Table Of Contentstudies
in applied
philosophy,
epistemology
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Juha Räikkä
rational
Jukka Varelius (Eds.) ethics
Adaptation and Autonomy:
Adaptive Preferences in
Enhancing and Ending Life
123
Studies in Applied Philosophy, Epistemology
and Rational Ethics
Volume 10
SeriesEditor
L.Magnani,Pavia,Italy
EditorialBoard
Prof.AtochaAliseda
InstitutodeInvestigacionesFilosoficas,UniversidadNacionalAutónomadeMéxico(UNAM),
CiudadUniversitaria,Coyoacan,04510,Mexico,D.F.
E-mail:atocha@filosoficas.unam.mx
Prof.GiuseppeLongo
CentreCavaillès,CNRS-EcoleNormaleSupérieure,Paris,France
E-mail:[email protected]
Prof.ChrisSinha
CentreforLanguagesandLiterature,P.O.Box201,22100Lund,Sweden
E-mail:[email protected]
Prof.PaulThagard
DepartmentofPhilosophy,FacultyofArts,WaterlooUniversity,Waterloo,Ontario,
CanadaN2L3G1
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Prof.JohnWoods
DepartmentofPhilosophy,UniversityofBritishColumbia,1866MainMallBUCHE370,
Vancouver,BCCanadaV6T1Z1
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AdvisoryBoard
AkinoriAbe AlfredoPereira
FacultyofLetters,ChibaUniversity,Inageku, InstituteofBiosciences,SãoPaulo
Chiba,Japan StateUniversity(UNESP),SãoPaulo,
HanneAndersen Brazil
DepartmentofPhysicsandAstronomy, LuísMonizPereira
ScienceStudies,AarhusUniversity,Aarhus, CentrodeInteligênciaArtificial(CENTRIA),
Denmark FaculdadedeCiênciaseTecnologia,
OtávioBueno UniversidadeNovadeLisboa,Caparica,Portugal
DepartmentofPhilosophy,UniversityofMiami, Ahti-VeikkoPietarinen
CoralGables,USA DepartmentofPhilosophy,History,Culture
SanjayChandrasekharan andArtStudies,UniversityofHelsinki,Finland
ScienceEducationCentre,TataInstituteof
DemetrisPortides
FundamentalResearch(TIFR),Mumbai,India
DepartmentofClassicsandPhilosophy,
MarceloDascal UniversityofCyprus,Nicosia,Cyprus
DepartmentofPhilosophy,TelAvivUniversity,
DagmarProvijn
TelAviv,Israel
CentreforLogicandPhilosophyofScience,
GordanaDodigCrnkovic GhentUniversity,Ghent,Belgium
Department of Computer Science and Networks,
SchoolofInnovation,DesignandEngineering, JoaoQueiroz
MälardalenUniversity,Sweden InstituteofArtsandDesign.FederalUniversity
ofJuizdeFora,Brazil
MichelGhins
Institutsupérieurdephilosophie, AthanasiosRaftopoulos
UniversitéCatholiquedeLouvain, DepartmentofPsychology,UniversityofCyprus,
Lovain-la-Neuve,Belgium Cyprus
MarcelloGuarini ChiakiSakama
DepartmentofPhilosophy,UniversityofWindsor, DepartmentofComputerandCommunication
Canada Sciences,WakayamaUniversity,Japan
RicardoGudwin ColinSchmidt
DepartmentofComputerEngineeringand Institutd’InformatiqueClaudeChappe,
IndustrialAutomation,theSchoolofElectrical UniversityofLeMans,France
EngineeringandComputerScience,
GerhardSchurz
StateUniversityofCampinas,Brazil
InstituteforPhilosophy,
AlbrechtHeeffer Heinrich-HeineUniversity,Germany
CentreforHistoryofScience,GhentUniversity,
NoraSchwartz
Belgium
DepartmentofHumanities,FacultyofEconomics,
MireilleHildebrandt UniversidaddeBuenosAires,Argentina
ErasmusUniversity,Rotterdam,TheNetherlands
CameronShelley
KennethEinarHimma
DepartmentofPhilosophy,
DepartmentofPhilosophy,SeattlePacific
UniversityofWaterloo,Waterloo,Canada
University,Seattle,USA
MichaelHoffmann FrederikStjernfelt
CenterforSemiotics,AarhusUniversity,
SchoolofPublicPolicy,GeorgiaInstitute
ofTechnology,Atlanta,USA Aarhus,Denmark
PingLi MauricioSuarez
DepartmentofPhilosophy, DepartmentofLogicandPhilosophyofScience,
