The concept of “harm” is ubiquitous in moral theorising, and yet remains poorly defined. Bradley suggests that the counterfactual comparative account of harm is the most plausible account currently available, but also argues that it is fatally flawed, since it falters on the omission and pre-emption problems. Hanna attempts to defend the counterfactual comparative account of harm against both problems. In this paper, I argue that Hanna’s defence fails. I also show how his defence highlights the fact that both the (...) omission and the pre-emption problems have the same root cause – the inability of the counterfactual comparative account of harm to allow for our implicit considerations regarding well-being when assessing harm. While its purported neutrality with regard to substantive theories of well-being is one of the reasons that this account is considered to be the most plausible on offer, I will argue that this neutrality is illusory. (shrink)

There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted (...) Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect. (shrink)

Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will (...) benefit from additional blood screening tests. On the ‘imposed risk’ argument, general cost-effectiveness standards do not apply when healthcare interventions impose risks on patients. This argument ignores the fact that imposing risks on patients is inevitable in healthcare and that these risks can be countered only within reasonable limits. Finally, the ‘manufacturing standard’ argument premises that general cost-effectiveness standards do not apply to procedures preventing the contamination of manufactured medical products. We contend that while this argument seems reasonable insofar as commercially manufactured medical products are concerned, publicly funded blood screening tests should respect the standards for general healthcare. We conclude that these particular arguments are unpersuasive, and we offer directions to advance the debate. (shrink)

It is common practice in intergenerational justice to set fixed thresholds determining what qualifies as justice. Static definitions of how much and what to save for future generations, however, overestimate human epistemological limits and predictive capacity in regard to uncertainty in social- and ecosystems. Long-term predictions cannot account for the inherent range of contingent variables at play, especially according to contemporary theories of punctuated equilibrium. It is argued that policies deliberately testing ecological limits as currently conceived must be excluded from (...) political calculations to minimize current actions from foreclosing future life quality and options. To better reduce harms to present and future generations and support the stability of just institutions (and the stable environments they depend on) as Rawls and others demand, polities can overcompensate resource allocation to environmental sustainability. Focus on reducing environmental harms benefits both current and future generations, reconciling distributive versus intergenerational justice trade-offs. (shrink)

The idea of coercion is one that has played, and continues to play, at least two importantly distinct moral-theoretic roles in our thinking. One, which has been the focus of a number of recent influential treatments, is a primarily deontic role in which claims of coercion serve to indicate relatively weighty prima facie wrongs and excuses. The other, by contrast, is a primarily axiological or eudaimonic role in which claims of coercion serve to pick out instances of some distinctive kind (...) of pro tanto human bad (such as unfreedom or interpersonal subjection). I argue that this turns out not to be a simple case of one idea put to two different uses, but rather a case of two subtly distinct ideas in need of separate philosophical treatment. Moreover, although often relatively neglected, the primarily eudaimonic idea of coercion is of enduring importance to both liberal-perfectionist and socialist political moralities, as well as to personal ethics. This paper aims to elucidate it and to examine its relationship to its better-theorised deontic cousin. In addition, the paper seeks to show how a better understanding of these aspects of the concept can enable us to resolve certain important and long-standing theoretical disagreements, such as the dispute over whether coercion is an ‘essentially moralised’ concept and the dispute over whether (genuine) offers can be coercive. (shrink)

Is there—or rather, ought there to be—a presumption of atheism, as Antony Flew so famously argued nearly half a century ago? It is time to revisit this issue. After clarifying the concept of a presumption of atheism, I take up the evaluative question of whether there ought to be a presumption of atheism, focusing on Flew’s arguments for an affirmative answer. I conclude that Flew’s arguments, one of which rests on an analogy with the presumption of innocence, fail.

