Practical reasons, roughly, are reasons to have our desires and goals, and to do what might secure these goals. I argue for the view that lack of freedom to do otherwise undermines the truth of judgments of practical reason. Thus, assuming that determinism expunges alternative possibilities, determinism undercuts the truth of such judgments. I propose, in addition, that if practical reason is associated with various values in a specified way, then determinism precludes such values owing to determinism's imperiling practical reason.

I start by using “Frankfurt-type” examples to cast preliminary doubt on the “Objective View” - that one is blameworthy for an action only if that action is objectively wrong, and follow by providing further arguments against this view. Then I sketch a replacement for the Objective View whose core is that one is to blame for performing an action, A, only if one has the belief that it is morally wrong for one to do A, and this belief plays an (...) appropriate role in the etiology of one's A-ing. I next defend this core against recently advanced objections and then show how it helps with defusing a skeptical challenge from the direction of causal determinism against blameworthiness. Finally, I exploit the core to isolate an analogous epistemic core for nonmoral but “normative” varieties of blameworthiness. (shrink)

Take determinism to be the thesis that for any instant, there is exactly one physically possible future (van Inwagen 1983, 3), and understand incompatibilism regarding responsibility to be the view that determinism is incompatible with moral responsibility. Of the many different arguments that have been advanced for this view, the crux of a relatively traditional one is this: If determinism is true, then we lack alternatives.1 If we lack alternatives, then we can't be morally responsible for any of our behavior. (...) Therefore, if determinism is true, then we can't be morally responsible for any of our behavior. The second premise is a version of the principle of alternate possibilities (PAP): persons are morally .. (shrink)

Take determinism to be the thesis that for any instant, there is exactly one physically possible future, and understand incompatibilism regarding responsibility to be the view that determinism is incompatible with moral responsibility. Of the many different arguments that have been advanced for this view, the crux of a relatively traditional one is this: If determinism is true, then we lack alternatives. If we lack alternatives, then we can't be morally responsible for any of our behavior. Therefore, if determinism is (...) true, then we can't be morally responsible for any of our behavior. The second premise is a version of the principle of alternate possibilities : persons are morally responsible for what they have done only if they could have done otherwise. This principle, in conjunction with the assumptions that responsibility requires control, and that this control consists in the freedom to do otherwise, provides the vital bridge from the initial premise to the skeptical conclusion. Some incompatibilists, joining ranks with various compatibilists, have sought to reject this principle by invoking so-called ‘Frankfurt examples.’. (shrink)

The problem of luck is advanced and defended against libertarian theories of responsibility-enabling ability. An outline of an account of ability is articulated to explore some features of the sort of ability moral responsibility requires. The account vindicates the luck objection and suggests a novel puzzle: Libertarianism is structurally barred from answering the problem of luck because responsibility requires, but inherently lacks, an explanation from reason states to actions that preserves reliability of connection between responsibility-grounding reasons-sensitivity and action.

I address three issues in this paper: first, just as many have thought that there is a requirement of alternative possibilities for the truth of judgments of moral responsibility, is there reason to think that the truth of judgments of intrinsic value also presupposes our having alternatives? Second, if there is this sort of requirement for the truth of judgments of intrinsic value, is there an analogous requirement for the truth of judgments of moral obligation on the supposition that obligation (...) supervenes on goodness? Third, if the truth of judgments of intrinsic value and those of moral obligation do presuppose our having access to alternatives, what should be said about whether determinism imperils the truth of such judgments? I defend an affirmative answer to the first question, a more guarded answer to the second, and a yet more restrained answer to the third. (shrink)

Frankfurt examples attempt to establish that a person can be morally responsible, morally blameworthy, for instance, for doing something despite not being able to do otherwise, as long as the conditions that render him unable to do otherwise play no role in bringing about what he does.Harry Frankfurt, “Alternate Possibilities and Moral Responsibility,” The Journal of Philosophy, Vol. 66 . A more cautious manner of arguing would be to assume only that it is not demonstrated that the agent is not (...) morally responsible. See, e.g., John M. Fischer, “Recent Work on Moral Responsibility,” Ethics, Vol. 110 ; Ishtiyaque Haji and Michael McKenna, “Defending Frankfurt’s Argument in Deterministic Contexts: A Reply to Palmer,” The Journal of Philosophy, Vol. 103 ; and Ishtiyaque Haji and Michael McKenna, “Dialectical Delicacies in the Debate about Freedom and Alternative Possibilities,” The Journal of Philosophy, Vol. 101 . But for present purposes, we can work with the stro .. (shrink)