SunYat-senUniversity,Guangzhou,P.R.China FacultyofPhilosophy,ComplutenseUniversityof
Madrid,Madrid,Spain
MichaelMinnameier
Goethe-UniversitätFrankfurtamMain,Frankfurt, JeroenvandenHoven
Germany ValuesandTechnologyDepartment,
MargaretMorrison DelftUniversityofTechnology,Delft,
DepartmentofPhilosophy,UniversityofToronto, TheNetherlands
Toronto,Canada Peter-PaulVerbeek
YukioOhsawa DepartmentofPhilosophy,UniversityofTwente,
SchoolofEngineering,TheUniversityofTokyo, Enschede,TheNetherlands
Tokyo,Japan RiccardoViale
SamiPaavola DepartmentofSociologyandSocialResearch,
CenterforResearchonActivity,Development, UniversityofMilan-Bicocca,Milan,Italyand
andLearning(CRADLE),InstituteofBehavioural ItalianCulturalInstituteofNewYork(Director),
Sciences,UniversityofHelsinki,Helsinki,Finland USA
WoosukPark MarionVorms
Humanities&SocialSciences,KAIST, UniversityParis1Panthéon-Sorbonne,IHPST,
Guseong-dong,Yuseong-guDaejeon,SouthKorea Paris,France
·
Juha Räikkä Jukka Varelius
Editors
Adaptation and Autonomy:
Adaptive Preferences in
Enhancing and Ending Life
ABC
Editors
JuhaRäikkä JukkaVarelius
DepartmentofBehaviouralSciences DepartmentofBehaviouralSciences
andPhilosophy andPhilosophy
UniversityofTurku UniversityofTurku
Turku Turku
Finland Finland
ISSN2192-6255 ISSN2192-6263 (electronic)
ISBN978-3-642-38375-5 ISBN978-3-642-38376-2 (eBook)
DOI10.1007/978-3-642-38376-2
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2013938366
(cid:2)c Springer-VerlagBerlinHeidelberg2013
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Contents
Introduction................................................... 1
JuhaRäikkä,JukkaVarelius
AdaptivePreferences,Autonomy,andExtendedLives................ 7
DonaldW.Bruckner
Adaptation,Autonomy,andAuthority ............................. 27
DaleDorsey
"ItWon’tBeasBadasYouThink:"AutonomyandAdaptationto
Disability ..................................................... 49
JasonHanna
AutonomyandEndofLifeDecisions:AParadox.................... 69
BenColburn
Gendered Adaptive Preferences, Autonomy, and End of Life
Decisions...................................................... 81
SereneJ.Khader
Sour Clinical Trials: Autonomy and Adaptive Preferences
inExperimentalMedicine ....................................... 101
JamesRocha
Preference Adaptation and Human Enhancement: Reflections
onAutonomyandWell-Being .................................... 117
MaartjeSchermer
Self-Deception,AdaptivePreferences,andAutonomy ................ 137
JamesStaceyTaylor
AdaptivePreferencesandSelf-Deception........................... 149
JuhaRäikkä
VI Contents
ProceduralExclusionCriteriaforAdaptivePreferences .............. 167
TillGrüne-Yanoff,SvenOveHansson
Refusing Life-Saving Treatment, Adaptive Preferences,
andAutonomy................................................. 183
JukkaVarelius
AuthorInformation ............................................... 199
Chapter1
Introduction
Juha Räikkä and Jukka Varelius
The value of individual autonomy is a cornerstone of liberal societies. While there
are various conceptions of the notion, it is arguable that on any plausible
understanding of individual autonomy an autonomous agent needs to take into
account the conditions that circumscribe her actions. If she ignores the limitations
to which she is subject, she is unlikely to succeed in living autonomously. Yet it
has also been suggested that allowing the options open for one to affect one’s
preferences threatens autonomy (Elster 1985, Colburn 2011, cf. Bruckner 2009).
