The recurring claim that the construct of psychopathy is value laden often is not qualified in enough detail. The chapters in this part of the volume, instead, investigate in depth the role and significance of values in different aspects of the construct of psychopathy. Following these chapters, but also by offering a background to them, we show how certain values are involved in the characterisation of psychopathy, inform societal needs satisfied by this construct, and have a central role in determining (...) whether psychopathy is a mental disorder. Moreover, we relate this description to our criticism of the view that the entrenchment of the notion of psychopathy with values in principle renders it irreconcilable with sound psychiatric theory and practice. However, we also recognize that the value-ladenness of psychopathy leaves open other important challenges. Meeting them needs addressing interdisciplinary interrelated issues that have empirical, normative, and theoretical dimensions. (shrink)

In this thesis, I will defend a new kind of compatibilist account of free action, indirect conscious control compatibilism (or indirect compatibilism for short), and argue that some of our actions are free according to it. My argument has three components, and involves the development of a brand new tool for experimental philosophy, and the use of cognitive neuroscience. The first component of the argument shows that compatibilism (of some kind) is a conceptual truth. Contrary to the current orthodoxy in (...) the free will literature, which is that our concept of free will is an incompatibilist concept - a concept according to which we have free will only if determinism is false - I will show that our concept of free will is in fact a compatibilist concept - a concept according to which we can have free will even if determinism is true - and I do so using a new experimental philosophy methodology inspired by two-dimensional semantics. -/- Of course, even if our concept of free will is a compatibilist concept, this does not mean that there are any free actions in the world: the current empirical evidence from the brain sciences appears to show that there might be no, or very few, free actions in the world, even on many compatibilist understandings of what it would take for there to be free will. The second component of the argument addresses this concern by extending our understanding of compatibilism. Agents act freely either when their actions are caused by compatibilistically acceptable psychological processes, or are indirectly caused by those same processes. Hence the name of my account: indirect compatibilism. -/- The final component of the argument defends my new account against some interesting objections and provides evidence from cognitive neuroscience that some of our actions count as free by the lights of indirect compatibilism. (shrink)

According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

In robustness analysis, hypotheses are supported to the extent that a result proves robust, and a result is robust to the extent that we detect it in diverse ways. But what precise sense of diversity is at work here? In this paper, I show that the formal explications of evidential diversity most often appealed to in work on robustness – which all draw in one way or another on probabilistic independence – fail to shed light on the notion of diversity (...) relevant to robustness analysis. I close by briefly outlining a promising alternative approach inspired by Horwich’s (1982) eliminative account of evidential diversity. (shrink)

The aim of this paper is to analyze the treatment/enhancement distinction as employed by those against using the newest biomedical technologies for purposes other than those strictly curative. First, we analyze the most common definitions related to treatment, such as health, disease or medicine, showing their limitations and problems. Secondly, we consider three different tasks usually assigned to the treatment/enhancement distinction: 1) to establish what we owe to others, 2) to establish what should be included as part of a medical (...) insurance system and 3) to distinguish the morally permissible from the morally impermissible. We conclude that the treatment/enhancement distinction is a useful, if limited, tool for the first two tasks, but an inadequate one for the third. (shrink)

The principle aim of this thesis is to provide an account of the nature of health. The starting-point is that health is a normative concept: health implies a standard or norm in relation to which an organism’s state is evaluated. Many philosophers take this to imply that health must be defined in subjective terms. They either think health consists in a certain type of subjective experience, or that health is relative to subjective values and goals. I argue that subjective definitions (...) of health fail to capture the essential properties of health and attempt to show that health is something normative and yet entirely objective. This would imply that there are normative facts in the world, and to support this claim I turn to debates in contemporary meta-ethics. I develop a meta-ethical theory according to which a subset of non-moral goods is grounded in objective features of living beings, and argue that this meta-ethical theory opens the possibility for an objective account of health. I then proceed to develop a theory of health that aims to capture what it means for any living to be healthy. I argue that the concept of health latches onto organisms’ capacities : the greater an organism’s range of capacities, i.e. the more it is capable of doing, the healthier it is. The norm relative to which an organism’s range of capacities is measured in evaluations of health, I go on to argue, is the maximum range of capacities possible for the species. Accordingly, an organism is healthy if it is capable of performing all species-specific activities. A closer analysis of this claim yields the formal definition that health consists in a multiplicity of potential activity vis-à-vis factual limitations set by the species. This definition of health is defended against various objections and potential counterexamples. In the context of human health, I attempt to show this definition of health captures both physical and mental dimensions of health; that it establishes a direct link between health and individual autonomy; and that it supports a Nietzschean account of ‘the greathealth’—the idea that being able to give up the concern for one’s health constitutes a superior kind of health. In the conclusions, I reflect on whether this conception of health could function as an ethical ideal, and consider the form that a health-based ethics could take. (shrink)

