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Autonomy as CapacityPosted on 4/13/2011 at 6:37 AM - LinkThere are three elements to the psychological capacity of autonomy: agency,Casinò Online independence, and rationality. Agency is awareness of oneself as having desires and intentions and of acting on them. (Desire includes inclinations, aversions, wants, and similar terms.) When people have a desire for some state of affairs, they form an intention to do what they believe will bring about the desired state of affairs; further, they want their desire to determine their action (Benn; Haworth). The capacity for agency distinguishes persons from inanimate objects and from nonhuman animals. Inanimate objects can be affected by objects and conditions external to them, as can persons, but unlike persons, inanimate objects cannot be said to act on desires. Nonhuman animals have desires, but there is no (noncontroversial) reason to believe that they have the capacity for self-consciousness that is manifest in having an awareness of desires and wanting them to be effective in action. Agency does not imply that persons are never influenced by external forces or that persons never act impulsively. It is an account of how persons are able to act and not how they always act. Independence is the absence of influences that so control what a person does that it cannot be said that he or she wants to do it. This may seem a feature of an autonomous action rather than an element of psychological capacity. However, there are cases in which a person’s course of life is under constant threat of violence from others, and the person acts always to avoid harm: war, poverty, abusive relationships, police states. When the whole of a person’s beliefs, plans, self-image, and ways of relating to others are the result of unrelenting coercion and manipulation, then that person has little or no capacity for autonomy. Autonomy also requires that persons have an adequate range of options. Coercion and manipulation limit options, but options are also limited by social and physical environments. If a person’s options are numerous and noncoerced but are trivial in relation to what is valued by the person, then there is no capacity for autonomy in a significant sense (Raz). This would be the case in a totalitarian, caste, or slave society where a combination of coercion and ideology suppress the aspirations and real options of a segment of the members of the society. A full account of the conception of AUTONOMY "Who Becomes Addicted?Posted on 3/17/2011 at 5:33 AM - LinkWho becomes addicted is a complex disease process that is best understood in a biopsychosocial model where biological, environmental, and social influences create this brain disease (Tsung et al.). While research in this area is ongoing, several findings are clear. First, genetics plays a powerful role in who becomes addicted and to what. For example, approximately 10 percent of the population has a preexisting biological, or genetic, predisposition to drug and alcohol dependency. This genetic relationship is supported by the higher concordance rates (likelihood of one twin having the condition if the other has) of substance dependence among identical twins (those who share the same genetic material), compared to fraternal twins (those with non-identical genetic material). Genetic factors underlie neurotransmitter receptor patterns in the brain that predispose a person to addiction (Rose et al.). Genetic factors are important in explaining why one person can have a drink and walk away and another person cannot stop drinking until he or she passes out. Second, there is clearly a drug effect. That is, while all drugs impact upon similar reward properties of the brain, the pharmacological properties of some drugs are more addictive than others. Some substances such as cocaine or narcotics can cause addiction in almost anyone, regardless of genetic predisposition, if they are used frequently for a long enough time. Third, environmental factors and drug use expectancies (i.e., motivation and intent) also play a role in the addiction process (Jang et al.). For example, rarely do cancer patients become addicts despite taking powerful doses of narcotic pain medication. Similarly, while an estimated 20 percent of American soldiers in Vietnam developed heroin addiction, 90 percent were able to give up heroin once they returned ADDICTION AND DEPENDENCE • 64 ENCYCLOPEDIA OF BIOETHICS 3rd Edi t ion from Vietnam. An outcome rate much higher than typically seen among heroin users. Finally, as Russian physiologist Ivan Pavlov (1849–1936) proved, whether it is food and a bell or a drug and a bell, salivation is salivation. Drugs are powerful conditioners shaping behavior and responses. Despite all of this evidence of addiction, the fields of psychiatry in particular and medicine in general have been slow to respond to the medical and societal challenges posed by addiction. Even the 2000 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R), the bible of psychiatric diagnosis, does not mention addiction, per se, but instead discusses dependence. " |
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