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Experimental vaccines are being developed for the treatment of ‘unhealthy lifestyles’ and associated chronic illnesses. Policymakers and other stakeholders will have to deal with the ethical issues that this innovation path raises: are there morally justified reasons to integrate these innovative biotechnologies in future health policies? Should public money be invested in further research? Focusing on the case of an experimental nicotine vaccine, this article explores the ethical aspects of ‘lifestyle vaccines’ for public health. Based on findings from a qualitative (...) study into a vaccine for smoking cessation, the article articulates possible value conflicts related to nicotine vaccination as an intervention in tobacco control. The ‘vaccinization’ of lifestyle disease piggybacks on the achievements of classic vaccines. Contrary to expectations of simplicity and success, quitting smoking with a vaccine requires a complex supportive network. Social justice and public trust may become important ethical challenges when deciding whether to use further public funds for research or whether to implement these innovative vaccines in the future. (shrink)

How sexuality should be regulated in a liberal political community is an important, controversial theoretical and empirical question—as shown by the recent criminalization of possession of some adult pornography in the United Kingdom. Supporters of criminalization argue that Mill, often considered a staunch opponent of censorship, would support prohibition due to his feminist commitments. I argue that this account underestimates the strengths of the Millian account of private conduct and free expression, and the consistency of Millian anticensorship with feminist values. (...) A Millian contextual defense of liberty, however, suggests several other policy approaches to addressing the harms of pornography. (shrink)

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

Blackmail raises a pair of parallel legal and moral problems, sometimes referred to as the "paradox of blackmail". It is sometimes legal and morally permissible to ask someone for money, or to threaten to release harmful information about them, while it is illegal and morally impermissible to do these actions jointly. I address the moral version of this paradox by bringing instances of blackmail under a general account of wrongful coercion. According to this account, and contrary to the appearances which (...) give rise to the paradox, threatening the release of harmful information to constrain another's actions is almost never morally impermissible unless it is likewise impermissible to carry out one's threat. To defend this claim I identify a special wrong that arises in the paradoxical cases of threatened information release. The account also resolves a number of other puzzles about blackmail—for example, why profiting from a threat in blackmail can sometimes be impermissible, even though accepting identical payment from an independent offer to retain the same information can be permissible. (shrink)

For too long, criminal law scholars overlooked immigration-based offences. Claims that these offences are not ‘true crimes’ or are a ‘mere camouflage’ to pursue non-criminal law aims deflect attention from questions concerning the limits of criminalization and leave unchallenged contradictions at the heart of criminal law theory. My purpose in this paper is to examine these offences through some of the basic tenets of criminal law. I argue that the predominant forms of liability for the most often used immigration offences (...) are, at least in principle, controversial and depart from what is often presented as the paradigm in criminal law. Above all, immigration offences are objectionable because they fall short in fulfilling the harm principle and, given that criminal punishment as used against immigration offenders is often a secondary, ancillary sanction to deportation, they license excessive imposition of pain. (shrink)

Journal Name: SATS Issue: Ahead of print.

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

Life-sustaining treatment is sometimes withdrawn or withheld from critically ill newborn infants with poor prognosis. Guidelines relating to such decisions place emphasis on the best interests of the infant. However, in practice, parental views and parental interests are often taken into consideration.In this paper I draw on the example of newborn infants with severe muscle weakness (for example spinal muscular atrophy). I provide two arguments that parental interests should be given some weight in decisions about treatment, and that they should (...) be given somewhat more weight in decisions about newborns than for older children. Firstly, the interests of the infant and of parents intersect, and are hard to separate. Parents’ views about treatment may be relevant to an assessment of the infant’s interests, and they may also affect those interests. Secondly, the interests of the infant in her future are relatively reduced by her developmental immaturity. In some situations parents’ welfare interests outweigh those of the infant. However, I argue that this would not justify treatment limitation except in the setting of severe impairment. (shrink)

In this article I examine whether Moral Foundations Theory can fulfil the promises that Haidt claims for the theory: that it will help in developing new approaches to moral education and to the moral conflicts that divide our diverse society. I argue that, first, the model that Haidt suggests for understanding the plurality of moralities—a shared foundation underlying diverse moralities—does not help to overcome conflicts. A better understanding of the nature and background of moral conflicts can lead to a more (...) respectful attitude towards people with conflicting views, but need not contribute to ending conflicts. Second, I show that pervasive moral conflicts should be dealt with on the level of politics. They require a morality of compromising. Third, I examine why this approach does not seem to work in the USA. (shrink)

