Beyond individualism: Is there a place for relational autonomy in clinical practice and research?

Dove, E. S., Kelly, S. E., et al. (2017).

Clinical Ethics, 12(3), 150–165.

https://doi.org/10.1177/1477750917704156

Abstract

The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person’s care and responsibility for connected others.

From the Discussion section

Together, these cases show that in our quest to enhance the practical value of the concept of relational autonomy in healthcare and research, we must be careful not to remove the patient or participant from the centre of decision-making. At the same time, we should acknowledge that the patient’s decision to consent (or refuse) to treatment or research can be augmented by facilitating and encouraging that her relations to, and responsibility for, others are considered in decision-making processes. Our case studies do not suggest that we should expand consent requirements to others per se, such as family members or community elders – that is, to add the requirement of seeking consent from further individuals who may also be seen as having a stake in the decision. Such a position would undermine the idea that the person who is centrally affected by a decision should typically have the final say in what happens with and to her, or her body, or even her data. As long as this general principle respects all legal exceptions (see below), we believe that it is a critical underpinning of fundamental respect for persons that should not done away with. Moreover, expanding consent or requiring consent to include others (however so defined) undermines the main objective of relational autonomy, which is to foreground the relational aspect of human identities and interests, and not merely to expand the range of individuals who need to give consent to a procedure. An approach that merely extends consent requirements to other people does not foreground relations but rather presumptions about who the relevant others of a person are.

The article is here.

An African Theory of Moral Status: A Relational Alternative to Individualism and Holism.

Metz, T. (2012).

Ethic Theory Moral Prac 15, 387–402. 

https://doi.org/10.1007/s10677-011-9302-y

Abstract

The dominant conceptions of moral status in the English-speaking literature are either holist or individualist, neither of which accounts well for widespread judgments that: animals and humans both have moral status that is of the same kind but different in degree; even a severely mentally incapacitated human being has a greater moral status than an animal with identical internal properties; and a newborn infant has a greater moral status than a mid-to-late stage foetus. Holists accord no moral status to any of these beings, assigning it only to groups to which they belong, while individualists such as welfarists grant an equal moral status to humans and many animals, and Kantians accord no moral status either to animals or severely mentally incapacitated humans. I argue that an underexplored, modal-relational perspective does a better job of accounting for degrees of moral status. According to modal-relationalism, something has moral status insofar as it capable of having a certain causal or intensional connection with another being. I articulate a novel instance of modal-relationalism grounded in salient sub-Saharan moral views, roughly according to which the greater a being's capacity to be part of a communal relationship with us, the greater its moral status. I then demonstrate that this new, African-based theory entails and plausibly explains the above judgments, among others, in a unified way.

From the end of the article:

Those deeply committed to holism and individualism, or even a combination of them, may well not be convinced by this discussion. Diehard holists will reject the idea that anything other than a group can ground moral status, while pure individualists will reject the recurrent suggestion that two beings that are internally identical (foetus v neonate, severely mentally incapacitated human v animal) could differ in their moral status. However, my aim has not been to convince anyone to change her mind, or even to provide a complete justification for doing so. My goals have instead been the more limited ones of articulating a new, modal-relational account of moral status grounded in sub-Saharan moral philosophy, demonstrating that it avoids the severe parochialism facing existing relational accounts, and showing that it accounts better than standard Western theories for a variety of widely shared intuitions about what has moral status and to what degree. Many of these intuitions are captured by neither holism nor individualism and have lacked a firm philosophical foundation up to now. Of importance here is the African theory’s promise to underwrite the ideas that humans and animals have a moral status grounded in the same property that differs in degree, that severely mentally incapacitated humans have a greater moral status than animals with the same internal properties, and that a human’s moral status increases as it develops from the embryonic to foetal to neo-natal stages.

The article is here.

Binding moral values gain importance in the presence of close others

Yudkin, D.A., Gantman, A.P., Hofmann, W. et al. 

Nat Commun 12, 2718 (2021). 

https://doi.org/10.1038/s41467-021-22566-6

Abstract

A key function of morality is to regulate social behavior. Research suggests moral values may be divided into two types: binding values, which govern behavior in groups, and individualizing values, which promote personal rights and freedoms. Because people tend to mentally activate concepts in situations in which they may prove useful, the importance they afford moral values may vary according to whom they are with in the moment. In particular, because binding values help regulate communal behavior, people may afford these values more importance when in the presence of close (versus distant) others. Five studies test and support this hypothesis. First, we use a custom smartphone application to repeatedly record participants’ (n = 1166) current social context and the importance they afforded moral values. Results show people rate moral values as more important when in the presence of close others, and this effect is stronger for binding than individualizing values—an effect that replicates in a large preregistered online sample (n = 2016). A lab study (n = 390) and two preregistered online experiments (n = 580 and n = 752) provide convergent evidence that people afford binding, but not individualizing, values more importance when in the real or imagined presence of close others. Our results suggest people selectively activate different moral values according to the demands of the situation, and show how the mere presence of others can affect moral thinking.

