This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

Mental conflict not always amounts to weakness of will. Irresistible motives not always speak of addiction. This book proposes an integrated account of what singles out these phenomena: addiction and weakness of will are both forms of secondary akrasia. By integrating these two phenomena into a classical conception of akrasia as poor resolution of an unnecessary conflict – valuing without intending while intending without valuing – the book makes an original contribution to central issues in moral psychology and philosophy of (...) action, including the relationship between responsibility and intentional agency, and the nature and scope of moral appraisal. In particular, the proposed integrated account is grounded in a general theory of responsibility and a related model of action as actualisation bringing together insights from both volitional and non-volitional conceptions, such as the intuition that it is unfair to hold a person responsible for things that are not up to her and the parity of actions and attitudes as legitimate objects of moral appraisal. Furthermore, the actualisation model supports a distinctive version of the Guise of the Good thesis which links valuing and intending in terms of success in action and explains why akratic actions and their offspring – addiction and weakness of will – are necessarily less than successful yet fully responsible. (shrink)

This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background (...) of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

In this paper, I argue that cognitive enhancement cannot be epistemically beneficial since getting things right in particular and epistemic agency in general both presuppose a kind of achievement. Drawing on Aristotle’s ethics, I distinguish four categories of actions: caused, attributable, responsible, and creditable. I conclude that to the extent that cognitive enhancement is incompatible with the latter category it undermines rather than strengthens autonomous agency in the realm of cognition.

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...) capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

This paper identifies a distinctive kind of moral luck, deep circumstantial luck and then explores its effects on moral responsibility. A key feature of the phenomenon is that it is recurrent rather than one-off. It also affects agents across a wide range of situations making it difficult to detect. Deeply unlucky agents are subject to unfavourable moral assessments through no fault of their own both in specific cases and when they try to respond to such initial assessments. In this respect, (...) deep circumstantial luck takes the form of a normative burden that grows over time. A process-oriented conception of moral responsibility as answerability is proposed to explain this phenomenon and highlight its implications for rethinking vicarious responsibility. (shrink)

According to a common assumption, truthfulness cannot have an intrinsic value in business. Instead, it is considered only instrumentally valuable for business, because it contributes to successful trust-building. Some authors deny truthfulness even this limited role by claiming that truth-telling is not an essential part of business, which is a sui generis practice like poker. In this article, I argue that truthfulness has indeed an intrinsic value in business and identify the conceptual confusions underlying the opposite view. My account of (...) truthfulness as a virtue shows that truthfulness is both valuable for its own sake and instrumental to further valuable goals. It helps pinpoint the implicit contradiction in claiming that truthfulness has an instrumental value only. I then challenge the reasons for considering business exempt from the constraints of truthfulness and elaborate on the analogy between game and business, which in fact supports instead of undermining my claim that business is a truthful practice. Finally, I illustrate my argument with a case study of the current crisis of trust faced by the pharmaceutical industry. (shrink)

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous (...) action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1). (shrink)

In this article, I develop an Aristotelian account of akrasia as a primary failure of intentional agency in contrast to a phenomenon I refer to as ‘ordinary weakness of will’: I argue that ordinary weakness of will is best understood as a secondary failure of intentional agency, that to tackle akrasia.

This Editorial outlines recent developments in the Journal’s scope, mission and review policy. It also illustrates the range of topics addressed on the pages of Ethical Theory and Moral Practice, which is now entering its 24th year.

This chapter outlines a new disentangling strategy for moral epistemology. It builds on the fundamental distinction between value-neutrality and value-independence as two separate aspects of methodological austerity introduced by Matthew Kramer. This type of conceptual analysis is then applied to two major challenges in moral epistemology: globalised scepticism and debate fragmentation. Both challenges arise from collapsing the fact/value dichotomy. They can be addressed by comprehensive disentangling that runs along both dimensions – value neutrality vs. value non-neutrality and value independence vs. (...) value dependence. The success of this strategy rests on two factors. The first is broadening the scope of disentangling to include theoretical-explanatory values on a par with distinctly ethical values. The second is differentiating between wider and narrower conceptualisations of what value neutrality requires with respect to contested matters. The objective is to pre-empt unjust theorising, a distinctive form of epistemic injustice that derives from the exclusive methodological focus on ethical evaluations at the expense of epistemic ones. When these methodological conditions are fulfilled, opponents should gain the confidence to treat each other as fellow inquirers engaged in the same project, that of reducing the scope of unhelpful disagreements. (shrink)

« Espace privé et espace public s’imbriquent. Vie privée et vie publique se percutent. Intimité et “extimité” se combinent. For intérieur et for extérieur se répondent. Toutefois, tandis que l’espace privé, la vie privée et maintenant l’intimité accèdent à la visibilité, le for intérieur demeure, pour l’instant, à l’abri des feux de la rampe. Les cas de conscience,...

This article offers an account of akrasia as a primary failure of intentional agency in contrast to a recent account of weakness of will, developed by Richard Holton, that also points to a kind of failure of intentional agency but presents this as both separate from akrasia and more fundamental than it. Drawing on Aristotle’s work, it is argued that the failure of intentional agency articulated by the concept of akrasia is the central case, whereas the phenomenon Holton’s account is (...) after, referred to as ‘ordinary weakness of will’, is best understood as an unsuccessful attempt to tackle akrasia and, more specifically, a secondary failure of intentional agency. (shrink)

This chapter aims to distinguish between pathologies of agency in the strict sense and mere sources of impediments or distortion. Expanding on a recent notion of necessarily less-than-successful agency, it complements a mainstream approach to mental disorders and anomalous psychological conditions in the philosophy of mind and action. According this approach, the interest of such clinical case studies is heuristic, to differentiate between facets of agency that are functionally and conceptually separate even though they typically come together. Yet, in the (...) absence of independent criterion for a pathology of as opposed to inner obstacle to agency, this heuristic is at risk of becoming circular or uninformative, falling back on a clinical diagnosis it is meant to take as a starting point only. The chapter develops such a criterion and shows how it could work tracking agential achievement across two core dimensions of agency: planning and responsiveness to reasons. The discussion concludes with some implications on assessing decisional capacity and safeguarding agent autonomy in psychiatric settings. (shrink)

This article offers a critical analysis of David Miller’s proposal that liberal immigration policies should be conceptualized in terms of a quasi-contract between receiving nations and immigrant groups, designed to ensure both that cultural diversity does not undermine trust among citizens and that immigrants are treated fairly. This proposal fails to address sufficiently two related concerns. Firstly, an open-ended, quasi-contractual requirement for cultural integration leaves immigrant groups exposed to arbitrary critique as insufficiently integrated and unworthy of trust as citizens. Secondly, (...) the focus on national culture instead of citizenship obfuscates the close link between political membership and political trustworthiness. An examination of two models of interpersonal trust, affective and cognitive,shows that there is no room for the mid-way position associated with a quasi-contract. The effect of grounding political trust in a shared national culture instead of democratic institutions is to normalize the domination of immigrants and citizens alike. (shrink)

This article explores the philosophical concept of akrasia, also known as weakness of will, and demonstrates its relevance to clinical practice. In particular, it challenges an implicit notion of control over one’s actions that might impede recovery from substance misuse. Reflecting on three fictional case vignettes, we show how philosophical work on akrasia helps avoid this potentially harmful notion of control by supporting a holistic engagement with people for whom substance misuse is a problem. We argue that such engagement enhances (...) their prospects of recovery by focusing on agency over time, as opposed to individual lapses. (shrink)