Any system health work must look at decision-making because decisions propagate throughout a system, shaping system dynamics. Usually, human decision-making is conducted from an individualist, objectivist perspective. What happens when we use an approach based on the radical relationality of Radical Participatory Design and Relational Design? This is the fourth paper in a series of papers which introduced Radical Participatory Design in the first two papers and Relational Design in the third paper. In this fourth paper, we explore the decision-making dynamics in Radical Participatory Design and Relational Design projects.

We use the term political ecology to speak about the power dynamics within any ecological system – a geographical population, a community, an ecosystem, and so forth. We analyze the political ecologies of individualist decision-making models. Then we explore how to embody a relational ontology within decision-filled human ecosystems and how a relational way of being changes decision-making. Referring to biology, we discuss ingredients for relational decision-making – relationality, emergent design principles, and autonomy. Those ingredients can lead to emergent and symbiotic design. Emergent design refers to design that emerges from consistently following a few basic principles. Symbiotic design occurs over time when deeply, relationally embedded entities retain autonomy and indirectly evolve to create a design that would not have occurred through an intentional design process. We then introduce Radical Biocracy as a type of decision-making model where decisions are not deliberated by groups or team members but emerge from the relationally autonomous choices and actions of individuals.

Care home residents were vulnerable to severe effects from Covid-19 infection and experienced high mortality, especially early in the pandemic. In response, many countries introduced visiting restrictions to limit transmission. These often proved extensive and prolonged, drawing fresh attention to issues of autonomy and human rights in long-term care. We conducted in-depth interviews with 27 family carers in England with relatives living in a care home during the pandemic. Adopting a relational autonomy lens, conceptualised using the capability approach, we examined how family carers considered their relatives’ capabilities to have been impacted by visiting restrictions and how relational support could be strengthened. Family carers were concerned for their relative’s fundamental capabilities, including physical health, emotional well-being, and feeling connected to significant others. Capability deprivations were associated with family separation, ‘adapted’ visits that were inappropriate for their relative’s needs, and lack of opportunity for family carers’ to provide emotional support, help staff identify their relative’s emotional and physical needs, monitor care standards or advocate for their relative. Optimising relational support during a public health emergency requires effective collaboration between care homes and family carers. Specific measures include (1) ensuring there is clarity, a sense of shared purpose, clear accountability and confidence in visiting restrictions, (2) providing family carers regular, personalised updates about their relative using a range of digital communication tools, (3) allowing choice about visiting arrangements where possible, and ensuring visits are appropriate for residents with dementia and (4) ensuring that family carers feel welcomed, involved and enabled to resume in-person visits at the earliest opportunity. Consultation with care homes, families and residents, and workforce and digital readiness should be prioritised.

This article reviews the common models of pious women's agency in the literature with respect to pious feminist perceptions in Turkey, and calls for a relational approach to subjectivity and autonomy. After critically assessing individualistic models of pious women's autonomy as well as the main theoretical tenets of Saba Mahmood's landmark study on the women's piety movement in Egypt, I argue that previous models cannot fully explain the second stage of pious subjectivity-formation in the pious feminist narratives in Turkey, which combines habituation with informed choice. In the intersection of applied theory and ethnographic empirical research, my study posits the need for a relational reformulation of these common models that can account for (1) self-constitutive engagement with multiple discursive traditions, and (2) the importance of complex and interrelated webs of relationships. I suggest that Jennifer Nedelsky's relational self and relational autonomy and Kenneth Gergen's relational multi-being might provide a starting point for such an approach.

According to relational views of autonomy, some social relations or forms of dependence are necessary for autonomous agency. Recent relational theorists have primarily focused on autonomy of action or practical autonomy, and the result has been a shift away from individualistic conceptions of autonomy in the practical realm. Despite these trends, individualistic conceptions are still the default when it comes to autonomy of belief or intellectual autonomy. In this paper, I argue for a relational account of intellectual autonomy. Specifically, I claim that intellectual autonomy requires a sense of one’s standing as an equal member of the epistemic community.

This essay explores the concept of the connected self-owner, which takes account of the metaphysical significance of relations among persons for persons’ capacities to be owners. This concept of the self-owner conflicts with the traditional libertarian understanding of the self-owner as atomistic or essentially separable from all others. I argue that the atomistic self cannot be a self-owner. A self-owner is a moral person with intentions, desires, and thoughts. But in order to have intentions, desires, and thoughts a being must relate to others through language and norm-guided behavior. Individual beings require the pre-existence of norms and norm-givers to bootstrap their selves, and norms, norm-givers, and norm-takers are necessary to continue to support the self. That means, I argue, that the self who can be an owner is essentially connected. Next, I ask how humans become connected selves and whether that connection matters morally. I distinguish among those connections that support development of valuable capacities. One such capacity is the autonomous individual. I argue that the social connections that allow the development of autonomous individuals have moral value and should be fostered. On the basis of these two values, I argue that we can support at least two nonvoluntary obligations, one negative and one positive, that we can ground in our metaphysical essence as connected self-owners.

Unlike England and Wales, Ireland has not yet moved from the traditional common law rejection of prenuptial agreements. Nevertheless, similar policy concerns continue to be debated in both jurisdictions, particularly regarding the balance between autonomy and fairness concerns, and gender equity. In 2007, an Irish ministerial Study Group recommended limited recognition of prenuptial agreements, foreshadowing similar proposals by the Law Commission for England and Wales in 2014. However, the Irish recommendations were never implemented, despite sustained lobbying. This paper draws on relational theory to scrutinise the Study Group's proposals, identifying its core assumptions and their implications. The paper contends that Irish courts dealing with spousal agreements have tacitly accepted liberal conceptualisations of autonomy, which may lead to injustice. Furthermore, the Study Group's recommendations have been overtaken by events. Recent decisions on spousal agreements emphasise respect for party autonomy, without interrogating what this means. This could be problematic if applied to prenuptial agreements. Accordingly, the paper suggests modifications to the Study Group's proposals, to address relational concerns. In this regard, the paper speaks to the broader debate on family autonomy, and draws on comparative perspectives, including the recommendations of the Law Commission for England and Wales, and the Canadian experience.

In this article, postmodernism is presented as posing a challenge to the role of philosophy within bioethics. It is argued that any attempt to develop a postmodern bioethics must respond to arguments concerning power, relational responsibility, and violence. Contemporary work on the topic of relational autonomy and naturalized bioethics is interpreted as engaging with the postmodern challenge. This article proposes that the role of philosophy in bioethics should be not to provide moral guidance but rather to adopt a critical approach to the possible consequences of privileging any position or understanding over others.

The fourth age remains a poorly understood phenomenon and there is a lack of understanding of the perceptions of those who might be considered to be living in it. This article draws on findings from a study of dignity in later life which examined the day-to-day experiences of participants who were in need of support and care because of failing health. It discusses their accounts of the changes to their sense of self and their identity that came about as a result of their ageing and health problems and looks also at the ways in which the support and care they received helped to shape their adjustment to those changes. The accounts given by participants reveal a great deal about the physical, mental and emotional effort entailed in maintaining a sense of self and highlight the essential role played by social relationships in the maintenance of identity. These findings are analysed by reference to emerging theories of the fourth age.