The idea is often illustrated in terms of the familiar fable of the Fox and the
Grapes. In the story, after realizing that it cannot reach some grapes hanging high
on the vine, a hungry fox turns away from them and declares them too sour for its
tastes. As the fox’s preference is suddenly altered in light of what it conceives to
be possible for it, the preference appears to be less than fully autonomous. While
the fox’s case concerns preference change in the face of the closing of the initially
most favored option, a relevantly similar kind of adaptation to circumstances can
apparently occur when an agent’s options remain as they are and when she gains
new and appealing options. In these kinds of cases too, an agent’s preference
could be shaped by her options in a way that could adversely affect her autonomy.
In one form or another, the phenomenon of adaptive preferences has received
attention in, for instance, recent discussions on the oppression of women and
utilitarian social choice theory (Elster 1985, Khader 2011, Nussbaum 2001, Sen
1984). Yet it has seldom been directly addressed in bioethical debates, and the
existing discussion on autonomy would not seem to cover the problems that
preference adaptation gives rise to in the bioethical context. Considering that
autonomy has a prominent role in contemporary bioethics (Beauchamp and
Childress 2009), this shortage is unfortunate. By gathering together previously
Juha Räikkä · Jukka Varelius
Department of Behavioural Sciences and Philosophy
FIN-20014 University of Turku
Finland
e-mail: {jraikka,jukvar}@utu.fi
J. Räikkä and J. Varelius (Eds.): Adaptation and Autonomy, SAPERE 10, pp. 1–6.
DO I: 10.1007/978-3-642-38376-2_1 © Springer-Verlag Berlin Heidelberg 2013
2 J. Räikkä and J. Varelius
unpublished articles on preference adaptation and autonomy, this volume aims to
remedy it in two central areas of contemporary bioethics, in connection with
human enhancement and in the end-of-life context.
In biosciences, the questions of how to improve our existing mental and
physical capacities and how to control the biological processes underlying normal
ageing are drawing increasing attention. In the extreme scenarios, the emerging
techniques of human enhancement are seen to ultimately free people from the
limitations of human nature, thus enabling the advent of immortal physically and
mentally supreme post-humans (Bostrom 2003, Harris 2007, Savulescu, Ter
Meulen, and Kahane 2011). However, these possibilities are not yet with us and it
appears difficult even to conceive what living with capacities significantly
different from those we now have would actually be like. Accordingly, the
possibility that our preferences for such lives are adapted to what we see as
appealing options should not be ignored.
Modern medicine has, of course, already taken significant steps in extending
human life expectancy. Yet the quality of the additional years it has made possible
has often been found less than satisfactory. Accordingly, and bolstered by the
ageing of societies, also bioethical end-of-life questions have recently arisen to
new prominence (Battin 2005, Gastmans and De Lepeleire 2010). As people
usually consider ending their lives when their most favored option – that of
continuing meaningful life without illness or injury – is no longer available for
them, the possibility that their end-of-life choices are based on adaptive
preferences appears significant.
Thus, if preference adaptation is incompatible with our conducting our lives in
the ways we truly want, it also appears to give us grounds to be concerned about
our existing preferences towards human enhancement and ending life.
