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Authenticity in Bioethics: Bridging the Gap between Theory and Practice
Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.ORCID iD: 0000-0003-1456-4352
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2019. , p. 147
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831 ; 62
Keywords [en]
Authenticity, autonomy, decision-making, healthcare, paternalism, informed consent, bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
URN: urn:nbn:se:kth:diva-244301ISBN: 978-91-7873-124-4 (print)OAI: oai:DiVA.org:kth-244301DiVA, id: diva2:1289625
Public defence
2019-06-10, Kollegiesalen, Brinellvägen 8, Stockholm, 13:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2014–4024Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–4024Available from: 2019-03-21 Created: 2019-02-18 Last updated: 2019-03-21Bibliographically approved
List of papers
1. The impossibility of reliably determining the authenticity of desires: implications for informed consent
Open this publication in new window or tab >>The impossibility of reliably determining the authenticity of desires: implications for informed consent
2017 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Authenticity, Autonomy, Informed consent, Decision-making, Healthcare
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-208635 (URN)10.1007/s11019-017-9783-0 (DOI)000425299900006 ()2-s2.0-85020429439 (Scopus ID)
Funder
Swedish Research Council, 2014–4024
Note

QC 20170612

Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2019-02-18Bibliographically approved
2. What Justifies Judgments of Inauthenticity?
Open this publication in new window or tab >>What Justifies Judgments of Inauthenticity?
2018 (English)In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Authenticity, Autonomy, Decision-making, Paternalism, Bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-233506 (URN)10.1007/s10730-018-9356-5 (DOI)000452209200004 ()2-s2.0-85049565770 (Scopus ID)
Note

QC 20180822

Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2019-07-15Bibliographically approved
3. A non-ideal authenticity-based conceptualization of personal autonomy
Open this publication in new window or tab >>A non-ideal authenticity-based conceptualization of personal autonomy
2018 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Autonomy, Authenticity, Anorexia nervosa, Healthcare, Bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-244298 (URN)10.1007/s11019-018-9879-1 (DOI)
Funder
Swedish Research Council, 2014–4024Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–4024
Note

QC 20190218

Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-02-18Bibliographically approved
4. Nine Cases of Possible Inauthenticity in Biomedical Contexts and What They Require from Bioethicists
Open this publication in new window or tab >>Nine Cases of Possible Inauthenticity in Biomedical Contexts and What They Require from Bioethicists
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Respect for autonomy is a main 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. This article collects nine cases in which the notion of authenticity has been or could be invoked in biomedical contexts. One recently developed theory aiming to provide normative guidance with regard to authenticity-related problems is applied when it is possible, while it is explained in detail why the theory is inept or impractical in the remaining cases. The article thus provides an overview of authenticity-related problems which may be helpful for autonomy theorists. Furthermore, it is argued that there is no universal problem of authenticity, but many problems, and that they may require various particular solutions rather than one universal solution. Among other things, it is suggested that bioethicists should explore non-ideal methodological approaches to authenticity-related problems to provide action-guidance with regard to them.

Keywords
Authenticity, autonomy, healthcare, bioethics
National Category
Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-244299 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–4024Swedish Research Council, 2014–4024
Note

QC 20180218

Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-02-18Bibliographically approved

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