This installment of the early-career research spotlight series looks at the work of Pamela Lomelino, an Assistant Professor of Philosophy at Loyola University Chicago. Lomelino received her Ph.D. in Philosophy from the University of Colorado in 2011. She has also received a number of certificates, including a Women & Gender Studies graduate certificate from the University of Colorado Women’s Studies Department and a College Teaching certificate from the University of Colorado Graduate Teacher Program. Lomelino specializes in bioethics, feminist philosophy, and ethics, focusing on questions of community, multiculturalism, and social justice. She tackles these questions in her book, Community, Autonomy & Informed Consent: Revisiting the Philosophical Foundation for Informed Consent in International Research, where she discusses how to make informed consent guidelines globally applicable. She is currently at work on her second book, which will examine the use of a relational autonomy based models of informed consent in the clinical context.
You say in your book that traditional accounts of autonomy, especially as they relate to questions of consent, are inadequate as they can be dangerous and even oppressive. What is the rationale for this claim, and which populations are most vulnerable to the oppression you are worried about?
Proponents of what I refer to as traditional accounts of autonomy believe that individuals are able to mentally isolate themselves (the set of beliefs and values that constitute the self) from their social context. Although these proponents acknowledge physical dependency resulting from illness, physical disabilities, etc., they insist persons are able to mentally isolate their beliefs and values from others’ influence in order to make fully autonomous choices.
This belief is oppressive in that it overlooks the ways that persons’ relationships and larger social context bear on their ability to make autonomous choices. Persons most likely to have their autonomy impeded by their relationships and the larger social context are those who are less powerful in society due to present social injustices (ex., persons of color, women, disabled-bodied persons, trans persons)
Your preferred concept of autonomy you call relational autonomy. What does this term mean, and how does it escape the problems mentioned above?
The term “relational autonomy” stems from Feminist Philosophy. In contrast to traditional accounts of autonomy, wherein persons are considered to be able to mentally isolate themselves from others’ influences, relational autonomy recognizes that persons inescapably exist within relationships. Although there is disagreement among relational autonomy theorists as to whether relationships are causal or constitutive of autonomy, the common thread among relational accounts of autonomy is the recognition that persons cannot entirely abstract themselves from their relationship with others. This recognition, in turn, leads to the insistence that ensuring respect for autonomy necessarily entails attending to ways that relationships and social context can enhance or impede persons’ ability to make self-governed or autonomous choices. It is this awareness that overcomes the problem that traditional autonomy accounts encounter — the problem of failing to recognize how relationships and the larger social context can impede autonomy.
There seems to be some resonance in what you’re saying with deontology and Virtue Ethics. In particular, I can envision Kant saying that “relational autonomy” isn’t really a form of autonomy as you’re being determined by your context, while Aristotle emphasizes the importance of developing relationships of friendship to live a good life. How does “relational autonomy” encourage one to live on a day to day basis, and what is its attitude towards conventional ethical theories?
It is not surprising that you would wonder how the notion of relational autonomy fits with ethical theory. Any conception of autonomy rests on presumptions about human nature, as does any ethical theory. Notably, traditional ethical theories, such as Kant’s and Aristotle’s rest on assumptions that persons can mentally isolate themselves from others’ influence. This notion seems more apparent in Kant’s discussions of autonomy. Although Aristotle most certainly acknowledges one’s relationships with others, especially in his discussions of the need for virtuous friendships in developing the virtues, he posits these relationships as intentionally chosen ones. This differs from relational autonomy in that relational autonomy theorists insist persons are inescapably related to others to some extent.
It seems like the nature of relational autonomy really hinges on how one defines “relationship.” Based on what you’ve said about the debate over whether relationships cause autonomy, it sounds like there’s not complete agreement on this definition. Can you lay out some of the ways feminists have defined “relationship” in this debate, and where you stand on the matter?
The primary idea that relational autonomy is meant to capture is the “relational” aspect of persons. Persons relate to their personal relationships as well as their social context. Hence, personal relationships as well as one’s general relationship with society (ex., as a member of an oppressed group within society) bear on autonomy. There remains disagreement in the philosophical literature regarding whether such capacities as autonomy are casually or constitutively social. If causally social, then certain external conditions are necessary for autonomy to be properly exercised; if constitutively social, then autonomy is inherently social in its very nature.
You’ve taught numerous healthcare ethics and bioethics classes. In your experience, which topics are students most interested in and what are some of your preferred ways of teaching them?
Even though I am early in my career, I have had the opportunity to teach a variety of courses in bioethics. Two of the courses I often teach are Philosophy of Medicine and Healthcare Ethics.
Because many of the students in the Philosophy of Medicine class plan to go into various medical fields, I gear the course towards the epistemological, metaphysical and ethical analysis of various aspects of clinical judgment. In order to get the students more involved; provide them the opportunity to be creative; and to reinforce the material they learn in class, each student constructs a very detailed profile of their own unique patient (age, gender, sexual preference, race, class, level of able-bodiedness, current relationship status, family, medical condition that brings them into see the doctor, etc). Throughout the semester, they are asked to map what they are learning onto their particular patient and to share this in class discussions.
In Healthcare Ethics, I divide the course between teaching students the theoretical tools necessary for philosophically analyzing ethical issues in the healthcare context and having them apply these newly acquired tools to specific healthcare ethics issues. Many of the specific issues change each semester, depending on what is currently being discussed in the media, so that students leave the class being able to more responsibly engage in current public discourses about these issues.
The activity you mentioned (students constructing profiles of their own unique patients) sounds fascinating. What are some of the best, or most interesting, submissions for that assignment?
Most of the submissions are fascinating. I am always pleasantly surprised at how inventive students get when creating their own patients; they really strive to come up with the most difficult scenarios for applying what we learn in class. Some examples are having patients with a disease normally associated with the opposite gender (such as a man with breast cancer); transgender patients; immigrants who gained citizenship in adulthood and are accustomed to non-Western medicine; and patients with no support structures (friends, family, etc.).
You can ask Pamela Lomelino questions about her work in the comments section below.
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