In the present paper, we shall discuss the notion of prototype and show its benefits. First, we shall argue that the prototypes of common-sense concepts are necessary for making prompt and reliable categorisations and inferences. However, the features constituting the prototype of a particular concept are neither necessary nor sufficient conditions for determining category membership; in this sense, the prototype might lead to conclusions regarded as wrong from a theoretical perspective. That being said, the prototype remains essential to handling most (...) ordinary situations and helps us to perform important cognitive tasks. To exemplify this point, we shall focus on disease concepts. Our analysis concludes that the prototypical conception of disease is needed to make important inferences from a practical and clinical point of view. Moreover, it can still be compatible with a classical definition of disease, given in terms of necessary and sufficient conditions. In the first section, we shall compare the notion of stereotype, as it has been introduced in philosophy of language by Hilary Putnam, with the notion of prototype, as it has been developed in the cognitive sciences. In the second section, we shall discuss the general role of prototypical information in cognition and stress its centrality. In the third section, we shall apply our previous discussion to the specific case of medical concepts, before briefly summarising our conclusions in section four. (shrink)

My doctoral project is a study of epistemological and ethical issues in Evidence-Based Medicine, a movement in medicine which emphasizes the use of randomized controlled trials. Much of the research on EBM suggests that, for a large part of the movement's history, EBM considered expertise, mechanisms, and values to be forces contrary to its goals and has sought to remove them, both from medical research and from the clinical encounter. I argue, however, that expertise, mechanisms and values have important epistemological (...) and ethical roles to play and can be incorporated into the current EBM movement. (shrink)

The subject-matter of this essay is the moral status of nature. This subject is dealt with in terms of normative reasons. The main question is if there are direct normative reasons to care for nature in addition to the numerous indirect normative reasons that there are for doing so. Roughly, if there is some such reason, and that reason applies to any moral agent, then nature has direct moral status as I use the phrase. I develop the notions of direct (...) normative reason and direct moral status in detail and identify and discuss the two main types of theory according to which nature has direct moral status: analogy-based nature-considerism and non-analogy-based nature-considerism. I argue for the plausibility of a particular version of the latter, but against the plausibility of any version of the former. The theory that is representative of AN claims that nature has direct moral status in virtue of possessing interests. Proponents of this theory fail to show that nature has interests of the kind that they reasonably want to ascribe to it, and that interests of this kind are morally significant. In contrast to AN, NN comes in a variety of different forms. I elaborate a version of NN according to which there are direct normative reasons to care for nature in virtue of its unique complexity, and its indispensability. I argue that even if these reasons should turn out not to apply to any moral agent, they are still genuine direct normative reasons: there is nothing irrational or misdirected about them. Finally, I show how the question of whether there are direct normative reasons to care for nature is relevant to private and political decision-making concerning nature. This is exemplified with a case from the Swedish mountain region. (shrink)

The basic work for this book was carried out during the spring of 1989 in Edinburgh, where I had been granted a research position at The Institute for Advanced Studies in the Humanities. I should like to express here my indebtedness to the Institute for the opportunity thus afforded me. I should also like to say how very grateful I am for the stimulating conversations I had there with Professor Timothy Sprigge and Dr. Elizabeth Telfer. Dr. Telfers’s own treatise Happiness (...) has been a major influence on my view of the questions involved. The basic view of health and illness presented in this book is more fully set out in my On the Nature of Health. As in the case of my previous larger projects, I have received a great amount of support and may wise comments from Professor Ingmar Pörn, Helsinki. Three Danish experts – Anton Aggernaes, Erik Ostenfeld and Peter Sandøe – have made valuable comments. Professor Heng ten Have, Nijmegen, has improved my reading of the philosophy of Jeremy Bentham. I should also like to thank my colleagues at the Department of Health and Society, University of Linköping, for helping me to avoid a number of the pitfalls that can so easily stumble into when it comes to a treatise like this. Especially I should like to mentioned Per-Erik Liss, Ingemar Nordin and Bo Petersson, all three of whom have read and commented on the entire manuscript. A Swedish version of this book, Livskvalitet och hälsa, came out in 1991. I have been made quite a number of corrections and additions, one type of addition being replies to critical points made in reviews of the Swedish version. I should like to thank Malcolm Forbes for valuable help putting my English into publishable condition. Linköping, May 1993 Lennart Noredenfelt. (shrink)