This article critically examines Kadri Vihvelin's proposal that to have free will is to have the ability to make choices on the basis of reasons, and to have this ability is to have a bundle of dispositions that can be exercised in more than one way. It is argued that partisans of Frankfurt examples can still make a powerful case for the view that being able to do otherwise, even on Vihvelin's compatibilist explication of ‘could have done otherwise,’ is not (...) required for moral responsibility. (shrink)

This article critically examines Kadri Vihvelin's proposal that to have free will is to have the ability to make choices on the basis of reasons, and to have this ability is to have a bundle of dispositions that can be exercised in more than one way. It is argued that partisans of Frankfurt examples can still make a powerful case for the view that being able to do otherwise, even on Vihvelin's compatibilist explication of ‘could have done otherwise,’ is not (...) required for moral responsibility. (shrink)

Recently, Neil Levy has proposed that an agent can acquire freedom-relevant agential abilities by virtue of the conditions in which she finds herself, and in this way, can be thought of as partially constituted by those conditions. This can be so even if the agent is completely ignorant of the relevant environmental conditions, and even if these conditions play no causal role in what the agent does. Drawing upon these resources, Levy argues that Frankfurt-style examples are not cogent. In this (...) paper, we explain why his argument fails. (shrink)

Key elements of Randolph Clarke's libertarian account of freedom that requires both agent-causation and non-deterministic event-causation in the production of free action is assessed with an eye toward determining whether agent-causal accounts can accommodate the truth of judgments of moral obligation.

In this paper, I expose a conundrum regarding divine creation as Leibniz conceives of such creation. What energizes the conundrum is that the concept of omnibenevolence—“consequential omnibenevolence”—that the Leibnizian argument for the view that the actual world is the best of all possible worlds presupposes, appears to sanction the conclusion that God has no practical reasons to create the actual world.

Frankfurt examples invite controversy over whether the pertinent agent in these examples lacks the specific ability to do otherwise, and whether what she does can be obligatory or permissible. We develop an account of ability that implies that this agent does not have the specific ability to refrain from performing the germane action. The account also undergirds a view of obligation that entails that it is morally required or prohibited for an agent to perform an action only if she has (...) the specific ability to do, and to do otherwise than, perform it. Therefore, in Frankfurt examples, it is neither obligatory nor impermissible for the relevant agent to do what she does. (shrink)

The set with the following members is inconsistent: F-Lesson: A person can be blameworthy for performing an action even though she cannot refrain from performing it. Equivalence: ‘Ought not’ is equivalent to ‘impermissible.’ OIC: ‘Ought’ implies ‘can’ and ‘ought not’ implies ‘can refrain from.’ BRI: Necessarily, one is morally blameworthy for doing something only if it is overall morally impermissible for one to do it. Since Equivalence seems unassailable, one can escape the inconsistency by renouncing any one of the other (...) members. I first argue against BRI and then motivate a replacement for it that ties blameworthiness to belief in impermissibility. (shrink)

I first question whether genuinealternatives are necessary for moralresponsibility by assessing the assumption thataccessibility to such alternatives is vital tohaving the kind of control required forresponsibility. I next suggest that theavailability of genuine alternatives courtsproblems of responsibility-subverting luck foran important class of libertarian theories. Isummarize one such problem and respond torecent replies it has elicited. I then proposethat if this ``luck objection'''' against theidentified class of libertarian theories ispersuasive, a similar objection appears toafflict compatibilist theories as well.Finally, I show that (...) reflections on luck maywell take some bite out of variousFrankfurt-type examples. These are examplesdesigned to establish that an agent can bemorally responsible for an action despiteacting with libertarian free will in theabsence of genuine or pertinent alternatives. (shrink)

