Concept Of Relational Autonomy Research Articles

Expanding student access to higher education: Examining the strategic processes for enhancing access to higher education from TVET colleges to universities of technology

In this article, the vexed issue of expanding access to higher education in South Africa is explored by investigating the pathways between technical and vocational education and training (TVET) colleges and universities of technology (UoTs). Central to this examination is the Unfurling Post-School Education and Training (UPSET) project, which seeks to formalise these pathways and establish a more inclusive and adaptable higher education system. Drawing on Hall’s (1996) theory of articulation and the concept of relational autonomy, the article highlights the transformative potential of strategic collaborations between TVET colleges and UoTs. Using a qualitative case study conducted at a university of technology in the Western Cape province, South Africa, the article describes the complexities of developing jointly offered higher certificates (HCs) in the post-school sector. It emphasises the strategic role of the UPSET project in revitalising existing practices and cultivating deliberate processes and practices to expand access to vocational education. The article contends that UoTs are ideally positioned to facilitate jointly offered HCs based on their integration of theoretical and practical knowledge and their robust industry affiliations. Furthermore, the article highlights various epistemological approaches to developing HCs in UoTs. It argues for a more integrated higher education system that values both vocational and academic pathways and contributes to social justice and economic empowerment in South Africa.

Neurodata-based headsets for the (digital) employee well-being – responsibilities between benefit and harm

Purpose This study aims to demonstrate the importance of recognizing stress in the workplace. Accurate novel objective methods that use electroencephalogram (EEG) to measure brainwaves can promote employee well-being. However, using these devices can be positive and potentially harmful as manipulative practices undermine autonomy. Design/methodology/approach Emphasis is placed on business ethics as it relates to the ethics of action in terms of positive and negative responsibility, autonomous decision-making and self-determined work through a literature review. The concept of relational autonomy provides an orientation toward heteronomous employment relationships. Findings First, using digital devices to recognize stress and promote health can be a positive outcome, expanding the definition of digital well-being as opposed to dependency, non-use or reduction. Second, the transfer of socio-relational autonomy, according to Oshana, enables criteria for self-determined work in heteronomous employment relationships. Finally, the deployment and use of such EEG-based devices for stress detection can lead to coercion and manipulation, not only in interpersonal relationships, but also directly and more subtly through the technology itself, interfering with self-determined work. Originality/value Stress at work and EEG-based devices measuring stress have been discussed in numerous articles. This paper is one of the first to explore ethical considerations using these brain–computer interfaces from an employee perspective.

Applying relational autonomy in US special education: Educators’ role in supporting parents’ decisions for deaf or hard-of-hearing children

ABSTRACT The concept of relational autonomy is widely applied in bioethics research to elucidate how patients’ abilities in agentively making medical decisions are constrained within a complex structural system and set of relations; thus, rather than being individualistic in nature, autonomy is relationally and interdependently situated. While this perspective is thought-provoking, it is seldom explored in settings outside of healthcare. An equally critical site of decision-making processes is found in special education, where parents of children with disabilities must contend with information from both teachers and physicians to make choices that best support their child’s learning and development. Families of deaf or hard-of-hearing (D/HH) children in particular are uniquely positioned to encounter decisions that intersect educational, medical, and sociocultural levels – that is, in the earliest years of a D/HH child’s life, parents must make decisions about the child’s medical care and whether they will receive hearing technology or treatments, which in turn shapes the inherently cultural decision of linguistic choice, which in turn shapes educational decisions about the type of schooling environment for the child. This study broadly asks: In the field of special education, how do parents make decisions for their D/HH child? Data is drawn from semi-structured, ethnographic interviews with 16 educators of the deaf or hard-of-hearing (EODs) across public, private, and state levels in California. IMPACT STATEMENT The findings can help contribute academic research into conversation with social justice-oriented work to improve language and educational access for D/HH children.

The Ambivalence of Consent

ABSTRACT This article explores the ambivalence of consent presented by Vanessa Springora’s recent memoir, Consent (2020). It argues that current notions of affirmative consent are inadequate for understanding the role of autonomy in scenarios characterised by inequality or injustice. Building on the insights of Quill R. Kukla, Emily Owens, and Carole Pateman, the article demonstrates that current concepts of consent are insufficient to address situations of deep structural inequalities, such as those foundational to Springora’s relationship with the writer Gabriel Matzneff. It argues that Matzneff's exploitation of Springora challenges two commonplace beliefs about consent that are nonetheless in tension with one another: the first, about the efficacy and desirability of a standard of affirmative consent, and the second, the belief that adolescents cannot act agentically and do not possess sexual autonomy. Reading these two claims with and against each other points toward the need for a new framework for consent grounded in the concept of relational autonomy. Ultimately, drawing on recent feminist theory, as well as the relational autonomy literature, I suggest that relational autonomy establishes the conditions of possibility under which consent can be established, debated, and refused.

