This paper is an attempt to reflect on our relative proximity and remoteness to Nazi perpetrators of evil by examining what Bernard Williams has called the problem of “moral luck.” Such situational factors as genetics, class, race/ethnicity, religion, political upheavals and special nurturing relationships provide us with what John Rawls has called the “starting points” of our lives as emergent adults and moral agents. For skeptics like Williams, though, it is unclear that either “saint” or “sinner” has the requisite moral (...) responsibility we take them ordinarily to have, given such situational luck. This paper responds to such skepticism by sketching a version of “compatibilism” that helps itself to insights from recent virtue theory in ethics and functionalism in cognitive science. A major part of this response is a discussion of Chapter 6 of David H. Jones’ important study, Moral Responsibility in the Holocaust, where he argues that Hitler was to blame for the evil he perpetrated because he was responsible for becoming the person he was through an active project of self-deception. Of particular concern here will be how we can use a functionalist account of mind, virtue/vice and compatibilism to understand the phenomenon of a moral agent engaged in an active project of self-deception. At stake here is, of course, our own proximity to such agency. (shrink)

The concept of “moral responsibility” has almost always been defined in relation to a certain idea of metaphysical freedom and to a conception of the physical world. So, classically, for indeterminist thinkers, human beings are free and therefore responsible, if their choices are not defined by a previous state of the world but derive from an autonomous selection among a set of alternatives. Differently, for the majority of determinist philosophers , the only form of freedom we need has to be (...) identified with freedom of the conduct, considered as opposite to any form of coercion. Some argue that, given the truth of determinism and the related suppression of concepts such as “guilt” and “praise”, or “merit” and “demerit”, morality could survive just as a utilitarian tool, even though this seems to be in conflict with our deepest feelings and practices. Considering some revisionist approaches of moral responsibility in connection with classical positions , I will reconstruct some of the attempts to release responsibility from the thematisation of freedom, exploring the possibility of redefining it as an independent concept. My conclusion is that the focus on the choice-action process and on the characteristics of the “self”, avoiding reference to alternative scenarios, could be a good starting point for elaborating a conception of what really counts for our moral life – even though, in the end, this could entail the abandonment of the traditional concept of responsibility itself. (shrink)

John Christman has recently objected to substantive conceptions of autonomy on the grounds that they introduce unwanted perfectionism into political thinking. I defend substantive conceptions of autonomy against Christman’s critique on two fronts. First, I defend substantive conceptions of autonomy against the charge that their utilisation in political theory would result in the inappropriate exclusion from democratic respect of individuals in oppressive relations. Second, I defend substantive conceptions of autonomy from the charge that they fail the ‘endorsement constraint’, i.e. that (...) incorporating a substantive conception of autonomy into the concept of the person at the heart of a political theory would be alienating for citizens. (shrink)

Minimalists generally see themselves as engaged in a descriptive project. They maintain that they can explain everything we want to say about truth without appealing to anything other than the T-schema, i.e., the idea that the proposition that p is true iff p. I argue that despite recent claims to the contrary, minimalists cannot explain one important belief many people have about truth, namely, that truth is good. If that is so, then minimalism, and possibly deflationism as a whole, must (...) be rejected or recast as a profoundly revisionary project. (shrink)

Sterelny's Thought in a Hostile World ([2003]) presents a complex, systematically structured theory of the evolution of cognition centered on a concept of decoupled representation. Taking Godfrey-Smith's ([1996]) analysis of the evolution of behavioral flexibility as a framework, the theory describes increasingly complex grades of representation beginning with simple detection and culminating with decoupled representation, said to be belief-like, and it characterizes selection forces that drive evolutionary transformations in these forms of representation. Sterelny's ultimate explanatory target is the evolution of (...) human agency. This paper develops a detailed analysis of the main cognitive aspects. It is argued that some of the major claims are not correct: decoupled representation as defined doesn't capture belief-like representation, and, properly understood, decoupled representation turns out to be ubiquitous among multicellular animals. However, some of the key ideas are right, or along the right lines, and suggestions are made for modifying and expanding the conceptual framework. (shrink)

(2013). Autonomy and the Normativity Question: Framing Considerations. International Journal of Philosophical Studies. ???aop.label???. doi: 10.1080/09672559.2012.727014.