John Martin Fischer has recently proposed that actions and omissions are asymmetric with respect to the requirement of alternative possibilities for moral responsibility: whereas moral responsibility for an action does not require freedom to refrain from performing the action, moral responsibility for failure to perform an action does require freedom to perform the action. In what follows, I first critically assess Fischer's asymmetry principle. In arguing against the principle, I raise some concerns about Fischer's association of responsibility with control. I (...) then motivate a riddle regarding omissions: some cases appear to show that a person is not responsible for failing to bring about something in virtue of the fact that the person could not bring about that thing. Other cases, though, seemingly show that a person is responsible for failing to bring about something even though the person could not bring about that thing. What explains the asymmetry in responsibility attributions in these cases involving omissions? Third, I consider some answers to this riddle and explain why they are inadequate. Finally, I sketch my own answer. (shrink)

Jennifer Hornsby's account of human action frees us from the temptation to think of the person who acts as 'doing' the events that are her actions, and thereby removes much of the allure of 'agent causation'. But her account is spoiled by the claim that physical actions are 'tryings' that cause bodily movements. It would be better to think of physical actions and bodily movements as identical; but Hornsby refuses to do this, seemingly because she thinks that to do so (...) would be to endorse the so-called 'standard causal story'. But Hornsby misses a possibility here, for we can insist on this identity claim without endorsing the standard story if we embrace an account which parallels the disjunctive account in the philosophy of perception. This will leave us with a picture of physical action that saves the insights of Hornsby's account without succumbing to its distortions. (shrink)

In this essay, I address the question of whether the indisputable progress being made by the neurosciences poses a genuine threat to the language game of responsible agency. I begin by situating free will as an ineliminable component of our practices of attributing responsibility and holding one another accountable, illustrating this via a discussion of legal discourse regarding the attribution of responsibility for criminal acts. I then turn to the practical limits on agents' scientific self-objectivation, limits that turn out to (...) be mirrored philosophically in the conceptual problems that plague reductionist strategies. Having shown that free will is rooted in unavoidable performative presuppositions belonging to agents' participant perspective, I then take up the difficult issue of how to reconcile an epistemic dualism of participant and observer perspectives with the assumption of ontological monism. I critically review a range of proposed physicalist solutions, including non-reductionist and (standard) compatibilist approaches. An underlying problem with scientistic, physicalist approaches is the methodological fiction of an exclusive ?view from nowhere? which relies on the problematic move of disengaging the objectivating perspective of the scientific observer from the investigators' participant perspective of those engaged in scientific practice. Since there is no way of getting around the requisite complementarity of both the observer's encounter with the objective world and the participant's involvement in shared lifeworld practices, the remaining option is to take an epistemological turn. But even the recognition that science is ultimately constituted from within the lifeworld still leaves us with the question as to how the human mind can understand itself as the product of natural evolution. I conclude with some tentative suggestions as to how this difficult question might be addressed. (shrink)

Much has been made about the ways that implicit biases and other apparently unreflective attitudes can affect our actions and judgments in ways that negatively affect our ability to do right. What has been discussed less is that these attitudes negatively affect our freedom. In this paper, I argue that implicit biases pose a problem for free will. My analysis focuses on the compatibilist notion of free will according to which acting freely consists in acting in accordance with our reflectively (...) endorsed beliefs and desires. Though bias presents a problem for free action, I argue that there are steps agents can take to regain their freedom. One such strategy is for agents to cultivate better self-knowledge of the ways that their freedom depends on the relationship between their conscious and unconscious attitudes, and the way these work together to inform action and judgment. This knowledge can act as an important catalyst for agents to seek out and implement short- and long-term strategies for reducing the influence of bias, and I offer four proposals along these lines. The upshot is that though bias is a powerful influence on our actions, we need not resign ourselves to its negative effects for freedom. (shrink)

Do I cause global warming, climate change and their related harms when I go for a leisure drive with my gas-guzzling car? The current verdict seems to be that I do not; the emissions produced by my drive are much too insignificant to make a difference for the occurrence of global warming and its related harms. I argue that our verdict on this issue depends on what we mean by ‘causation’. If we for instance assume a simple counterfactual analysis of (...) causation according to which ‘C causes E’ means ‘if C had not occurred, E would not have occurred’, we must conclude that a single drive does not cause global warming. However, this analysis of causation is well-known for giving counterintuitive results in some important cases. If we instead adopt Lewis’s analysis of causation, it turns out that it is indeterminate whether I cause global warming when I go for a single drive. Still, in contexts where we seek to control or understand global warming, there is a pressure to adopt a more fragile view of this event. When we adopt such a view, it turns out that a single drive does cause global warming. This means that we cannot like Sinnott-Armstrong and Kingston and Sinnott-Armstrong reject the idea that I should refrain from going for a leisure drive simply because such a drive does not cause global warming. (shrink)

I argue that realism about causal powers sublates the passivist, Humean-inflected free will problematic. In the first part of the paper I show that adopting what I call ‘powers-non-determinism’ reconfigures the conceptual terrain with respect to the causation component of the contemporary problematic. In part two I show how adopting ‘powers-non-determinism’ significantly alters the nature of the discussion with respect to the agency component of the problematic. In part three I compare ‘powers-non-determinism’ to an otherwise- Humean agent causal position.