Fostering relational autonomy in end-of-life care: a procedural approach and three-dimensional decision-making model

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in...

Group‐identification, collectivism, and perspectival autonomy

AbstractOne of the aims of the 40th Annual Spindel Conference was to discuss whether the ongoing, but relatively distinct, investigations of relational autonomy and collective intentionality could crossfertilize. Whereas the concept of relational autonomy was developed to do justice to the relational character of selfhood, and as an alternative to traditional conceptions of autonomy, which were accused of exaggerating the self‐reliance and social independence of the self, recent discussions of collective intentionality have often centered on the question of whether and how collective intentions differ from aggregations of individual intentions. As different as they might otherwise be, theoretical explorations of autonomy and collective intentionality intersect at a crucial point: both require an understanding of the relationship between the self and the group, between individual subjectivity and social life. The aim of the following paper is to argue that the collective intentionality literature contains insights that cannot merely contribute to our understanding of autonomy, but also prevent us from taking our relationism too far.

Learning Lessons from the Populist Defeats: From Negative to Positive Constitutionalism

The article explains how populists have exploited the weaknesses of liberal constitutionalism and the public-private divide. It argues that populists have not rejected constitutionalism as a project but a negative version of it. In its place, they incorporated their vision of a government unrestricted by individual rights and entered the private sphere with their doctrines. The lesson from the victories of populism is therefore to move toward positive constitutionalism that ensures the well-being of all. Drawing on the concept of relational autonomy, the article explains what this shift consists of in the areas of reproductive rights and gender-based violence. The conclusions outline a shift in the operation of the basic principles of constitutionalism, focusing on the relational nature of rights understood not only as shields, but also as claims to positive state action.

Relational Autonomy, the Right to Reject Treatment, and Advance Directives in Japan

Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die.

Autonomy and social influence in predictive genetic testing decision‐making: A qualitative interview study

Beauchamp and Childress' definition of autonomous decision-making includes the conditions of intentionality, understanding, and non-control. In genetics, however, a relational conception of autonomy has been increasingly recognized. This article aims to empirically assess aspects of social influence in genetic testing decision-making and to connect these with principlist and relational theories of autonomy. We interviewed 18 adult genetic counsellees without capacity issues considering predictive genetic testing for cancer predisposition for themselves and two counselling physicians in Switzerland. We conducted a qualitative analysis, building on a grounded theory study about predictive genetic testing decision-making. We found that some participants agreed to predictive genetic testing predominantly because relatives wanted them to do it, with some even acting contrary to their own convictions. Others, in contrast, based their decision on purely individualistic reasons but expressed difficulties in explaining their decision to their social environment. Healthcare professionals had a critical influence on decision-making in many cases without being manipulative, as perceived by counsellees. Still, cases of coercion and social pressure occurred within social relationships. In conclusion, predictive genetic testing decision-making includes relational and individualistic aspects, and both are compatible with autonomous decision-making. While the principlist and relational notions of autonomy compete on a theoretical level, they are two sides of the same coin when used as analytical lenses for genetic testing decision-making. Social acceptance of refusal of testing should be improved to mitigate social pressure. Individuals should be encouraged to decide for themselves how much their social environment influences their decision regarding predictive genetic testing.

BETWEEN AN ETHIC OF CARE AND AN ETHIC OF AUTONOMY

In this article I review the contested terrain of relationality, dependency and care within contemporary disability studies and feminist care theory. I begin and end with short personal narratives centring on my relationship with my sister, who has an intellectual disability. These stories are my point of departure in exploring the article’s central theme – that the agency and autonomy of individual persons only emerges relationally, through the support and enablement of others. I argue that the concept of relational autonomy, which seeks to reconcile an understanding of our constitutive relationality with a respect for individuality, offers a way of thinking through the tensions between care ethics and disability studies productively. In the concept of relational autonomy that I propose, neither autonomy nor care is privileged, but both are placed in service of the other: autonomy cannot be enabled without care, and care cannot be enabling without respect for autonomy. The article concludes with a discussion of representation and the problem of appropriating the other’s voice, an area where the question of the dichotomy between dependency and autonomy is particularly pronounced. Looking at the ways in which voice can be supported and enabled through relational forms of representation, I demonstrate how relational autonomy works as a lived dynamic, highlighting the sorts of caring practices and relationships that foster rather than stifle personal autonomy, and the need for greater support from wider social and political institutions to allow these practices and relationships to flourish.

