Transformative Experience

Previously proposed strategies for tackling hermeneutical injustices take for granted the interests people have in certain things about them being intelligible to them and/or to others, and seek to enable them to satisfy these interests. Strategies of this sort I call interests-as-given strategies. I propose that some hermeneutical injustices can instead be tackled by doing away with certain of these interests, and so with the possibility of their unfair non-satisfaction. Strategies of this sort I call interests-in-question strategies. As a case (...) study in when such an interests-in-question strategy ought to be pursued, I look at how to tackle hermeneutical injustices arising in the context of gender-affirming healthcare as provided to adults by the National Health Service in the UK. I argue that considerations of trust, privacy, and respect all support pursuing such a strategy. One way to do so, I suggest, would be by replacing the existing gatekeeping model with an informed consent model for the provision of gender-affirming healthcare. Considerations of hermeneutical justice can hence be added to the already-impressive case for undertaking this shift. (shrink)

The following seems to be a truism in modern day philosophy: No agent can have had other parents (IDENTITY). IDENTITY shows up in discussions of moral luck, parenting, gene editing, and population ethics. In this paper, I challenge IDENTITY. I do so by showing that the most plausible arguments that can be made in favor of IDENTITY do not withstand critical scrutiny. The paper is divided into four sections. In the first, I document the prevalence of IDENTITY. In the second, (...) I examine a defense of IDENTITY on the basis of genetic considerations. In the third, I examine a defense of IDENTITY that I call gamete essentialism. In the fourth, I return to genetic considerations to wrap up the paper. (shrink)

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts appear to (...) count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself. (shrink)

This paper explores how transformative experience generates decision-making problems of particular seriousness in medical settings. Potentially transformative experiences are especially likely to be encountered in medicine, and the associated decisions are confronted jointly by patients and clinicians in the context of an imbalance of power and expertise. However in such scenarios the principle of informed consent, which plays a central role in guiding clinicians, is unequal to the task. We detail how the principle’s assumptions about autonomy, rationality and information handle (...) transformative experiences poorly, appealing to several difficult cases for medical decision-making to illustrate the resulting problem, and we consider how the existing literature on complications with consent fails to offer a resolution. We argue that recognition of the problem has a role to play in achieving a more effective response to transformative decisions. In Sect. 1 we introduce several representative cases of challenging patient decision-making that clinicians might face. In Sect. 2 we detail how transformative experience has been analysed in the recent literature, before outlining in Sect. 3 the theoretical basis of the principle of informed consent, which plays a central role in how clinicians are expected to support decision-making. In Sect. 4, having laid the groundwork for a clear description, we return to the cases given in Sect. 1 to confirm how their transformative nature presents a problem: either clinicians treat the decisions faced by these patients as ‘normal’, encouraging them to focus on information provision that patients may be unable to act on, or they treat them as transformative, in which case they lack the resources to recognise whether they are helping patients make (subjectively) good decisions. In Sect. 5 we argue that the existing literature does not offer any escape from this problem. We close in Sect. 6 by noting the significant impact that appreciating the problem of transformative experience could have on supporting transformative decisions in medicine and briefly suggesting how we might aim to develop new approaches to dealing with these. (shrink)

Hot-cold empathy gaps are a pervasive phenomena wherein one’s predictions about others tend to skew ‘in the direction’ of one’s own current visceral states. For instance, when one predicts how hungry someone else is, one’s prediction will tend to reflect one’s own current hunger state. These gaps also obtain intrapersonally, when one attempts to predict what one oneself would do at a different time. In this paper, we do three things: We draw on empirical evidence to argue that so-called hot-cold (...) empathy gaps arise when one projects one’s own current state into a simulation about another. Second, we argue that this process does not typically confer knowledge, even when the predictions it produces happen to be accurate. Third, we suggest that these results can be used to develop a challenge for L.A. Paul's view that authentic action sometimes requires subjective knowledge of one’s own values and how these values relate to relevant outcomes. We then sketch an alternative view of the epistemic grounds of authenticity, one on which authenticity requires a kind of understanding. The relevant form of understanding can be achieved by subjective knowledge but can also be achieved elsewise, such as through testimony from a close friend about what one values. (shrink)

Sometimes it is not us but those to whom we stand in special relations that face transformative choices: our friends, family, or beloved. A focus upon first-personal rational choice and agency has left crucial ethical questions regarding what we owe to those who face transformative choices largely unexplored. In this paper, I ask: under what conditions, if any, is it morally permissible to interfere with to try to prevent another from making a transformative choice? Some seemingly plausible answers to this (...) question fail precisely because they concern transformative experiences. I argue that we have a distinctive moral right to revelatory autonomy grounded in the value of autonomous self-making. If this right is outweighed then, I argue, interfering to prevent another making a transformative choice is permissible. This conditional answer lays the groundwork for a promising ethics of transformative experience. (shrink)

I argue that when it comes to understanding other people, humans have a problem that involves a combination of poor imagination and excessive trust in this imagination. Often, the problem has to do with what I call "runaway simulation" - clinging to the assumption that another person resembles you despite glaring counter-evidence. I then argue that the same type of problem appears intra-personally, as we fail miserably to imagine potential and future selves. Finally, I argue that this fact goes a (...) long way to explain the phenomenology of many transformative experiences, an explanation that does not require a special kind of knowledge to exist along the lines of "knowing what it's like". (shrink)