In most cases, we think that what settles what act it is right to perform is sensitive to what we take the facts about the world to be. But those facts include many controversial metaphysical claims about the world. I argue that depending on what metaphysical model we take to be correct, we will have very different views about what the right actions are. In particular, I argue that if a particular metaphysical model — the branching universe model — is (...) correct, then many of our ethical intuitions are false. We need to think carefully about the relation between ethical and metaphysical intuitions, and ethical and metaphysical theories. (shrink)

In this paper I propose and develop a social account of global autonomy. On this view, a person is autonomous simply to the extent to which it is difficult for others to subject her to their wills. I argue that many properties commonly thought necessary for autonomy are in fact properties that tend to increase an agent’s immunity to such interpersonal subjection, and that the proposed account is therefore capable of providing theoretical unity to many of the otherwise heterogeneous requirements (...) of autonomy familiar from recent discussions. Specifically, I discuss three such requirements: (i) possession of legally protected status, (ii) a sense of one’s own self-worth, and (iii) a capacity for critical reflection. I argue that the proposed account is not only theoretically satisfying but also yields a rich and attractive conception of autonomy. (shrink)

In current American medical practice, autonomy is assumed to be more valuable than human life: if a patient autonomously refuses lifesaving treatment, the doctors are supposed to let him die. In this paper we discuss two values that might be at stake in such clinical contexts. Usually, we hear only of autonomy and best interests. However, here, autonomy is ambiguous between two concepts—concepts that are tied to different values and to different philosophical traditions. In some cases, the two values (that (...) of agency and that of authenticity) entail different outcomes. We argue that the comparative value of these values needs to be assessed. (shrink)

Are government restrictions on hate speech consistent with the priority of liberty? This relatively narrow policy question will serve as the starting point for a wider discussion of the use and abuse of nonideal theory in contemporary political philosophy, especially as practiced on the academic left. I begin by showing that hate speech (understood as group libel) can undermine fair equality of opportunity for historically-oppressed groups but that the priority of liberty seems to forbid its restriction. This tension between free (...) speech and equal opportunity creates a dilemma for liberal egalitarians. Nonideal theory apparently offers an escape from this dilemma, but after examining three versions of such an escape strategy, I conclude that none is possible: liberal egalitarians are indeed forced to choose between liberty and equality in this case and others. I finish the paper by examining its implications for other policy arenas, including markets in transplantable human organs and women’s reproductive services. (shrink)

My aim here is to clarify the practice of honoring and validating the relational model of self which plays an important role in feminist therapy. This practice rests on a tangle of psychological claims, moral and political values, and mental health norms which require analysis. Also, severe pathology affects the relative "relationality" of the self. By understanding it we can better understand the senses of autonomy compatible with and even required for a desired relationality.

In this paper I make the following claims. In order to see anthropogenic climate change as clearly involving moral wrongs and global injustices, we will have to revise some central concepts in these domains. Moreover, climate change threatens another value that cannot easily be taken up by concerns of global justice or moral responsibility.

It has been suggested that, in addition to individual level decision-making, informed consent procedures could be used in collective decision-making too. One of the main criticisms directed at this suggestion concerns decision-making power. It is maintained that consent is a veto power concept and that, as such, it is not appropriate for collective decision-making. This paper examines this objection to collective informed consent. It argues that veto power informed consent can have some uses in the collective level and that when (...) it is not appropriate the decision power a concerned party ought to have in connection with an arrangement should be made relative to the interest she has at stake in it. It concludes that the objection examined does not undermine collective informed consent. (shrink)

First, what constitutes a person's death? It is clear enough that people die when their lives end, but less clear what constitutes the ending of a person's life.

