Can addiction be credibly invoked as an excuse for moral harms secondary to particular decisions to use drugs? This question raises two distinct sets of issues. First, there is the question of whether addiction is the sort of consideration that could, given suitable assumptions about the details of the case, excuse or mitigate moral blameworthiness. Most discussions of addiction and moral responsibility have focused on this question, and many have argued that addiction excuses. Here I articulate what I take to (...) be the best argument for this view, based on the substantial difficulty that people with severe addiction experience in controlling drug-related behavior. This, I argue, may in some cases be sufficient to ground a mitigating excuse, given the way in which addiction undermines agents’ responsiveness to relevant moral reasons to do otherwise. Much less attention has been devoted to a second set of issues that critically affect the possibility of applying this mitigating excuse in particular cases, derived from the ambivalent nature of agential control in addiction. In order to find a fitting response to moral harm, the person with the right standing to blame must make a judgment about the extent to which the agent possessed certain morally relevant capacities at the time of the act. In practice, this will often prove tremendously difficult to assess. The ethical challenge for the person with the right standing to blame is fundamentally one of making a judgment about matters that seem underdetermined by the available evidence. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

How exactly do mental disorders affect one’s agency? How might therapeutic interventions help patients regain or improve their autonomy? Do only some disorders excuse morally inappropriate behavior, such as theft or child neglect? Or is there nothing about having a disorder, as such, that affects whether we ought to praise or blame someone for their moral success or failure? Our volume gathers together empirically-informed philosophers who are well equipped to tackle such questions. Contributors specialize in free will, agency, and responsibility, (...) but they are informed by current scientific and clinical approaches to a wide range of psychopathologies, including autism, addiction, Tourette syndrome, personality disorders, depression, dementia, phobias, schizophrenia, and obsessive-compulsive disorder. These conditions exhibit a diverse array of symptoms that can contribute quite differently to being blameworthy or praiseworthy. (shrink)

The burgeoning science of ethics has produced a trend toward pessimism. Ordinary moral thought and action, we’re told, are profoundly influenced by arbitrary factors and ultimately driven by unreasoned feelings. This book counters the current orthodoxy on its own terms by carefully engaging with the empirical literature. The resulting view, optimistic rationalism, shows the pervasive role played by reason, and ultimately defuses sweeping debunking arguments in ethics. The science does suggest that moral knowledge and virtue don’t come easily. However, despite (...) the heavy influence of automatic and unconscious processes that have been shaped by evolutionary pressures, we needn’t reject ordinary moral psychology as fundamentally flawed or in need of serious repair. Reason can be corrupted in ethics just as in other domains, but a special pessimism about morality in particular is unwarranted. Moral judgment and motivation are fundamentally rational enterprises not beholden to the passions. (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s mental (...) disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

Most philosophical discussions of psychopathy have centered around its significance in relation to empathy, moral cognition, or moral responsibility. However, related questions about the extent to...

Most philosophical discussions of psychopathy have centered around its significance in relation to empathy, moral cognition, or moral responsibility. However, related questions about the extent to...

The question of whether psychopaths are criminally and morally responsible has generated significant controversy in the literature. In this paper, we discuss what relevance a psychopathy diagnosis has for criminal responsibility. It has been argued that figuring out whether psychopathy is a mental illness is of fundamental importance, because it is a precondition for psychopaths’ eligibility to be excused via the legal insanity defense. But even if psychopathy counts as a mental illness, this alone is not sufficient to show the (...) insanity defense is applicable; it must also be shown that, as a result of the illness, specific deficits in moral understanding or control are present. In this paper, we show that a diagnosis of psychopathy will generally not indicate that a defendant is eligible for an insanity defense. This is because the group of individuals subsumed under the diagnosis is so heterogeneous that while some psychopaths do show significant impairments in affect and control which may impact on their responsibility, many psychopaths are not incapacitated in a way relevant to responsibility. (shrink)

The aim of this paper is to present a solution to a problem that arises from the fact that people who commit crimes under the influence of serious mental disorders may still have a capacity to refuse treatment. Several ethicists have argued that the present legislation concerning involuntary treatment of people with mental disorder is discriminatory and should change to the effect that psychiatric patients can refuse care on the same grounds as patients in somatic care. However, people with mental (...) disorders who have committed crimes and been exempted from criminal responsibility would then fall outside the scope of criminal justice as well as that of the psychiatric institutions if they were to refuse care. In this paper, I present and develop a solution to how society should deal with this group of people, called Advance criminal responsibility. The basic idea being that if a person with a potentially responsibility exempting psychiatric condition refuses care, that person is responsible for any future criminal acts which are due to the mental disorder. (shrink)

Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as _the responsibility problem_, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients’ potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do (...) away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model. (shrink)

A version of the principle of alternate possibilities claims that one is only blameworthy for actions which one was able to avoid. Much of the discussion about PAP concerns Frankfurt’s counterexamples to it. After fifty years of refined debates, progress might seem hopeless. Yet, we can make headway by asking: “what’s our reason for believing PAP?” The best answer is this: lacking eligible alternatives—alternatives whose cost is not too high to reasonably opt for—is a good excuse. Yet, this principle is (...) subject to straightforward counterexamples, unless it is given an epistemicised reading. And in this latter case, it does not support PAP. So, PAP is unsupported, at least for now. (shrink)

Does a diagnosis of brain dysfunction matter for ascriptions of moral responsibility? This chapter argues that, while knowledge of brain pathology can inform judgments of moral responsibility, its evidential value is currently limited for a number of practical and theoretical reasons. These include the problem of establishing causation from correlational data, drawing inferences about individuals from group data, and the reliance of the interpretation of brain findings on well-established psychological findings. Brain disorders sometimes matter for moral responsibility, however, because they (...) change an individual’s moral psychology in a way that is beyond their control. While control over psychological changes is not an excusing factor, brain disorders can mitigate moral responsibility because they confront individuals with new psychological deficits or urges for which their previous moral education and existing external and internal moral resources have not prepared them. (shrink)