Accordingly, the following eleven articles focus on the relationship between
adaptive preferences and personal autonomy in ways relevant to assessing how, if
at all, preference adaptation affects autonomy in connection with the choices we
make as regards enhancing and ending human life.
In Chapter Two, Donald W. Bruckner focuses on preference adaptation and
autonomy in the context of human enhancement and in connection with the
extension of human life in particular. On the basis of examining central accounts
of autonomy and adaptive preferences he argues that, in the sense that should
concern us, adaptive preferences and the actions that result from them can be fully
autonomous. Bruckner then applies the analysis of autonomy and adaptation that
he endorses to the questions of whether the preference to extend one’s life would
be autonomous and whether preferences one would have within a significantly
extended human life would be autonomous. He argues that such preferences, even
if adaptive, would be autonomous in the relevant sense, provided that the agent
who held them displayed a particular kind of dialogical reflectiveness with regard
to the content of those preferences.
In the third chapter, Dale Dorsey asks whether the normative authority of the
decisions and actions based on adaptive preferences is affected by their having
that particular kind of origin. In light of his investigation into the concept of
1 Introduction 3
normative authority, Dorsey maintains that, while there is good reason to believe
that adaptive preferences are non-autonomous, no account of preferential
autonomy can preclude all forms of preference adaptation. Dorsey offers two
potential solutions to this puzzle. The first is that, insofar as there is no acceptable
method by which to distinguish the normatively authoritative preferences from
those that lack normative authority, the view that preferences should play a
normative role should be rejected. The second is that the question of whether all
forms of preference adaptation involve a lack of normative authority should be
reconsidered. Dorsey favors the latter solution and suggests that adaptive
preferences that are suitably “deep” are normatively authoritative.
In Chapter Four, Jason Hanna considers preference adaptation and autonomy
from the viewpoint of disability, focusing on a case of a disabled patient who
refuses life-sustaining therapy. After explaining why adaptation is likely to
account for some of the preference changes that often follow the onset of
disability, Hanna goes on to challenge two arguments purporting to show that
mistaken predictions about the effects of disability on quality of life compromise
the autonomy of the medical choices of such patients. He suggests that such
predictive errors are problematic because of their effect on the decision-maker’s
well-being, not because they undermine her autonomy. There is nothing
distinctively problematic about adaptive preferences, Hanna maintains, and a
decision-maker should heed her adaptive preferences when doing so will improve
her well-being. Accordingly, Hanna’s discussion suggests that legitimate concerns
about well-being are sometimes misrepresented as concerns about autonomy.
In the fifth chapter, Ben Colburn assesses the view that respect for personal
autonomy implies that people should have control over the time and manner of
their deaths. He suggests that, as people usually make end-of-life choices in
circumstances they find unacceptable, their preferences are likely to have been
affected in ways that preclude voluntary choice. Accordingly, as voluntariness is a
central aspect of autonomy, the end-of-life choices people make are, Colburn
continues, seldom autonomous. He argues that we should respond to this rather
paradoxical result by aiming to change the circumstances in which people make
end-of-life choices so that they would always have acceptable alternatives. This,
Colburn concludes, would allow people the best possible chance of an
autonomous death.
In Chapter Six, Serene J. Khader considers preference adaptation and autonomy
in the context of end-of-life decision-making. More precisely, focusing on
gendered preferences related to care, Khader asks whether it is sometimes
appropriate for medical practitioners to intervene in end-of-life choices that are
adapted to unjust social arrangements. She maintains that such choices often
qualify as autonomous in what has been deemed a central sense of autonomy, but
that we see them as morally problematic despite that. After arguing that changing
the pertinent preferences is not an appropriate goal for medical personnel involved
in end-of-life decisions, Khader maintains that concern for patient autonomy
sometimes warrants intervening in such choices. Intervention is justified, she
continues, when the choices are inconsistent with the patient’s value system or are