Ethics, Policy & Environment, Volume 15, Issue 2, Page 248-251, June 2012.

Manipulation arguments for incompatibilism all build upon some example or other in which an agent is covertly manipulated into acquiring a psychic structure on the basis of which she performs an action. The featured agent, it is alleged, is manipulated into satisfying conditions compatibilists would take to be sufficient for acting freely. Such an example used in the context of an argument for incompatibilism is meant to elicit the intuition that, due to the pervasiveness of the manipulation, the agent does (...) not act freely and is not morally responsible for what she does. It is then claimed that any agent's coming to be in the same psychic state through a deterministic process is no different in any relevant respect from the pertinent manner of manipulation. Hence, it is concluded that compatibilists' proposed sufficient conditions for free will and moral responsibility are inadequate, and that free will and moral responsibility are incompatible with determinism. One way for compatibilists to resist certain manipulation arguments is by appealing to historical requirements that, they contend, relevant manipulated agents lack. While a growing number of compatibilists advance an historical thesis, in this paper, I redouble my efforts to show, in defense of nonhistorical compatibilists like Harry Frankfurt, that there is still life left in a nonhistorical view. The historical compatibilists, I contend, have fallen shy of discrediting their nonhistorical compatibilist rivals. (shrink)

Typical justifications of prudence are based on the fact that we are temporally extended agents who remain numerically identical over time. After showing that prudential considerations should instead be based on our identity at a particular time, I outline a normative context for prudential reasons, based on a present commitment to temporal neutrality. I then consider how contingency in the content of a present commitment to temporal neutrality provides a flexible context that can help to resolve current debates about whether (...) agents are required to maximize value, maximin value, minimax loss or are required to conform to any of a host of other options on how to adjudicate various types of conflict between present and future values. (shrink)

The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of (...) practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order. (shrink)

Two plausible claims seem to be inconsistent with each other. One is the idea that if one reasonably believes that one ought to fi, then indeed, on pain of acting irrationally, one ought to fi. The other is the view that we are fallible with respect to our beliefs about what we ought to do. Ewing’s Problem is how to react to this apparent inconsistency. I reject two easy ways out. One is Ewing’s own solution to his problem, which is (...) to introduce two different notions of ought. The other is the view that Ewing’s Problem rests on a simple confusion regarding the scope of the ought-operator. Then, I discuss two hard ways out, which I label objectivism and subjectivism, and for which G.E. Moore and Bishop Butler are introduced as historical witnesses. These are hard ways out because both of these views have strong counterintuitive consequences. After explaining why Ewing’s Problem is so difficult, I show that there is conceptual room in-between Moore and Butler, but I remain sceptical whether Ewing’s Problem is solvable within a realist framework of normative facts. (shrink)

It is no news that you and I are agents as well as persons. Agency and personhood are surely connected, but it is not obvious just how they are connected. I believe that being a person and being an agent are intimately linked by what I call a ‘first-person perspective’: All persons and all agents have first-person perspectives. Even so, the connection between personhood and agency is not altogether straightforward. There are different kinds of agents, and there are different kinds (...) of first-person perspectives. On the one hand, all persons are agents, but not all agents are persons; on the other hand, all moral agents are persons, but not all persons are moral agents. (shrink)

Niko Kolodny It is often said that there is a special class of norms, ‘rational requirements’, that demand that our attitudes be related one another in certain ways, whatever else may be the case.1 In recent work, a special class of these rational requirements has attracted particular attention: what I will call ‘requirements of formal coherence as such’, which require just that our attitudes be formally coherent.2 For example, we are rationally required, if we believe something, to believe what it (...) entails. And we are rationally required, if we intend an end, to intend what we take to be necessary means to it. The intuitive idea is that formally incoherent attitudes give rise to a certain normative tension, or exert a kind of rational pressure on each another, and this tension, or pressure, is relieved just when one of the attitudes is revised. As John Broome observes, these requirements are, by their nature, ‘wide scope’, which is to say that there is no particular attitude that one must have or lack in order to satisfy them. This is because they require just formal coherence, and there is no particular attitude that one must have or lack in order to be formally coherent. (shrink)