A principle that many have found attractive is one that goes by the name “'Ought' Implies 'Can'.” According to this principle, one morally ought to do something only if one can do it. This essay has two goals: to show that the principle is false and to undermine the motivations that have been offered for it. Toward the end, a proposal about moral obligation according to which something like a restricted version of 'Ought' Implies 'Can' is true is floated. Though (...) no full-fledged argument for this proposal is offered, that it fits with a rather natural and intuitive picture of the structure of morality and seems to explain certain salient features of the debate over whether the principle is true, goes some way toward recommending it. (shrink)

In 1969 harry frankfurt attacked the principle of alternate possibilities, I.E., The principle that one is morally responsible for what one has done only if one could have done otherwise. The first two parts of this paper offer a supplement to and clarification of that principle; the third part defends the supplemented version of it against three frankfurt arguments; and the fourth comments on a recent discussion of it by michael zimmerman.

The standard argument for the incompatibility of determinism and moral responsibility employs the following two premises:A person is morally responsible for what he has done only if he could have done otherwise:A person could have done otherwise only if his action was not causally determined.While premise two has been the focus of an enormous amount of controversy, premise one until recently has remained virtually unchallenged. However, since Harry Frankfurt’s provocative paper in 1969, premise one, which he dubbed the principle of (...) alternate possibilities, has begun to attract its share of the debate. Frankfurt argued that PAP is false and that its falsity undermines the position of those who assert the incompatibility of determinism and moral responsibility. Two previous papers I wrote were devoted in part to showing that Frankfurt’s argument is ineffective; one of those papers also argued that, while PAP is indeed false as it stands, if it is appropriately supplemented, it can continue to serve its traditional role in the determinism-responsibility debate. (shrink)

The Principle that freedom is necessary for moral responsibility has received a variety of explications, but few philosophers have doubted that in some plausible sense it is true. However, two philosophers have recently challenged it using very different but equally ingenious arguments. J.F.M. Hunter has provided the more obviously direct attack in arguing that considerations of freedom as such are in no way relevant to assessments of moral responsibility. Harry Frankfurt has directed his fire at the version of the freedom (...) principle which says that a person is morally responsible for what he has done only if he could have done otherwise. Both Frankfurt and Hunter point out the significance of their arguments for the determinism/moral responsibility debate: if there is no freedom requirement for moral responsibility, then even if determinism threatens freedom, it does not follow that determinism threatens moral responsibility. (shrink)

Orthodoxy holds that the difference between weakness of will and compulsion is a matter of the resistibility of an agent's effective motivation, which makes control-based views of agency especially well equipped to distinguish blameworthy weak-willed acts from non-blameworthy compulsive acts. I defend an alternative view that the difference between weakness and compulsion instead lies in the fact that agents would upon reflection give some conative weight to acting on their weak-willed desires for some aim other than to extinguish them, but (...) not to their compulsive desires. This view allows identificationist theorists of moral responsibility to explain why weak-willed actions, but not compulsive actions, are attributable to agents such that they can, in theory, be praised or blamed for them. After motivating and presenting the view in detail, I show how it has unique resources for explaining the ethics of managing one's compulsions. (shrink)

It is often taken for granted that monitoring stands in some kind of tension with trusting (e.g., Hieronymi 2008; Wanderer and Townsend 2013; Nguyen forthcoming; McMyler 2011, Castelfranchi and Falcone 2000; Frey 1993; Dasgupta 1988, Litzky et al. 2006) — especially three-place trust (i.e., A trusts B to X), but sometimes also two-place trust (i.e., A trusts B, see, e.g., Baier 1986). Using a case study involving relationship breakdown, repair, and formation, I will argue there are some ways in which (...) monitoring can be conducive to two-place trust, and to instances of three-place trust that are likely to be repeated over time—especially when previously established two-place trust has broken down. The result, I hope, is not any kind of abandoning of the important idea that monitoring can undermine trust, but an appreciation of where the conflict between monitoring and trust doesn’t lie – one from which future work will hopefully be better positioned to illuminate where exactly the conflict is. (shrink)