Freedom of association, as I understand it, refers to the liberty a person possesses to enter into relationships with others—for any and all purposes, for a momentary or long-term duration, by contract, consent, or acquiescence. It likewise refers to the liberty to refuse to enter into such relationships or to terminate them when not otherwise compelled by one's voluntary assumption of an obligation to maintain the relationship. Freedom of association thus is a quite capacious liberty.

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity—finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level (...) yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the ‘unreasonable’ attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making. (shrink)

This article claims that health promotion is best practised in the light of an Aristotelian conception of the good life for humans and of the place of health within it.

Ethical extensionism is a common argument pattern in environmental and animal ethics, which takes a morally valuable trait already recognized in us and argues that we should recognize that value in other entities such as nonhuman animals. I exposit ethical extensionism’s core argument, argue for its validity and soundness, and trace its history to 18th century progressivist calls to expand the moral community and legal franchise. However, ethical extensionism has its critics. The bulk of the paper responds to recent criticisms, (...) including (1) environmental ethicists’ objection against its austere conception of moral value (2), feminist ethicists’ claim that extensionism fails to account for the moral significance of difference, (3) disability theorists’ concern that ethical extensionist arguments are offensive, and (4) animal rights theorists’ lament that extensionism is a practical failure. While something is to be gained from each criticism, I argue that they ultimately fail and that extensionism remains compelling. (shrink)

Judging on the basis of standard accounts of commodification, one might reasonably suggest that liberalism intrinsically lacks an adequate theory of commodification. Liberalism, with its commitment to individual choice and to neutrality as regards competing evaluation practices, seems conceptually incapable of identifying or abolishing many significant forms of commodification. This essay aims to refute this claim. It employs a strategy of appealing to the harm principle as grounds for a liberal anti-commodification theory. I claim that we are harmed when we (...) are denied ways to meaningfully engage in certain evaluative practices, ways that depend on evaluations shared with others with whom we stand in meaningful social relationships. Markets can crowd out these shared evaluations, and to this extent cause us psychological harm; this in turn supplies grounds for restrictions on certain markets within a liberal state. (shrink)

Overall, there’s a rich literature on free speech and hate speech. However, there’s been comparatively less discussion on hate speech that brings in empirical psychological and medical evidence on the possible health harms hate speech can have for minorities. I introduce and piece together a set of pre-existing scientific data that’s new to the philosophical literature to help sufficiently establish an argument that governments should ban hate speech. Given the adverse effects hate speech can have on one’s mental and physical (...) health, hate speech causes harm at many times. Since it causes such harm and leads to overridingly negative consequences, the government ought to regulate such speech. (shrink)

The gamer’s dilemma, initially proposed by Luck (Ethics and Information Technology 11(1):31–36, 2009) posits a moral comparison between in-game acts of murder and in-game acts of paedophilia within single-player videogames. Despite each activity lacking the obvious harms of their real-world equivalents, common intuitions suggest an important difference between them. Some responses to the dilemma suggest that intuitive responses to the two cases are based on important differences between the acts themselves or their social meaning. Others challenge the fundamental assumptions of (...) the dilemma. In this paper, we identify and explore key imaginative and emotional differences in how certain types of in-game violence are experienced by players, consider how these differences factor into the moral lives of players, and use these insights to resolve the dilemma. The view we develop is that the key moral emotion in offensive video gameplay is self-repugnance. This is not repugnance of the act one directs a game character to perform in the game, nor repugnance of the character one plays. It is repugnance of oneself in playing the game. If self-repugnance is a fitting emotional response to playing a videogame, then this is prima facie grounds for thinking it is wrong to play the videogame. Our approach to the gamer’s dilemma is to distinguish the fittingness conditions of self-repugnance from the fittingness conditions of other moral emotions as they pertain to playing videogames. We argue that because of the virtual character of the actions performed in video games, self-repugnance is a fitting response to particular kinds of offensive gameplay. On the other hand, in-game murder is not invariably a fitting ground for self-repugnance. We argue that this difference is grounded in imaginative responses to the harm of death and the harms of profound suffering. Our task is to explain and justify this difference in fittingness conditions and use this to resolve the gamer’s dilemma. (shrink)