Autonomy and valuing are two significant practical phenomena that have been analysed in terms of higher-order wanting. I argue that reference to higher-order capacities is indeed required to make sense of both concepts, but also that such analyses need a more differentiated understanding of "wanting to want" than has hitherto been proposed. Central for autonomy is the instantiation of four types of optative relationship by an accountable agent under conditions of rationality. Valuing requires the disposition to instantiate only one of (...) the relevant structures. Clarity on this allows an analysis of the precise relationships between the two phenomena. (shrink)

The autonomous person is one who has, in some sense, mastery over their desires. The prevailing way to understand such personal autonomy is in terms of a hierarchy of desires. For Harry Frankfurt, persons not only have first-order desires, but possess the additional capacity to form second-order desires. Second-order desires are formed through reflection on first-order desires and are thus expressive of the rational capacity which is characteristic of persons. Frankfurt's account of freedom of the will is founded on his (...) analysis of persons. It is only because persons possess second-order desires, resulting from their capacity for rational evaluation of first-order desires, that persons (and not those Frankfurt calls 'wantons') are well placed to possess freedom of will. Various objections have been raised in the literature against such second-order desire accounts of freedom of the will or autonomy. In my article, I raise the problem of instrumental second-order desires. I discuss the forms instrumental second-order desires can take and attempt to show that these cannot be the second-order desires that Frankfurt has in mind in his account. I then extend my critique by looking at non-instrumental second-order desires. I consider various forms which non-instrumental second-order desires can take and advance the argument that Frankfurt cannot have second-order desires such as these in mind either. Finally, I note that none of the suggestions considered will deliver a second-order desire account of autonomy, and that it is baffling just what Frankfurt does have in mind. (shrink)

The main goal of this paper is to show that Pettit and Smith’s (1996) argument concerning the nature of free belief is importantly incomplete. I accept Pettit and Smith’s emphasis upon normative constraints governing responsible believing and desiring, and their claim that the responsibly believing agent needs to possess an ability to believe (or desire) otherwise when believing (desiring) wrongly. But I argue that their characterization of these constraints does not do justice to one crucial factor, namely, the presence of (...) an unreflective, sub-personally constituted, ability to spot the kind of situations in which the reflective critical abilities constitutive of responsible believing (and desiring) should be deployed. (shrink)

In contemporary philosophy, the will is often regarded as a sheer philosophical fiction. In Will as Commitment and Resolve , Davenport argues not only that the will is the central power of human agency that makes decisions and forms intentions but also that it includes the capacity to generate new motivation different in structure from prepurposive desires. The concept of "projective motivation" is the central innovation in Davenport's existential account of the everyday notion of striving will. Beginning with the contrast (...) between "eastern" and "western" attitudes toward assertive willing, Davenport traces the lineage of the idea of projective motivation from NeoPlatonic and Christian conceptions of divine motivation to Scotus, Kant, Marx, Arendt, and Levinas. Rich with historical detail, this book includes an extended examination of Platonic and Aristotelian eudaimonist theories of human motivation. Drawing on contemporary critiques of egoism, Davenport argues that happiness is primarily a byproduct of activities and pursuits aimed at other agent-transcending goods for their own sake. In particular, the motives involved in virtue and in its practice as understood by Alasdair MacIntyre are projective rather than eudaimonist. This theory is supported by analyses of radical evil, accounts of intrinsic motivation in existential psychology, and contemporary theories of identity-forming commitment in analytic moral psychology. Following Viktor Frankl, Joseph Raz, and others, Davenport argues that Harry Frankfurt's conception of caring requires objective values worth caring about, which serve as rational grounds for projecting new final ends. The argument concludes with a taxonomy of values or goods, devotion to which can make life meaningful for us. (shrink)