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by (...) environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. (shrink)

This thesis is about the notions of health and pathology in medical theory. I develop a theory, which defines ‘health’ and ‘pathology’ in a way that solves several problems with earlier suggestions of how to define these terms. I call the theory ‘the disposition profile efficiency theory’, abbreviated ‘the DPE-theory’. According to the DPE-theory, a trait token is healthy, roughly, if and only if all of its dispositions for performing physiological functions are efficient enough. A trait token is pathological, roughly, (...) if and only if at least one of its dispositions for performing a physiological function is not efficient enough. The notion of efficiency, I suggest, is reference class-relative: the efficiency of a trait token’s disposition for performing a physiological function expresses a relation between the trait token and a health standard for the trait token’s bearer’s reference class. The thesis also examines the most discussed theory of health and pathology, “the biostatistical theory” proposed by Boorse. Both the DPE-theory and the biostatistical theory are evaluated against a number of desiderata: the theory should be theoretically sound; only use empirical, statistical, and logical terms; not involve values; be clear; both account for health and pathology as reference class-relative properties, and account for the importance of integration of different physiological functions for health; and have reasonable implications. It is argued that the DPE-theory satisfies the desiderata, and that it does so better than the biostatistical theory. The main contributions of the thesis are the DPE-theory’s models of dispositions, its approach to defining reference classes, its efficiency measure, and its way of drawing the line between high enough efficiencies and too low efficiencies. Other important contributions concern the desideratum about reasonable implications. It is shown how the DPE-theory contributes to solving two much discussed objections directed towards the biostatistical theory, “the problem of common diseases” and “Kingma’s dilemma”. Further, the DPE-theory is used to illuminate discussions about certain types of conditions for which it is contested whether they should count as healthy or pathological. (shrink)

This paper reports experiences of health and well-being common to actors in community gardens in Berlin and Paris. Community gardening has become an ever growing phenomenon since the 1990s, and to a larger extend since 2000 in western European cities. Despite the promising research from the US that has shown that community gardens have a potential for health promotion, there is a dearth of evidence from Europe. This study tries to fill this gap and maps the potential of community gardens (...) for health and well-being as explained and experienced by the gardeners. The effect of community garden projects on human health and well-being cannot be reduced to the effect of nature on health alone. This study shows that there are at least two other major mechanisms at play, if we want to understand the phenomenon or evaluate its effects, namely the effects of community and 'free and open spaces'. Gardeners report health-related experiences with green space, such as stress relief and feeling of calm and vitality and increased well-being through sensual experiences and observing nature. Furthermore the garden projects open up a social space, which for many gardeners creates experiences of health through regular social contact, experiences of joy of sharing and having activities together. Furthermore, the community garden project was proposed to create a context and opportunities for flow, creativity and self-efficacy if it is a free and open space. However, not all experiences on well-being in CGPs are postive, and to all these spaces and their effects there are also certain limitations and conditions. Moreover, this study makes a theoretical contribution to the concept of health and well-being on the basis of the fuzziness around the concept of health encountered in the field. I propose that a holistic concept of health might be most suitable to describe health related to bottom-up community action like community gardens. To assess the effects of such projects in terms of well-being, this concepts should be dissentagled into the concept of health and happiness, whereas happiness in turn relates not only to life satisfaction but also to eudaimonian happiness related to meaning and doing good. Although this research project could not be comprehensive enough to provide all necessary evidence to evaluate health effects of community gardens, we believe that it provides viable paths for investigations into community driven health promotion and emerging healthy settings. (shrink)

Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of (...) real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic. (shrink)

Scientists, philosophers, and even the lay public commonly accept that schizophrenia stems from a biological or internal ‘dysfunction.’ However, this assessment is typically accompanied neither by well-defined criteria for determining that something is dysfunctional nor empirical evidence that schizophrenia satisfies those criteria. In the following, a concept of biological function is developed and applied to a neurobiological model of schizophrenia. It concludes that current evidence does not warrant the claim that schizophrenia stems from a biological dysfunction, and, in fact, that (...) unusual neural structures associated with schizophrenia may have functional or adaptive significance. The fact that current evidence is ambivalent between these two possibilities (dysfunction versus adaptive function) implies that schizophrenia researchers should be much more cautious in using the ‘dysfunction’ label than they currently are. This has implications for both psychiatric treatment as well as public perception of mental disorders. (shrink)

Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper deals with the (...) question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (shrink)

This paper aims to provide a clarification of the long debate on whether enhancement will or will not diminish authenticity. It focuses particularly on accounts provided by Carl Elliott and David DeGrazia. Three clarifications will be presented here. First, most discussants only criticise Elliott’s identity argument and neglect that his conservative position in the use of enhancement can be understood as a concern over social coercion. Second, Elliott’s and DeGrazia’s views can, not only co-exist, but even converge together as an (...) autonomy based theory of authenticity. Third, the current account of autonomy provided by DeGrazia fails to address the importance of rationality and the ability of self-correction, which, as a result impedes the theory to provide a fully developed account for authenticity. In conclusion, a satisfactory account of authenticity cannot focus only on identity or subjective preference. (shrink)

Hasta la fecha, el significado de salud y por lo tanto de tratamiento y rehabilitación está referenciado al cuerpo normal o típico de la especie. Las intervenciones terapéuticas tienen cada vez más el potencial de generar habilidades corporales más allá de las ‘normales’ (mejoras terapéuticas). El campo de la rehabilitación, el deseo de disfrutar de habilidades corporales especialmente más allá de las típicas para la especie y la dirección y gobernanza de la ciencia y la tecnología están cada vez más (...) interrelacionadas. Cómo juzgamos y hacemos frente a habilidades corporales o falta de ellas, entre otros, influencia la dirección y gobernanza de los procesos de ciencia y tecnología, productos e investigación y desarrollo e influencia el sentido y el alcance de la salud y la rehabilitación, la identidad y la descripción de los profesionales de salud y rehabilitación, los deseos de los clientes de salud y rehabilitación para recabar sus puntos de vista sobre cuestiones relativas a la mejora del cuerpo y su impacto sobre los profesiones de salud y rehabilitación. La mayoría de encuestados perciben las mejoras humanos más allá de lo ‘normal’ y los cambios asociados como algo inevitable. Los resultados indican que ya es hora de que el discurso de mejora se mueva fuera de la esfera ética y de que el análisis de impacto de mejoras más allá de lo normal se lleve a cabo, que incluya a los hasta ahora prácticamente invisibles profesionales de la salud y la rehabilitación, sus clientes y académicos la política de discapacidad. (shrink)

The paper compares three accounts of distributive justice in health (and more specifically healthcare). I discuss two egalitarian accounts—Daniels's fair equality of opportunity for health and Segall's luck-egalitarian equity in health—and contrast them with a sufficientarian account based on sufficiency of capabilities. The discussion highlights some important theoretical differences and similarities among the three accounts. The focus, however, is on the practical implications of each account regarding four hypothetical cases (synthesized growth hormone for short children, non-therapeutic abortion, forms of compensation (...) for paraplegics, and reconstructive breast surgery versus plastic surgery). My aim is to show that by replacing egalitarian concerns with sufficiency, and by focusing on capabilities (versus opportunities), it is possible to provide a more plausible account of justice in healthcare. (shrink)

Causal selection has to do with the distinction we make between background conditions and “the” true cause or causes of some outcome of interest. A longstanding consensus in philosophy views causal selection as lacking any objective rationale and as guided, instead, by arbitrary, pragmatic, and non-scientific considerations. I argue against this position in the context of causal selection for disease traits. In this domain, causes are selected on the basis of the type of causal control they exhibit over a disease (...) of interest. My analysis clarifies the principled rationale that guides this selection and how it involves both pragmatic and objective considerations, which have been overlooked in the extant literature. (shrink)

This contribution explores the connection between health and subjectivity. Up until recently a marginally discussed topic in health theories, recent critical research in health psychology introduces notions of subjectivity to theories of health. These notions can be linked to phenomenology, embodied subjectivity, and psychosocial theories that have moved away from a partial, internal understanding of subjectivity. These recent theories tend to define subjectivity as a coherence of concrete, embodied and situated subjectivity that extends capabilities and activities towards a world of (...) social relations. The article at hand shows that embodied and situated subjectivity is a basic function of health that sustains the qualities of human life. To comprehend health as a subjective practice in human lives, we need an understanding of people’s subjective participation in their everyday social lives. Hence, I will argue for the concept of conduct of life as an important concept for health psychology. The concept of conduct of life enables an analysis of how people conduct their activities and of their access to life possibilities, within social settings and societal power systems. The concept can be used to analyse the connection between subjectivity and health in the cultural and social relations by which people actually live. (shrink)