According to an appealing and common view, the moral status of an action – whether it is wrong, for example – is sometimes important in itself in terms of the moral status of other actions – especially those that respond to the original action. This view is especially influential with respect to the criminal law. It is accepted not only by legal moralists but also by adherents of the harm principle, for example. In this paper, I argue against this view. (...) The main arguments emphasize the distinctions between the moral status of actions, consequences, and agents. I argue that what matters, in terms of other actions, is not the moral status of the original action but rather other factors that may be confused with it, such as the moral status of its consequences – whether they are good or bad – and the moral status of the agent – whether she is praiseworthy or blameworthy. The intuitive appeal of the common view is, I argue, at least partly due to a conflation of these factors. Most importantly, once we recall the distinctions between these factors, we can see more clearly that this view lacks a compelling rationale. Or, at least, that it is based on assumptions that, first, are much more controversial than their conclusion, and, second, do not support every aspect of this view – and thus do not offer a unified foundation for this view. (shrink)

This article takes a critical look at the classic couplet of theories on the justification of rights, namely, the choice theory and the interest or benefit theory, where the two are understood to be in conflict. The argument is made that this couplet is best replaced with a new one, namely, a sophisticated rendering of the benefit theory coupled with the autonomy theory, such that any conflict is resolved. The latter two theories take different cases in justifying the attribution of (...) rights: The autonomy theory is concerned with justifying the attribution of rights to adult, rational, and competent subjects, arguing that this attribution requires a sufficiently autonomous claim by such subjects, while the benefit theory seeks to justify the attribution of rights to subjects who lack any of these three properties, meaning that they cannot be considered adult, rational, or competent. (shrink)

What is objectionable about “blacking up” or other comparable acts of imagining involving unethical attitudes? Can such imaginings be wrong, even if there are no harmful consequences and imaginers are not meant to apply these attitudes beyond the fiction? In this article, we argue that blackface—and imagining in general—can be ethically flawed in virtue of being oppressive, in virtue of either its content or what imaginers do with it, where both depend on how the imagined attitudes interact with the imagining’s (...) context. We explain and demonstrate this using speech act theory alongside a detailed case study of blackface. (shrink)

In an attempt to resolve the problem or the marriage between law and morality, Dr. John Ezenwankwor publishes this book, Law and Morality: An Appraisal of Hart's Concept of Law. In it, he delves into a critical analysis of the works of a British legal philosopher, Herbert Lionel Adolphus Hart (1907-1992), who made landmark contributions to the moral and legal questions surrounding human actions or conducts. Incidentally, he surpasses his master, Hart, in this book, by correcting his mistaken and poor (...) consideration of the influence of morality in holding the society together and his dismissal of legal enforcement of morality. (shrink)

Mary Kate McGowan’s Just Words offers an interesting account of exercitives. On McGowan’s view, one of the things we do with words is change what’s permitted, and we do this ubiquitously, without any special authority or specific intention. McGowan’s account of exercitives is meant to identify a mechanism by which ordinary speech is harmful, and which justifies the regulation of such speech. It is here that I part ways. I make three main arguments. First, McGowan’s focus on harm is misguided; (...) that ordinary speech is harmful is harder to support, and in turn does not less to support conclusions about whether it is wrong and warrants regulation, than Just Words suggests. Second, if the speech is harmful, McGowan’s account of exercitives is ill-suited to explain why; the relevant instances of ordinary speech seem to express speakers’ views about moral norms, not change social norms. Third, McGowan’s argument for why ordinary speech should be regulated because it is a form of discrimination presupposes a great deal that is controversial about what makes discrimination wrong and legally actionable, and even if it is right it may license the regulation of more speech than many, including McGowan, would deem acceptable. (shrink)