In this work I examine the reasons offered by David Lewis in favor of tolerance in his works “Mill and Milquetoast” and “Academic Appointments: Why Ignore the Advantage of Being Right?” In the first section I expose and discuss the conception of tolerance that is the target of Lewis’s objections, namely, the conception defended by J.S. Mill. In the second section I expose and discuss Lewis’s main reasons in favor of tolerance and the advantages that, according to Lewis, has his (...) position in relation to that of Mill. In the third section I discuss some of the philosophical and political consequences that seem to follow from Lewis’s proposal and from his criticisms of Mill’s conception of tolerance. (shrink)

A number of influential Kantian philosophers assume that true need represents shared and fundamental human concerns that can both ground duties of aid and limit how much an agent can be morally required to do for others. In this paper, I take on this misreading and argue that true need is representative of personal priorities. This subjectivist reading fits better with Kant’s own characterization of true need and with his conceptions of need and happiness. Moreover, I argue that Kant’s own (...) conception of true need is philosophically appealing, as it is anti-paternalistic. Agents are free to determine their own true need. This frees Kant from the challenge of coming up with a list of true human needs that are supposedly stable across cultures, epochs and individuals. Furthermore, my reading also implies that the mere fact that someone else considers something their true need does not necessitate our help. (shrink)

Conscience is an idea that has significant currency in liberal democratic societies. Yet contemporary moral philosophical scholarship on conscience is surprisingly sparse. This paper seeks to offer a rigorous philosophical account of the role of conscience in moral life with a view to informing debates about the ethics of conscientious objection in medicine. I argue that conscience is concerned with a commitment to moral integrity and that restrictions on freedom of conscience prevent agents from living a moral life. In section (...) one I argue that conscience is a principle of moral awareness in rational agents, and that it yields an awareness of the personal nature of moral obligation. Conscience also monitors the coherence between an agent’s identity-conferring beliefs and intentions and their practical actions. In section two I consider how human beings are harmed when they are forced to violate their conscience. Restrictions on the exercise of conscience prevent people from living in accord with their own considered understanding of the requirements of morality and undermine one’s capacity for moral agency. This article concludes with a consideration of how a robust theory of conscience can inform our understanding of conscientious objection in medicine. I argue that it is in the interest of individual practitioners and the medical profession generally to foster moral agency among doctors. This provides a prima facie justification for permitting at least some kinds of conscientious objection. (shrink)

This book offers a solution to the ancient philosophical problem regarding the nature and the justification of morality. The importance of this subject matter is obvious, not merely as an abstract philosophical problem, but perhaps even more as a practical challenge, regarding the way we ought to live our lives: the values that ought to direct us, and the ends that we ought to pursue. -/- In the course of this inquiry, a wide array of philosophical topics is explored: the (...) nature of intentional action, and the role played by reason and desires in agency; the question of the final end of agency – better known in ancient terminology as the question of the purpose of life, and in modern terms as the question of the meaning of life; the nature of moral obligations and their rational justification; the challenge posed by determinism for the freedom of the will, with its implications on fatalism and moral responsibility; and normative questions regarding the value of life. (shrink)

This thesis focuses on what I call the question of exclusion. This question, I argue, is one that poses serious challenges to social contract approaches to justice and political legitimacy. In an intuitive way, the exclusion of some individuals seems to be a corollary of the social contractualist approach, which ascribes justice or legitimacy to a social arrangement insofar as it can be regarded as the product of the (actual – expressed or tacit – or hypothetical) consent of specified parties. (...) Consequently, this approach excludes those whose consent is not required in order to view an arrangement as legitimate or just. Given the enormous and continuing influence of John Rawls’s social contract theory, I take the Rawlsian view as my primary focus, concentrating on the way in which the question of exclusion raises challenges for Rawlsian contractualism. According to Rawls’s theory, those who participate in the hypothetical contract and to whom political power ought to be justifiable are reasonable and rational. They are reasonable in the sense that they understand and are willing to comply with the requirements of justice and they are rational in that they have the capacity to form, revise, and pursue a conception of the good. This gives rise to two categories of exclusion. In the first part of the thesis, I examine the exclusion of those who will develop the two moral powers sufficiently only if those who are represented in the social contract act (or refrain from acting) in certain ways. This category includes children, foetuses, and unreasonable citizens. Intuitively, justice issues in requirements in at least some of these cases, but it is hard to make sense of this on the Rawlsian approach. In the second part of the thesis, I address the question of exclusion regarding those who will never develop the two moral powers to the requisite degree, such as individuals with severe cognitive disabilities and non-human animals. Again, intuitively, justice issues in requirements here, but their justification is not clear on the contractualist approach. My conclusion is threefold. First, I argue that the problems the question of exclusion poses cannot be addressed by a single solution. Second, I safeguard Rawlsian contractualism by showing how each problem can be resolved. Third, I offer policy-prescriptions on a number of issues, such as education, abortion, and the criminal justice system. (shrink)