From the Discussion

Our findings converge with work highlighting the practical contexts where binding values are pitted against individualizing ones. Research on the psychology of whistleblowing, for example, suggests that the decision over whether to report unethical behavior in one’s own organization reflects a tradeoff between loyalty (to one’s community) and fairness (to society in general). Other research has found that increasing or decreasing people’s “psychological distance” from a situation affects the degree to which they apply binding versus individualizing principles. For example, research shows that prompting people to take a detached (versus immersed) perspective on their own actions renders them more likely to apply impartial principles in punishing close others for moral transgressions. By contrast, inducing feelings of empathy toward others (which could be construed as increasing feelings of psychological closeness) increases people’s likelihood of showing favoritism toward them in violation of general fairness norms. Our work highlights a psychological process that might help to explain these patterns of behavior: people are more prone to act according to binding values when they are with close others precisely because that relational context activates those values in the mind.

The research is here.

There are no good choices

Ezra Klein
vox.com
Originally published 14 Sept 20

Here is an excerpt:

In America, our ideological conflicts are often understood as the tension between individual freedoms and collective actions. The failure of our pandemic response policy exposes the falseness of that frame. In the absence of effective state action, we, as individuals, find ourselves in prisons of risk, our every movement stalked by disease. We are anything but free; our only liberty is to choose among a menu of awful options. And faced with terrible choices, we are turning on each other, polarizing against one another. YouTube conspiracies and social media shaming are becoming our salves, the way we wrest a modicum of individual control over a crisis that has overwhelmed us as a collective.

“The burden of decision-making and risk in this pandemic has been fully transitioned from the top down to the individual,” says Dr. Julia Marcus, a Harvard epidemiologist. “It started with [responsibility] being transitioned to the states, which then transitioned it to the local school districts — If we’re talking about schools for the moment — and then down to the individual. You can see it in the way that people talk about personal responsibility, and the way that we see so much shaming about individual-level behavior.”

But in shifting so much responsibility to individuals, our government has revealed the limits of individualism.

The risk calculation that rules, and ruins, lives

Think of coronavirus risk like an equation. Here’s a rough version of it: The danger of an act = (the transmission risk of the activity) x (the local prevalence of Covid-19) / (by your area’s ability to control a new outbreak).

Individuals can control only a small portion of that equation. People can choose safer activities over riskier ones — though the language of choice too often obscures the reality that many have no economic choice save to work jobs that put them, and their families, in danger. But the local prevalence of Covid-19 and the capacity of authorities to track and squelch outbreaks are collective functions.

The info is here.

Why do so many Americans hate the welfare state?

Joe Humphries
irishtimes.com
Originally posted October 24, 2019

Interview with Elizabeth Anderson

Here is an excerpt:

Many ethical problems today are presented as matters of individual rather than collective responsibility. Instead of looking at structural injustices, for example, people are told to recycle more to save the environment, or to manage their workload better to avoid exploitation. Where does this bias come from?

“One way to think about it is this is another bizarre legacy of Calvinist thought. It’s really deep in Protestantism that each individual is responsible for their own salvation.

“It’s really an anti-Catholic thing, right? The Catholics have this giant institution that’s going to help people; and Protestantism says, no, no, no, it’s totally you and your conscience, or your faith.

“That individualism – the idea that I’ve got to save myself – got secularised over time. And it is deep, much deeper in America than in Europe – not only because there are way more Catholics in Europe who never bought into this ideology – but also in Europe due to the experience of the two World Wars they realised they are all in the boat together and they better work together or else all is lost.

“America was never under existential threat. So you didn’t have that same sense of the absolute necessity for individual survival that we come together as a nation. I think those experiences are really profound and helped to propel the welfare state across Europe post World War II.”

You’re well known for promoting the idea of relational equality. Tell us a bit about it.

“For a few decades now I’ve been advancing the idea that the fundamental aim of egalitarianism is to establish relations of equality: What are the social relations with the people around us? And that aims to take our focus away from just how much money is in my pocket.

“People do not exist for the sake of money. Wealth exists to enhance your life and not the other way around. We should be focusing on what are we doing to each other in our obsession with maximising profits. How are workers being treated? How are consumers being treated? How is the environment being treated?”

The info is here.

How Silicon Valley is erasing your individuality

Franklin Foer
Washington Post
Originally posted September 8, 2017

Here is an excerpt:

There’s an oft-used shorthand for the technologist’s view of the world. It is assumed that libertarianism dominates Silicon Valley, and that isn’t wholly wrong. High-profile devotees of Ayn Rand can be found there. But if you listen hard to the titans of tech, it’s clear that their worldview is something much closer to the opposite of a libertarian’s veneration of the heroic, solitary individual. The big tech companies think we’re fundamentally social beings, born to collective existence. They invest their faith in the network, the wisdom of crowds, collaboration. They harbor a deep desire for the atomistic world to be made whole. (“Facebook stands for bringing us closer together and building a global community,” Zuckerberg wrote in one of his many manifestos.) By stitching the world together, they can cure its ills.