Great technological advances in such areas as computer science, artificial intelligence, and robotics have brought the advent of artificially intelligent robots within our reach within the next century. Against this background, the interdisciplinary field of machine ethics is concerned with the vital issue of making robots “ethical” and examining the moral status of autonomous robots that are capable of moral reasoning and decision-making. The existence of such robots will deeply reshape our socio-political life. This paper focuses on whether such highly (...) advanced yet artificially intelligent beings will deserve moral protection once they become capable of moral reasoning and decision-making. I argue that we are obligated to grant them moral rights once they have become full ethical agents, i.e., subjects of morality. I present four related arguments in support of this claim and thereafter examine four main objections to the idea of ascribing moral rights to artificial intelligent robots. (shrink)

The Southern Journal of Philosophy, Volume 60, Issue 1, Page 88-117, March 2022.

It is often taken for granted that monitoring stands in some kind of tension with trusting (e.g., Hieronymi 2008; Wanderer and Townsend 2013; Nguyen forthcoming; McMyler 2011, Castelfranchi and Falcone 2000; Frey 1993; Dasgupta 1988, Litzky et al. 2006) — especially three-place trust (i.e., A trusts B to X), but sometimes also two-place trust (i.e., A trusts B, see, e.g., Baier 1986). Using a case study involving relationship breakdown, repair, and formation, I will argue there are some ways in which (...) monitoring can be conducive to two-place trust, and to instances of three-place trust that are likely to be repeated over time—especially when previously established two-place trust has broken down. The result, I hope, is not any kind of abandoning of the important idea that monitoring can undermine trust, but an appreciation of where the conflict between monitoring and trust doesn’t lie – one from which future work will hopefully be better positioned to illuminate where exactly the conflict is. (shrink)

Deep Self views of moral responsibility have been criticized for positing mysterious concepts, making nearly paradoxical claims about the ownership of one’s mental states, and promoting self-deceptive moral evasion. I defend Deep Self views from these pervasive forms of skepticism by arguing that some criticism is hasty and stems from epistemic injustice regarding testimonies of experiences of alienation, while other criticism targets contingent features of Deep Self views that ought to be abandoned. To aid in this project, I provide original (...) naturalistic analyses of “Self” and “internality” that replace the view’s metaphorical language with common-sensical concepts that make clear their usefulness. (shrink)

While agreeing with Fischborn’s (2018) contention that, according to one traditional definition of compatibilism, my position should be classified as that of a libertarian incompatibilist, I argue here for a different view of compatibilism. This view involves, on the one hand, local probabilistic causation of decisions (rather than universal strict determinism) and, on the other, free will conceived as involving decisions generated by a decision-making process carried out by the brain, which consciously contemplates different alternatives and could in principle have (...) been different from what it was, implying that the agent could in normal conditions have done otherwise in the same circumstances. After discussing different views of causation (including determinism) and of free will, I make a revision of some passages from my earlier work, quoted by Fischborn. I conclude that what is crucial in the question of (in)compatibilism is the (in)compatibility between freedom of decisions and natural causation of human actions. According to this looser and, I argue, more pertinent view of compatibilism, I maintain my previous classification of my position on the matter as compatibilist. (shrink)

This paper explores the relationship between dynamic and truth conditional semantics for epistemic modals. It provides a generalization of a standard dynamic update semantics for modals. This new semantics derives a Kripke semantics for modals and a standard dynamic semantics for modals as special cases. The semantics allows for new characterizations of a variety of principles in modal logic, including the inconsistency of ‘p and might not p’. Finally, the semantics provides a construction procedure for transforming any truth conditional semantics (...) for modals into a dynamic semantics for modals with similar properties. (shrink)

David Widerker has forcefully argued that a libertarian is on firm ground in believing that the principle of alternative possibilities (PAP) is true. Eleonore Stump has argued that not all libertarians need accept PAP, and that its acceptance is not required for a rejection of compatibilism.This paper is a defense of Widerker against Stump. I argue that it is not at all clear that Stump’s view of freedom is libertarian in nature, and that she has not provided a good reason (...) for thinking that a libertarian can abandon PAP. (shrink)