This thesis presents a communicative account of personhood that argues for the inseparability of the metaphysical and the practical concepts of a person. It connects these two concepts by coupling the question “what is a person” with the question "how does one become a person". It argues that participation in social interactions that are characterized by mutual recognition and giving-and-taking reasons implied by the practical concept of a person is in fact an ecological and developmental condition for an entity to (...) possess the kind of characteristics and capacities such as reflexive self-consciousness addressed by the metaphysical concept. The chief theoretical contribution of the dissertation research lies, accordingly, in demonstrating that an adequate metaphysical concept of a person has to make reference to the kind of social processes that are necessary for the emergence and development of the distinguishing attributes of persons among other moving, perceiving, desiring and cognizing agents. Methodologically, it undertakes an original philosophical analysis that is enriched by an interdisciplinary investigation of several notions and insights from semiotics, comparative and developmental psychology, cognitive science and anthropology. The main argument of the thesis is that one becomes a person through internally recreating a social, communicative process; namely, that of dialogical transformation of habits. We find the paradigmatic case of this social process in mutual persuasion. The internalization of this process in the form of an inner dialogue cultivates a social self that is in ongoing communication with the embodied, organismic self of uncritically habituated attitudes, convictions and desires. This inner dialogue can be conceived as a temporally extended process of self-persuasion, which is characterized by an ongoing strive for attaining higher degrees of self-control; that is, for achieving a more coherent alignment between our habits and the kind of person we would like to be. It starts with self-interpretation and self-evaluation, and culminates in the formation of higher-order desires that facilitate habit-change and novel habit formation in accordance with certain social, moral, aesthetical or intellectual categories and norms one comes to endorse. For this reason, self-induced, deliberate habit-change is also a process of appropriation or self-appropriation, through which we strive to cultivate habits of feeling, thinking, acting that we can deem more truly ours. The thesis demonstrates that the capacity for engaging in this kind of self-persuasion consists chiefly in the capacities for metasemiosis, perspective-taking, and for cultivating habits of reflexivity. It explicates how all these capacities have a social origin and ultimately a social function by showing that they all presuppose certain higher-order communicative patterns that arose through an evolutionary and cultural history, and develop through the internal reconstruction of these patterns as cognitive-semiotic processes. The thesis concludes that becoming a kind of being who can engage in self-persuasion, thus a person, consists ultimately in internalizing the patterns of communicative social interactions in the form of an ongoing auto-communication. (shrink)

Most contemporary accounts of moral responsibility take desert to play a central role in the nature of moral responsibility. It is also assumed that desert is a backward-looking concept that is not directly derivable from any forward-looking or consequentialist considerations, such as whether blaming an agent would deter the agent from performing similar bad actions in the future. When determining which account of moral responsibility is correct, proponents of desert-based accounts often take intuitions about cases to provide evidence either in (...) favor of or against a proposed theory. In this paper, I discuss two experiments that test whether folk intuitions accord with what desert-based accounts would predict. Results suggest that moral responsibility intuitions are sensitive to forward-looking considerations, thus posing a problem for desert-based accounts of moral responsibility. If appealing to intuitions about cases is a valid method of discovering the nature of moral responsibility and desert, it seems either desert is not entirely backward-looking or moral responsibility is not exclusively desert-based. These experimental results also suggest that consequentialist accounts of moral responsibility, which have largely been abandoned due to their counterintuitive nature, are perhaps not so counterintuitive after all. (shrink)

