiculturalism by Chandran Kukathas – may be able to mediate tensions between them. I argue that the right of exit is an insufficient test for consent because some cultures may render some members incapable of effectively exercising their autonomy. I use empirical evidence drawn from legal cases and social science in conjunction with a philosophical account of agency as fundamentally ‘relational’ to unpack and defend this controversial claim. Understanding agency in relational terms sheds light on precisely how oppressive culturally permitted relationships can simultaneously constitute some individuals’ primary identities while serving to harm those very same individuals in the process. This account of agency and culture also avoids both the liberal assumption of a sovereign self and also any essentialism or reification of culture. I suggest that for an individual to have the capacity to effectively use of the right of exit, they must be able to conceive of themselves as an agent, which includes having a sense of their own moral worth and the ability to imagine the possibility of living a different kind of life.

Health, illness and disease are topics well-suited to interdisciplinary inquiry. This book brings together scholars from around the world who share an interest in and a commitment to bridging the traditional boundaries of inquiry. We hope that this book begins new conversations that will situate health in broader socio-cultural contexts and establish connections between health, illness and disease and other socio-political issues. This book is the outcome of the first global conference on Making Sense of: Health, Illness and Disease, held at St Catherine's College, Oxford, in June 2002. The selected papers pursue a range of topics from the cultural significance of narratives of health, illness and disease to healing practices in contemporary society as well as patients' illness experiences.

A student guide to reconciling human rights with cultural difference, using political philosophy and real-life case studiesHow can universal human rights be reconciled with respect for wide cultural differences? This textbook introduces the core issues for students and addresses them through an interdisciplinary analysis of key case studies. Throughout the book, an alternative philosophical framework is offered as a model through which universalism and difference can be reconciled into a single global vision.Key FeaturesCombines the theory and application of human rights to provide practical help for students and course leadersKey case studies examine the rights of women, ethnic and national minorities, indigenous peoples and religious communitiesAddresses a broad range of on-going political struggles and issues, including FGM, LGBT rights, freedom of speech and the rights of indigenous peoplesOutlines a new human rights-based philosophical perspective that enables students to understand human rights within culturally diverse environmentsHelpful student features include:Core questions: each chapter starts with 10 core questions, which students are invited to answer as they read to put what they learn into practiceFurther reading: every chapter ends with suggestions for further reading, to help students deepen their study in particular areasTwo-colour layout: blue text boxes and headings draw your attention to important information and make the book easier to read.