In virtue of what is something a reason for action? That is, what makes a consideration a reason to act? This is a metaphysical or meta-normative question about the grounding of reasons for action. The answer to the grounding question has been traditionally given in ‘pure’, univocal terms. This paper argues that there is good reason to understand the ground of practical normativity as a hybrid of traditional ‘pure’ views. The paper 1) surveys the three leading ‘pure’ answers to the (...) question of a normative ground, 2) examines one or two of the most difficult problems for each, proposing along the way a new objection to one, and 3) argues that a particular hybrid view about normative grounds –‘hybrid voluntarism’ – avoids each of the main problems faced by the three leading ‘pure’ views. (shrink)

Unrealistic therapeutic beliefs are very common—the majority of patient-subjects enrol in phase 1 trials seeking and expecting significant medical benefit, even though the likelihood of such benefit has historically proven very low. The high prevalence of therapeutic misestimation and unrealistic optimism in particular has stimulated debate about whether unrealistic therapeutic beliefs in early-phase clinical trials preclude adequate informed consent. We seek here to help resolve this controversy by showing that a crucial determination of when such therapeutic beliefs are ethically problematic (...) turns on whether they are causally linked and instrumental to the motivation to participate in the trial. Thus, in practice, it is ethically incumbent on researchers to determine which understanding and beliefs lead to the participant’s primary motivation for enrolling, not to simply assess understanding, beliefs and motivations independently. We further contend that assessing patient-subjects’ appreciation as a component of informed consent—it is already an established component of decision-making capacity assessments—can help elucidate the link between understanding-beliefs and motivation; appreciation refers to an individual’s understanding of the personal significance of both the medical facts and the experience of trial participation. Therefore, we recommend that: in addition to the usual question, ‘Why do you want to participate in this trial?’, all potential participants should be asked the question: ‘What are you giving up by participating in this trial?’ and researchers should consider the settings in which it may be possible and practical to obtain ‘two-point consent’. (shrink)

Feminists, critical race scholars, and other social‐justice theorists sometimes object to “abstraction” in liberal normative theory. Arguing that oppression affects individual agents in powerful yet subtle ways, they contend that allegedly abstract theories often reinforce oppressive power structures. Here I critically examine and ultimately reject Onora O'Neill's “abstraction without idealization” as a solution to this problem. Because O'Neill defines abstraction as simply the “bracketing of certain predicates,” her methodology fails to guide decisions about what to bracket and what to include (...) in the theory. Moreover, it may not be possible to abstract without also relying on some particular ideals. While abstraction is unavoidable, I conclude that it must be employed with greater attention to sociopolitical hierarchies and by using ideals that do not collude with structures of oppression. I discuss the work of Susan Babbitt and Elizabeth Anderson as examples of how nonoppressive ideals might be incorporated into normative theory. (shrink)