Traditionally, the management of technology has focused on the stages before or after development of technology. In this approach the technology itself is conceived as the result of a deterministic enterprise; a result that is to be either rejected or embraced. However, recent insights from Science and Technology Studies (STS) have shown that there is ample room to modulate technology during development. This requires technology managers and engineering ethicists to become more involved in the technological research rather than assessing it (...) from an outsider perspective. Instead of focusing on the question whether or not to authorize, approve, or adopt a certain technology or on the question of who is to blame for potential mistakes, the guiding question in this new approach is how research is to be carried out. (shrink)

This article starts with the idea that the task of social philosophy can be defined as the diagnosis and therapy of social pathologies. It discusses four conceptions of social pathology. The first two conceptions are ‘normativist’ and hold that something is a social pathology if it is socially wrong. On the first view, there is no encompassing characterization of social pathologies available: it is a cluster concept of family resemblances. On the second view, social pathologies share a structure (e.g. second-order (...) disorder). The last two conceptions are ‘naturalist’ and hold that something is wrong because it is pathological. The third view takes it that society is the kind of substance that can fall ill – an organism. The fourth view operates with the notion of a social life that can degenerate. The four conceptions are compared along six criteria: (1) is the view plausible?; (2) is it informative (if true)?; (3) does it help define the task of social philosophy?; (4) does it take naturalistic vocabulary seriously?; (5) does it hold that pathologies share a structure?; and (6) how does it see the primacy of being wrong and being pathological? (shrink)

The paper examines Schiller’s argument concerning the subjective experience of adopting a morality based on Kantian principles. On Schiller’s view, such experience must be marked by a continuous struggle to suppress nature, because the moral law is a purely rational and categorically commanding law that addresses beings who are natural as well as rational. Essential for Schiller’s conclusion is the account he has of what it takes to follow the law, that is, the mental states and functions that encapsulate the (...) idea of moral self contained in Kant’s ethics. Focusing on the fundamental psychological elements and processes to which Kant’s theory appeals and on which it depends to have application, the paper defends an alternative idea of moral self to the one Schiller attributes to Kant. (shrink)

Philosophical lessons come in many different shapes and sizes. Some lessons are big, some are small. Some lessons go deep and have a big impact, some are shallow and have almost none. Some lessons are not really philosophical at all or would not really be lessons for an audience of academic philosophers. I mention these truisms not to disparage this informative book on 'moral OCD' (moral obsessive-compulsive disorder, or 'Scrupulosity') but rather to emphasize how difficult it can be to discern (...) the book's intended audience, given its interdisciplinary aims and structure. That question is never explicitly addressed (it is admittedly a slim book, slimmer than it appears), but the question has consequences for how to think about the book's ultimate value, and for whom. The book might attract two groups in particular: philosophers working on the nature of responsibility (the subject of the book's longest chapter) and psychiatric researchers or mental health professionals interested in moral philosophy and the philosophy of mental illness. I will return to what moral philosophers can learn from moral OCD, but there will be spoilers. (shrink)

Political participation lies at the heart of normative democratic theory. To foster participatory interactions between citizens, some advocates and designers are resorting to gamification as the use of psycho-motivational involvement strategies from games in non-game contexts. The hope is that through gamification mechanisms, citizens will be drawn more easily towards participation platforms, apps, and digital services, as well as remain there longer, thereby effectively enhancing participation numbers and time. In this article, I will explore the potential problems of these involvement (...) strategies, namely the worry that they may be able to undermine citizen’s individual and political autonomy by manipulating them into participating. Depending on the severity of the psycho-motivational effect as well as the covertness of the mechanism, gamification may constitute inadmissible forms of paternalism. (shrink)