About time: how time influences and facilitates patient autonomy in the clinical encounter

In this article I discuss the little examined relationship between time and patient autonomy. Using the findings from a study on the experience of premenopausal cancer patients making fertility preservation decisions during their treatment, I focus on how the patients in the study understood time, and how this understanding interacted with and influenced their decision-making. I then analyse in more depth the importance of time in patient decision-making, and the relationship of time to concepts of patient autonomy and decision-making in the field of bioethics more generally. Focusing on the relational conception of autonomy, I conclude that time is an integral part of patient autonomy which warrants further research, such that it can be better integrated into concepts of patient autonomy, and the policy and guidelines that they inform and influence.

An Exploration of the Relational Autonomy of People with Substance Use Disorders: Constraints and Limitations

The concept of relational autonomy was used to investigate how people with substance use disorders (SUDs) exercise their autonomy when using mental health services, according to stakeholders’ perspectives. A qualitative study, using a critical approach, was conducted with participants from a mental health service facility. We performed in-depth individual and group interviews with 15 participants, conducted observations, and analyzed patients’ records and service reports. People with SUDs’ autonomy were constrained by three relational dimensions: (a) the broader social context of coercion and its influence on the values and attitudes of stakeholders; (b) the oppressive systems and structures within the treatment setting; and (c) the limited personal capacity to exercise autonomy in people with SUDs. This work revealed the multidimensionality of people with SUDs’ limitations in exercising their autonomy within a mental health care setting. An understanding of autonomy as relational could promote reflection and stimulate innovation when approaching patients within these facilities.

Relational autonomy in the care of the vulnerable: health care professionals\u2019 reasoning in Moral Case Deliberation (MCD)

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

The Relational Experience of Poverty: Challenges for Family Planning and Autonomy in Rural Areas

This is a qualitative study of a family planning education program in New York State using in‐depth interviews with 16 low‐income participants. The study demonstrates how challenges faced by the rural poor in family planning and health autonomy are exacerbated by lack of social support and isolation. Service providers are therefore critical to clients’ achievement of health and family planning goals. Such services are needed not merely because of individual deficiencies, but also due to the relational nature of the effects of poverty. The concept of relational autonomy is used to explain the experiences of the rural poor in this study.

Freedom as non-domination in behavioral and biomedical research

In the biomedical and behavioral sciences, it is widely recognized that researchers conducting studies involving human participants must respect the autonomy of research subjects. There is significant debate in the clinical research ethics and bioethics literatures about what it means for an individual to be autonomous. According to proponents of the Liberal Conception of Autonomy (LCA), an autonomous person is an agent who has interests and opinions and the capacity to deliberate about them. In contrast, proponents of the Relational Conception of Autonomy (RCA) argue that because humans are social creatures, autonomy is a relational concept and ought to be recognized as such by medical professionals. In this article, I argue that the LCA/RCA debate is flawed, and that the notion of freedom as non-domination, rather than autonomy, ought to be adopted for biomedical research ethics policies regarding informed consent and research agenda-setting. I then argue that this view of freedom should also be adopted for research ethics policies for the behavioral social sciences.

Through a glass, darkly: ethics of mental health practitioner-patient relationships in traditional societies

ABSTRACTAssumptions about the universality of ethics and the use of dominant ethical frameworks of mental health care may obscure the differences and contextual realities in traditional societies. The ‘culture’ of the encounter between the mental health practitioner and the patient can be viewed through three dominant perspectives; paternalism, autonomy and reciprocity. Culture strongly influences how persons construct and negotiate their autonomous identities and the concept of relational autonomy may be more relevant in traditional societies like India. In this article, research studies and practitioner viewpoints are brought together to highlight the debates related to patient-practitioner communication, confidentiality and disclosure, informed consent and decision-making capacity, involuntary admissions and discharge processes, use of covert medication, advance directives and cultural influences on the definition of professional boundaries. Understanding the complex interplay of cultural beliefs and p...

