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What should recognition entail? Responding to the reification of autonomy and vulnerability in medical research
  1. Jonathan Lewis1,
  2. Soren Holm1,2
  1. 1Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK
  2. 2Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Jonathan Lewis, Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK; jonathan.lewis-2{at}manchester.ac.uk

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Smajdor claims that ‘recognition’ is the solution to the ‘reifying attitude’ that results from ‘the urge to protect “vulnerable” people through exclusion from research’.1 Specifically, for Smajdor, an assent-based framework—as a means of recognising and respecting the autonomy of vulnerable individuals who would otherwise be excluded from biomedical research—provides such recognition.

If the sole reason for the reification of vulnerable individuals in research contexts is a need to protect them due to their inability to fulfil standards for informed consent, then recognition in the form of assent would, in principle, provide a solution to the reification issue. The central claim of this commentary, however, is that what has been reified are the concepts of autonomy and vulnerability themselves. On that basis, overcoming such reification demands a deeper consideration of the forms that recognition should take if we are to enable vulnerable individuals to make autonomy claims concerning research participation.

Smajdor appeals to Honneth’s account of reification, for which one of starting points is Adorno’s characterisation of reification as ‘identity-thinking’. For Adorno, what identity thinking entails is that concepts ‘are no longer measured against what they contain, and what they contain is no longer measured against concepts; instead, concepts are taken in isolation’ (pp 41–42).2 In short, individuals are reduced to concepts such that their ‘particularity’, ‘heterogeneity’ and ‘individuality’ are ignored (p 94).2

Thus, what we mean when we claim that the concepts of autonomy and vulnerability are reified is that, in practice, certain conceptions of autonomy and vulnerability are held by those …

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Footnotes

  • Contributors JL drafted the commentary. JL and SH contributed equally to its revision. JL and SH both approved the final version for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • For Honneth, recognition that manifests in love/friendship, and the self-trust it supports, is predominantly an object of intimate relationships. Thus, it is not considered here.