Part I of the dissertation examines the cognitive aspects of autonomy. The central question concerns what kind of cognitive capacity autonomy is. It will be argued that the concept of autonomy is best understood in terms of a metacognitive capacity of the individual. It is argued that metacognition has two components: procedural reflexivity and metarepresentation. Metarepresentation in turn can be divided into inferential reflexivity and other-attributiveness. These two components are essential for autonomy. Particular emphasis is put on procedural reflexivity. Further, (...) since the essential function of metacognition is control, it is argued that the concept of autonomy, understood as a metacognitive capacity, can be interpreted in terms of control. Issues arising from empirical data from neuroscience on functional, as well as impaired, metacognition, and on undermined autonomy, are dealt with. It is argued that autonomy cannot be determined with respect to subjective conditions. Neurological impairments, like Anton’s Syndrome, dementia, and thought insertion in schizophrenia, are put forward in support of this claim. To determine autonomy we require external conditions. In order to determine whether an individual is autonomous, both the metacognitive status of the individual and the external setting must be considered, since they are in interplay and consequently influence each other. In Part II, the analysis put forward in Part I is applied to Swedish healthcare. It is argued that the distinction between autonomy as a right and as a capacity must be explicit in order to understand what autonomy means and to deal with it effectively in healthcare practice. A discussion about whether or not the patient’s right to autonomy sometimes tends to be over-emphasized in healthcare is put forward. Special emphasis is placed on psychitaric issues such as deinstitutionalization and participation. Following the closure of the mental hospitals, deinstitutionalization and community-based care have become central topics in psychiatry. At the same time, the implementation of such care can be demanding for patients suffering from a persistent mental disorder. In part II it is also suggested that the metacognitive account of the concept of autonomy might help clarify the criteria governing coercive care. Finally, some suggestions concerning developments and improvements in Swedish healthcare, especially in psychiatry, where the concept of autonomy is important but problematic, are put forward. (shrink)

The Western focus on personal autonomy as the normative basis for securing persons’ consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor’s wish to donate after she (...) has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept. (shrink)

There is a long-standing interest in business ethics around the concept of free will, but study of its possible influence on consumer behavior is only in the nascent stage. This lack of research is particularly acute in certain consumption contexts, especially ones based on highly restricted access that appear to suggest abrogation of the will. In this paper, we offer a novel approach that involves reexamination of qualitative/ethnographic research that has chronicled consumption restrictions without consideration of potential implications for free (...) will. Using a new reanalysis method, we show that some of what is described as “vulnerability” using other theoretical paradigms is subsumed within this domain. Findings demonstrate that a complex relationship between free will and various consumption processes and outcomes exists that is acted out within and outside licit and illicit/formal and informal markets. These restrictions allow for a different vantage point to address free will and consumption, with implications for business ethicists and researchers interested in human quality treatment or human dignity-centered business frameworks. (shrink)

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient autonomy. These different manifestations of (...) autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

Ser eficaz a la hora de tomar los medios pertinentes para nuestros fines se ha considerado como uno de los aspectos paradigmáticos de la racionalidad. Sin embargo, reconocer la normatividad de la racionalidad instrumental parece implicar la problemática tesis de que uno debe tomar los medios apropiados para sus fines por el mero hecho de tener estos fines, con independencia de cuán irracionales o inmorales sean. En estas páginas defiendo una concepción de la racionalidad instrumental que permite a un mismo (...) tiempo reconocerla como normativa y afirmar que hay medios que uno no debería tomar aun cuando se proponga fines para los que son pertinentes. (shrink)

The purpose of this paper is twofold. First, I defend and expand the Fortificationist Theory of Punishment. Second, I argue that this theory implies that non-consensual neurointerventions – interventions that act directly on one’s brain – are permissible. According to the FTP, punishment is justified as a way of ensuring that citizens who infringe their duty to demonstrate the reliability of their moral powers will thereafter be able to comply with it. I claim that the FTP ought to be expanded (...) to include citizens’ interest in developing their moral powers. Thus, states must ensure that their citizens develop their moral reliability, not only because they must enforce their citizens’ compliance with certain duties, but also because states have the duty to maintain the conditions for stability and satisfy their citizens’ interest in developing their moral powers. According to this account of the FTP, if neurointerventions are the only or best way of ensuring that offenders can discharge their fortificational duties, states have strong reasons to provide these interventions. (shrink)