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directives or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency (...) of one’s future incompetent self by issuing an advance directive? -/- In this paper, I use a virtue-ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self’s life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self-dictatorship, which is the vice of trying to control one’s life to an excessive degree, and that a self-dictator fails to give due moral consideration to the future self’s liberty or agency. I then introduce the Daoist idea of wu-wei, which recommends embracement of what happens in one’s life, as one of the possible remedies for the overemphasis on the value of autonomy and control. (shrink)

This paper focuses on consent and third-party coercion, viz. cases in which a person consents to another person performing a certain act because a third party coerced her into doing so. I argue that, in these cases, the validity of consent depends on the behavior of the recipient of consent rather than the third party’s coercion taken separately, and I will specify the conditions under which consent is invalid. My view, which is a novel version of what I call a (...) Recipient-Focus-View, holds that coercion invalidates consent only if consent was ‘obtained by’ coercion, but not if consent was ‘merely motivated by’ coercion. I explain and support my view on the basis that it best reconciles an unnoticed tension between two fundamental principles in the debate on consent and that it can deal with cases that undermine other Recipient-Focus-Views. (shrink)

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease, involving dialysis or conservative care. Shared decision-making is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift (...) from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD. (shrink)

ABSTRACT I motivate ‘Origin Conventionalism’—the view that which facts about one’s origins are essential to one’s existence depends partly on our person-directed attitudes. One important upshot is that the view offers a novel and attractive solution to the Nonidentity Problem. That problem typically assumes that the sperm-egg pair from which a person originates is essential to that person’s existence; in which case, for many future persons that come into existence under adverse conditions, had those conditions not been realized, the individuals (...) wouldn’t have existed. This is problematic because it delivers the counter-intuitive conclusion that it’s not wrong to bring about such adverse conditions since they don’t harm anyone. Origin Conventionalism, in contrast, holds that whether a person’s sperm-egg origin is essential to their existence depends on their person-directed attitudes. I argue that this provides a unique and attractive way of preserving the intuition that the actions in the ‘nonidentity cases’ are morally wrong because of the potential harm done to the individuals in question. (shrink)

McGowan argues “that ordinary utterances routinely enact norms without the speaker having or exercising any special authority” and thereby not “merely cause” but “constitute” harm if harm results from adherence to the enacted norms. The discovery of this “previously overlooked mechanism,” she claims, provides a potential justification for “further speech regulation.” Her argument is unsuccessful. She merely redefines concepts like “harm constitution” and “norm enactment” and fails to explain why speech that “constitutes” harm is legally or morally problematic and thus (...) an initially more plausible target for speech regulation than speech that “merely causes” harm. Even if she could explain that, however, her account would still be incapable of identifying cases where utterances “constitute harm.” This is so for two reasons. First, she provides neither analytical nor empirical criteria for deciding which so-called “s-norms” have been enacted by an “ordinary utterance.” Second, even if such criteria could be provided, there is no epistemically available means to distinguish whether harm has ensued due to adherence to the enacted s-norms or through other mechanisms. Given this lack of criteria and practical applicability, there is no way that this account could serve as a principled basis for speech regulation – it could only serve as a pretext for arbitrary censorship. (shrink)

Non-beneficial paediatric research is vital to improving paediatric healthcare. Nevertheless, it is also ethically controversial. By definition, subjects of such studies are unable to give consent and they are exposed to risks only for the benefit of others, without obtaining any clinical benefits which could compensate those risks. This raises ethical concern that children participating in non-beneficial research are treated instrumentally; that they are reduced to mere instruments for the benefit of science and society. But this would make the research (...) incompatible with the widely endorsed principle of the primacy of the human subject, which stipulates that the interests of the participating individual should prevail over the interests of science and society. This paper deals with this conflict. It analyses solutions to this problem developed in the literature, and shows that they are unsuccessful. Finally, it offers a new idea of how to reconcile the conduct of non-beneficial paediatric research with the PP. The paper argues for a new formula of the PP, and shows that it implies a specific non-comparative definition of the minimal risk threshold. (shrink)