Rhetorically, the tech companies gesture toward individuality — to the empowerment of the “user” — but their worldview rolls over it. Even the ubiquitous invocation of users is telling: a passive, bureaucratic description of us. The big tech companies (the Europeans have lumped them together as GAFA: Google, Apple, Facebook, Amazon) are shredding the principles that protect individuality. Their devices and sites have collapsed privacy; they disrespect the value of authorship, with their hostility toward intellectual property. In the realm of economics, they justify monopoly by suggesting that competition merely distracts from the important problems like erasing language barriers and building artificial brains. Companies should “transcend the daily brute struggle for survival,” as Facebook investor Peter Thiel has put it.

The article is here.

Resisting Temptation for the Good of the Group: Binding Moral Values and the Moralization of Self-Control

Mooijman, Marlon; Meindl, Peter; Oyserman, Daphna; Monterosso, John; Dehghani, Morteza; Doris, John M.; Graham, Jesse
Journal of Personality and Social Psychology, Jun 12 , 2017.

Abstract

When do people see self-control as a moral issue? We hypothesize that the group-focused “binding” moral values of Loyalty/betrayal, Authority/subversion, and Purity/degradation play a particularly important role in this moralization process. Nine studies provide support for this prediction. First, moralization of self-control goals (e.g., losing weight, saving money) is more strongly associated with endorsing binding moral values than with endorsing individualizing moral values (Care/harm, Fairness/cheating). Second, binding moral values mediate the effect of other group-focused predictors of self-control moralization, including conservatism, religiosity, and collectivism. Third, guiding participants to consider morality as centrally about binding moral values increases moralization of self-control more than guiding participants to consider morality as centrally about individualizing moral values. Fourth, we replicate our core finding that moralization of self-control is associated with binding moral values across studies differing in measures and design—whether we measure the relationship between moral and self-control language across time, the perceived moral relevance of self-control behaviors, or the moral condemnation of self-control failures. Taken together, our findings suggest that self-control moralization is primarily group-oriented and is sensitive to group-oriented cues.

The article is here.

The Dark Side of Free Will

Published on Dec 9, 2014

This talk was given at a local TEDx event, produced independently of the TED Conferences. What would happen if we all believed free will didn't exist? As a free will skeptic, Dr. Gregg Caruso contends our society would be better off believing there is no such thing as free will.

Evolution and the American Myth of the Individual

By John Edward Terrell
The New York times - Opinion Pages
Originally posted November 30, 2014

Here is an excerpt:

When I was a boy I was taught that the Old Testament is about our relationship with God and the New Testament is about our responsibilities to one another. I now know this division of biblical wisdom is too simple. I have also learned that in the eyes of many conservative Americans today, religion and evolution do not mix. You either accept what the Bible tells us or what Charles Darwin wrote, but not both. The irony here is that when it comes to our responsibilities to one another as human beings, religion and evolution nowadays are not necessarily on opposite sides of the fence. And as Matthew D. Lieberman, a social neuroscience researcher at the University of California, Los Angeles, has written: “we think people are built to maximize their own pleasure and minimize their own pain. In reality, we are actually built to overcome our own pleasure and increase our own pain in the service of following society’s norms.”

While I do not entirely accept the norms clause of Lieberman’s claim, his observation strikes me as evocatively religious.

The entire article is here.

The Last Right: Why America Is Moving Slowly on Assisted Suicide

By Ross Douthat
The New York Times Sunday Review
Originally posted on October 11, 2014

Here is an excerpt:

The tragedy here is almost deep enough to drown the political debate. But that debate’s continued existence is still a striking fact. Why, in a society where individualism seems to be carrying the day, is the right that Maynard intends to exercise still confined to just a handful of states? Why has assisted suicide’s advance been slow, when on other social issues the landscape has shifted dramatically in a libertarian direction?

Twenty years ago, a much more rapid advance seemed likely. Some sort of right to suicide seemed like a potential extension of “the right to define one’s own concept of existence” that the Supreme Court had invoked while upholding a woman’s constitutional right to abortion. Polls in the 1990s consistently showed more support — majority support, depending on the framing — for physician-assisted suicide than for what then seemed like the eccentric cause of same-sex marriage.

The entire article is here.

Is Individuality the Savior of Eugenics?

By Nathaniel Comfort
Scientific American Blog
Originally published August 23, 2013

Is eugenics a historical evil poised for a comeback? Or is it a noble but oft-abused concept, finally being done correctly?

Once defined as “the science of human improvement through better breeding,” eugenics has roared back into the headlines in recent weeks in both Mr. Hyde and Dr. Jekyll personae. The close observer may well wonder which will prevail. The snarling Mr. Hyde is the state control over reproduction. Although this idea may evoke visions of Nazi genocide, the U.S. itself has a long, unsavory eugenic history, peaking between 1910 and the mid-thirties but tailing out through the 20th century. And now into the 21st: the recent investigation by the Center for Investigative Reporting, which showed that between 2006 and 2010 nearly 150 pregnant prisoners had been sterilized against their will in California, was a stunning reminder that traces of the old eugenics remain in our own time.

The entire blog post is here.