ABSTRACTWhen is sacrifice – and particularly self-sacrifice – called for? This question turns out to be difficult to answer, for it tends to arise when values conflict, and hence the answer to it depends on how conflicts of values are to be resolved. If values are constructed, and if there is no single right way to construct them or prioritize them when they conflict, though there are identifiable ways in which the construction of values can go wrong, we may be (...) left in a position of ambivalence about what should be sacrificed. In cases of conflict in which self-sacrifice is one of the options, ambivalence may be particularly appropriate. In part this is because there may be in such cases special sources of plurality and incommensurability of values, because the conflict is likely to be between something that is valued by a social group, and something that is valued particularly by an individual who has to consider self-sacrificing. And in part it is because individuals may have trouble balancing self-regarding and other-regarding concerns in the process of value construction. This paper elaborates these complications, and presents cases in which we might suspect that someone has self-sacrificed too much or too little. (shrink)

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of autonomy, and argue that (...) a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Judgment and Agency contains Sosa’s latest effort to explain how higher epistemic value of the sort missing from an unwitting clairvoyant’s beliefs might be a special case of performance normativity, with its superior value following from truisms about performance value. This paper argues that the new effort rests on mistaken assumptions about performance normativity. Once these mistaken assumptions are exposed, it becomes clear that higher epistemic value cannot be a mere special case of performance normativity, and its superiority cannot be (...) guaranteed just by truisms about performance value. Sections 1 and 2 set the stage, clarifying the thesis and the relevant features of Sosa’s strategy, and explaining why the strategy requires the mistaken assumptions. Section 3 presents a dilemma for the new account of higher epistemic value. Section 4 deepens the case for one of the horns. Section 5 takes stock and draws some broader morals. (shrink)

According to Fischer and Ravizza, an agent has guidance control over some action A, whenever A is issued from one of their own moderately reasons-responsive mechanisms. This involves two elements: the process P leading to their action being suitably responsive to reasons-; and their taking an attitude towards processes of kind P such that they see themselves as the agents of the behaviour those processes issue. For the purposes of this paper, I assume that guidance control amounts to actually guiding (...) some action. I present, and defend, a counterexample in which an agent intentionally acts via a suitably reasons-responsive process which they have taken responsibility for and yet, intuitively, does not actually guide their action. On this basis, I argue that taking responsibility for a moderately reasons-responsive mechanism is not sufficient for having guidance control. (shrink)

This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources such as tissue (...) samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

We use recent interventionist theories of causation to develop a compatibilist account of causal sourcehood, which provides a response to Manipulation Arguments for the incompatibility of free will and determinism. Our account explains the difference between manipulation and determinism, against the claim of Manipulation Arguments that there is no relevant difference. Interventionism allows us to see that causal determinism does not mean that variables outside of the agent causally explain her actions better than variables within the agent, whereas the causal (...) source of a manipulated agent’s actions instead lies outside of the agent in the intentions of the manipulator. As a result, determined agents can have free will and be morally responsible in a way that manipulated agents cannot, contrary to what Manipulation Arguments conclude. In this way, our account demonstrates not only how Manipulation Arguments fail but also how compatibilism can be strengthened by means of a plausible account of causal sourcehood. (shrink)

For those who maintain that free will is incompatible with causal determinism, a persistent problem is to give a coherent characterization of action that is neither determined by prior events nor random, arbitrary, lucky or in some way insufficiently under the control of the agent to count as free action. One approach—that of Roderick Chisholm and others—is to say that a third alternative is for an action to be caused by an agent in a way that is not reducible to (...) event causal terms. A different approach than the Chisholmian appeal to primitive substance causation is one that, instead, involves causal relations purely among events. This paper presents a particular event-causal indeterminist account of free action, describing both its attractions and recent objections to it, and then proposes a revised version, with the aim of supporting the plausibility of an event-causal indeterminist approach to free will. (shrink)