Choosing an out-of-hospital birth centre: Exploring women's decision-making experiences

Objectivethe primary objective for this study was to explore women's experiences of choosing to plan a birth at an out-of-hospital birth centre. We sought to understand how women make the choice to plan for an out-of-hospital birth and the meaning that women ascribe to this decision-making process. Design, setting, and participantsa qualitative phenomenological study was conducted in Winnipeg, Canada with a sample of seventeen post partum women who represent the socio-demographic characteristics of the actual users of the Birth Centre in Winnipeg. The women participated in semistructured interviews. Through a feminist perspective and using interpretative phenomenological analysis (IPA), each participant's experience of birthplace decision-making was explored. Findingssix themes emerged through the analysis: (1) Making the decision in the context of relationships; (2) Exercising personal agency; (3) An expression of one's ideology; (4) Really thinking it through; (5) Fitting into the eligibility criteria; and (6) The psychology of the space. The findings suggested that a woman's sense of safety was related to each of these themes. Key conclusions and implications for practicethe birth centre decision-making experience has many similarities to the homebirth decision-making process. The visceral impact of the physical design of the facility plays an important role and differentiates the birth centre decision from other birth setting options. The concept of relational autonomy was emphasised in this study, in that women make the decision in the context of their relationships with their midwives and partners. The study has implications for midwifery practice and health-care policy related to: client education on birth settings, design of birth environments, validation of the birth centre concept, and upholding the women-centred midwifery model of care. The study highlighted the importance of increasing access to out-of-hospital birth centres.

How to Deal With Relatives of Patients Dying in the Hospital? Qualitative Content Analysis of Relatives' Experiences

ContextHospital care and communication tend to be focused on the individual patient, and decision making is typically based on the principle of individual autonomy. It can be questioned whether this approach is adequate when a patient is terminally ill. ObjectivesOur aim was to explore the involvement and experiences of relatives in the hospital during the patient's last phase of life. MethodsThis study was embedded in a retrospective questionnaire study on the quality of dying of a consecutive sample of patients who died in a general university hospital in The Netherlands. We performed a secondary qualitative analysis of relatives' comments and answers to open questions. Relatives of 951 deceased adult patients were asked to complete a questionnaire; 451 questionnaires were returned and analyzed for this study. ResultsRelatives expressed a need for 1) comprehensible, timely, and sensitive information and communication, 2) involvement in decision making, 3) acknowledgment of their position, 4) being able to trust health care staff, and 5) rest and privacy. When relatives felt that their role had sufficiently been acknowledged by health care professionals (HCPs), their experiences were more positive. ConclusionRelatives emphasized their relation with the patient and their involvement in care of the patient dying in the hospital. An approach of HCPs to care based on the concept of individual autonomy seems inadequate. The role of relatives might be better addressed by the concept of relational autonomy, which provides HCPs with opportunities to create a relationship with relatives in care that optimally addresses the needs of patients.

Autonomy and the socialisation of architects

The socio-cultural production of architects' identities, and their professional personas, is a lively source of continuing debate. At one extreme, there is the claim to autonomy that highlights the distinctiveness of architecture and its cultural and disciplinary specificity. This view is challenged by those who emphasise architects' dependence, for acting and actions, on their embeddedness into collective, social, settings and relationships. In the paper, we consider what it may mean to be ‘autonomous of’ and ‘dependent on’ in relation to the actions of architects. There is limited specification in architectural writings about what autonomy and dependence are, and we suggest that there is a need not to discount such terms, but to reformulate them by recognising that the socially constructed self is an integral part of individual action. In this respect, we seek to amplify, and evaluate, the concept of relational autonomy that distances the notion of autonomy from individualistic, under-socialised, accounts of architects and their practices. Referring to three empirical examples of practice, we amplify this understanding by, first, outlining what a relational autonomous approach to architecture might entail, and, secondly, assessing how far it may enable a conception of the practices of architects in ways whereby, following Tony Fry's observations, they are conceived as much broader than ‘the specificity of any particular activity’ that expresses their existence.

Relational Autonomy: An Example from Breast Cancer Nursing

This article is an exploration of how the concept of relational autonomy might be applied in practice. The discussion uses the example of breast cancer nursing as a lens through which to consider how a view of autonomy as relational might affect the ways in which practitioners work with their clients.