Eleonore Stump has argued that a proponent of libertarian freedom must maintain that an agent is sometimes morally responsible for his mental action and that such moral responsibility is incompatible with that mental action’s being causally determined. Nevertheless, she maintains that this moral responsibility does not require that the agent be free to perform another mental action (act otherwise). In this paper, I argue that Stump fails to make a good case against the view that moral responsibility requires the freedom (...) to act otherwise. (shrink)

The derivation of the generally held Principle of Alternative Possibilities (PAP), roughly ‘you are morally responsible only if you could do otherwise’, from an even more generally held moral principle, K (for Kant), that roughly speaking ‘ought implies can’, has recently been the focus of significant debate. In this paper I shall argue that by focusing on PAP interpreted in terms of commissions alone an alternative derivation of PAP interpreted in terms of omissions is being overlooked. The advantage of the (...) new derivation is that it avoids many of the criticisms directed at the original derivation. Key Words: alternative possibilities • blameworthiness • moral responsibility • omissions. (shrink)

The thesis that in social sciences causal explanations are possible only in terms o mechanisms due to the lack of genuine laws has been increasingly popular among social scientist and philosophers. In this article it is examined whether the explanation by mechanism is necessarily an explanation without laws or, on the contrary, it can involve some kind o laws. To this end it is argued, firstly, that mechanisms are not always the antonym of law insofar as they express propensities and (...) so tendencies; secondly, that these tendencies ar causal and entail capacities and dispositions; thirdly, that capacities and dispositions involve in human behaviour have to face the problem of free will; and finally, reasons are offered i favor of considering causal tendencies as authentic laws. The ultimate aim of this article is to demonstrate that explanation of social facts can involve well-established laws in its explanans although they are not universal laws. (shrink)

Harry Frankfurt has famously criticized the principle of alternate possibilities—the principle that an agent is morally responsible for performing some action only if able to have done otherwise than to perform it—on the grounds that it is possible for an agent to be morally responsible for performing an action that is inevitable for the agent when the reasons for which the agent lacks alternate possibilities are not the reasons for which the agent has acted. I argue that an incompatibilist about (...) determinism and moral responsibility can safely ignore so-called “Frakfurt-style cases ” and continue to argue for incompatibilism on the grounds that determinism rules out the ability to do otherwise. My argument relies on a simple—indeed, simplistic—weakening of the principle of alternate possibilities that is explicitly designed to be immune to Frankfurt -style criticism. This alternative to the principle of alternate possibilities is so simplistic that it will no doubt strike many readers as philosophically fallow. I argue that it is not. I argue that the addition of one highly plausible premise allows for the modified principle to be employed in an argument for incompatibilism that begins with the observation that determinism rules out the ability to do otherwise. On the merits of this argument I conclude that deterministic moral responsibility is impossible and that Frankfurt ’s criticism of the principle of alternate possibilities—even if successful to that end—may be safely ignored. (shrink)

I develop a puzzle, the resolution of which, I argue, requires an unfamiliar distinction between two forms or senses of metaphysical modality, each bearing a different relationship to time. In one sense of ‘metaphysically possible’, it is metaphysically possible for it to be a time other than the time it is now; in another sense, this is not metaphysically possible.

Alfred Mele and David Robb (1998, 2003) offer what they claim is a counter-example to the principle of alternative possibilities (PAP), the principle that a person is morally responsible for what he has done only if he could have done otherwise. In their example, a person makes a decision by his own indeterministic causal process though antecedent circumstances ensure he could not have done otherwise. Specifically, a simultaneously occurring process in him would deterministically cause the decision at the precise time (...) it actually occurs if he were not to make it 'on his own' i.e. without being deterministically caused.Their case is designed to avoid a well-known dilemma that has plagued earlier apparent counterexamples of this sort. We argue, however, that Mele andRobb's example does not have all the features necessary in order for it to undermine PAP. It still fails to avoid the original dilemma. (shrink)

In their article, Herrera-Ferra et al. (2023) highlight how the progress and implementation of neurotechnology, especially in conjunction with artificial intelligence, have revealed potential impli...

Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical (...) analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)