In his latest book, Criminalizing Sex (2020), Stuart P. Green, professor of philosophy of law at Rutgers, develops a unified liberal theory of the criminalization of sexual offenses. The exercise he undertakes is not an easy. Nevertheless, through the use of accessible language, rigorous reasoning and sometimes amusing examples, Green succeeds in offering both a state of the art of knowledge on the subject and in elaborating a legal system that allows for the advancement of thinking in the area of (...) sexual offenses according to the liberal ethics of harms and wrongs. The author starts from the observation that in recent years, criminal legislation on sexual offenses has undergone profound transformations: it has generally become more repressive with regard to non-consensual relationships (rape, sexual assault, etc.) but also more flexible with regard to mutually consensual relationships (homosexuality, adultery, etc.). This apparent double movement invites him to explore conceptual and normative implications of these divergent tendencies, starting from the premise that an ideal liberal criminal justice system should only punish situations where a perpetrator would impose a non-consensual sexual relationship on another. Such a vision of law, which emphasizes individual autonomy while preventing harm to others, follows in the footsteps of those promoted by John Stuart Mill (On Liberty), Herbert L.A. Hart (The Morality of the Criminal Law), and Joel Feinberg (The Moral Limits of the Criminal Law, 4 vols.). (shrink)

Epistemic paternalism is the practice of interfering in the process of inquiry of another,without prior consultation and for the sake of her epistemic good. We will examine two main types of epistemic paternalism: eudaimonic and strict. In the case of eudaimonic epistemic paternalism, epistemic improvement is used only as a means to achieve non-epistemic benefits. In the case of strict epistemic paternalism, epistemic improvement is valued as a good in itself. The main objection against each type of epistemic paternalism is (...) that this practice leads to a violation of personal autonomy. We will defend a more moderate form of strict epistemic paternalism which is motivated by both epistemic and non-epistemic benefits. At the same time, this moderate form leads to the development of specific epistemic virtues, which results in an increase rather than a violation of personal autonomy. We will show that the question of the justification of epistemic paternalism is especially relevant in crises, such as the current pandemic caused by the covid-19 virus. (shrink)

Sex. Die meisten von uns haben ihn. Mal schlecht, mal gut, manchmal phänomenal. Die wenigsten denken lange drüber nach. Oder reden offen drüber. Dabei ist gar nicht so klar, was Sex eigentlich gut macht. Und wann ist Sex schlecht? Oder nicht nur schlecht, sondern sogar moralisch problematisch? Hilkje Hänel zeigt, dass es gar nicht so einfach ist, zwischen (moralisch) problematischem Sex und gutem Sex klar zu unterscheiden und dass es dabei häufig vor allem auf den Kontext und unsere Kommunikation ankommt. (...) Auf der Basis aktueller Wissenschaft und medialer Bewegungen wie #MeToo verteidigt Hänel ihre Ansichten gegen die wichtigsten Einwände und argumentiert für mehr Respekt im Bett. (shrink)

In this paper, we examine how the availability of massive quantities of data i.e., the “Big Data” phenomenon, contributes to the creation, spread, and harms of online misinformation. Specifically, we argue that a factor in the problem of online misinformation is the evolved human instinct to recognize patterns. While the pattern-recognition instinct is a crucial evolutionary adaptation, we argue that in the age of Big Data, these capacities have, unfortunately, rendered us vulnerable. Given the ways in which online media outlets (...) profit from the spread of misinformation by preying on this pattern-finding instinct, we conceptualize the problem that we identify as a morally objectionable form of “epistemic exploitation.” As we argue, the consumer of digital misinformation is often exploited by having her pattern-recognition instinct used against her. This exploitation is morally objectionable because it deprives her of an epistemic good to which she has a right. This epistemic good is the integrity of the pattern-recognition instinct itself which, we argue, is a capacity that allows us to participate in uniquely human goods. While our primary goal is to bring attention to this form of epistemic exploitation, we conclude by briefly evaluating some general solutions to the growing problem of online misinformation. (shrink)