Who is recognised as a philosopher and what counts as philosophy influence both the content of a philosophical education and academic philosophy’s continuing demographic skew. The “philosophical who” and the “philosophical what” themselves are a partial function of matters that have been passed over in collective silence, even if that now feels to some like a silence belonging to the distant past. This paper discusses some philosophical silences regarding race, gender, and disability in the context of reflection on philosophical education (...) and on philosophical practice in the public sphere. It focuses on Charles Mills’ writings on race, Susan Babbitt’s on race and gender, and on more collaboratively-generated work on eugenics and disability. (shrink)

In this paper, we explore the link between understanding and transformative decisions. Paul (2014) suggests that one important aspect of making some decisions is that we make them not just on the basis of what data from other people tell us, but based on our own acquaintance with how the decision affects us. In this paper, we draw out a parallel between the sort of reasoning that Paul argues is required for authentic decision making and the sort of epistemic grasp (...) of a subject matter that is required for understanding. The central claim of this paper is that one’s ability to make a decision authentically is proportional to one’s ability to model what it is like to have the possible resultant experience. We endorse a broad notion according to which one can model something by thinking about relevantly similar things. (shrink)

We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics guidance. But Walsh’s account of the moral value (...) of the preferences of patients with dementia suffers from three major problems: (1) it does not engage the actual practices of clinical ethics; (2) it provides an inadequate account of why these patients’ preferences matter; and (3) it offers a poor explanation of clinicians’ intuitions in these cases. Her arguments engage a philosophical debate that is largely irrelevant to clinical practice and she therefore leaves pressing real-world clinical ethics questions unaddressed. After underscoring some of Walsh’s main points, we will discuss each of these shortcomings. (shrink)

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

In standard decision theory, the probability function ought to be updated in light of evidence, but the utility function generally stays fixed. However, there is nothing in the formal theory that prevents one from instead updating the utility function, while keeping the probability function fixed. Moreover, there are good arguments for updating the utilities and not just the probabilities. Hence, the first puzzle is whether there is anything that justifies updating beliefs, but not desires, in light of evidence. The paper (...) argues that there is not, but that this raises a second puzzle. (shrink)

The idea of an eternal and immortal life like the one we lead now seems quite appealing because (i) it will be sufficiently like our own earth-bound life and (ii) we will have the same kinds of desires we have now to want to live an eternal life. This paper will challenge the view that we have a conception of what the conscious experience of an immortal is like, regardless of whether we might want to live it. Given that for (...) us to conceive of an immortal life we must project onto it our own view of what it is like to live our own life and given that an immortal life may not be anything like the life we live, we cannot conceive of what it is like to be immortal. (shrink)

The source of the following considerations is the observation that academic philosophy at universities does not fit well with philosophy education processes, e.g., those at school. Both sides seem to be separate from each other. I assume that the two areas rely on two very different concepts of philosophy. To work out a concept of philosophy more appropriate to the educational context, I methodically apply the practical turn to our philosophising in very different contexts. Moreover, I elaborate that it is (...) precisely the modern scientific paradigm that underlies philosophy as scientific practice and that the former represents a problematic con-striction of philosophising in educational contexts. For where the ideal is objective scientific knowledge — from which everything subjective has been removed — there can be no deeper transformation of the subject through philosophy. My thesis is that philosophy is better suited to the educational context as transformative and not as scientific practice. As a consequence, the question arises as to whether the study of philosophy on teacher training courses needs a new impulse in the direction of philosophy as transformative practice. (shrink)

Laurie Paul argues that, when it comes to many of your most significant life-changing decisions, the principles of rational choice are silent. That is because, in these cases, you anticipate that one of your choice options would yield a transformative experience. We argue that such decisions are best seen as ones in which you anticipate awareness growth. You do not merely lack knowledge about which possible outcome will arise from a transformative option; you lack knowledge about what are the possible (...) outcomes. We show how principles of rational choice can be extended to cases of anticipated awareness growth. (shrink)

Different forms of methodological and ontological naturalism constitute the current near-orthodoxy in analytic philosophy. Many prominent figures have called naturalism a image, a Weltanschauung, or even a “philosophical ideology”. This suggests that naturalism is indeed something over-and-above an ordinary philosophical thesis. However, these thinkers fail to tease out the host of implications this idea – naturalism being a worldview – presents. This paper draws on remarks of Dilthey and Jaspers on the concept of worldviews in order to demonstrate that naturalism (...) as a worldview is a presuppositional background assumption which is left untouched by arguments against naturalism as a thesis. The concluding plea is to re-organize the existing debate on naturalism in a way that treats naturalism not as a first-order philosophical claim, but rather shifts its focus on naturalism’s status as a worldview. (shrink)

There is a long tradition of employing a phenomenological approach to gain greater insight into the unique experience of psychiatric illness. Researchers in this field have shed light upon a distur...

In ethical reflections on new technologies, a specific type of argument often pops up, which criticizes scientists for “playing God” with these new technological possibilities. The first part of this article is an examination of how these arguments have been interpreted in the literature. Subsequently, this article aims to reinterpret these arguments as symbolic arguments: they are grounded not so much in a set of ontological or empirical claims, but concern symbolic classificatory schemes that ground our value judgments in the (...) first place. Invoking symbolic arguments thus refers to how certain new technologies risk undermining our fundamental symbolic distinctions by which we organize and evaluate our interactions with the world and in society. Such symbolic distinctions, moreover, tend to be resilient against logical argumentation, mainly because they themselves form the basis on which we argue in the cultural and ethical sphere in the first place. Therefore, effective strategies to evaluate and counter these arguments require another approach, showing that these technologies either do not challenge these classifications or, if they do, how they can be accompanied by the proper actions to integrate these technologies into our society. (shrink)

In her recent book, L. A. Paul presses a serious problem for normative decision theory. Normative decision theory seems to be inapplicable when the values of potential outcomes are unknown, or when our preferences may change as a result of our choice. Paul then offers a framework for overcoming these problems, known as therevelation approach. I argue that, contrary to what Paul suggests, this approach is unhelpful in the large class of cases where the decision at hand centrally concerns persons (...) other than the decision-maker. Unless Paul’s account is supplemented in order to handle such cases, many decisions will remain rationally intractable. (shrink)

This paper explores how engaging in and with philosophy in the streets has unique and special potential for children doing philosophy both inside and outside the classroom. We highlight techniques drawn from research into the political, social and activist potential of street art, and we illustrate how to apply these techniques in a P4C context in what we call guerrilla philosophy. We argue that guerrilla philosophy is a pedagogically powerful method to philosophically engage students whose ages range from 11-13. In (...) calling attention to the power of guerrilla philosophy to engage students philosophically, we are tacitly assuming a Deweyan philosophical approach, which emphasises the importance of promoting civic-mindedness as a social value; the reliance on imaginative, creative and experiential forms of learning as essential to education ; and a vision of the classroom as an embodiment of the larger civic community to which we all belong and in which we all must cooperate and engage. This paper traces these three themes in Dewey’s philosophical views of education and democracy, and considers how they are given a twenty-first century interpretation through street art, guerrilla philosophy and children’s activism. (shrink)

ABSTRACT Is uncertainty about preferences rationally possible? And if so, does it matter for rational decision? It is argued that uncertainty about preferences is possible and should play the same role in rational decision-making as uncertainty about worldly facts. The paper develops this hypothesis and defends it against various objections.

ABSTRACTIs the question ‘will you regret it if you do this?’ helpful when people face difficult life decisions, such as terminating a pregnancy if a disability is detected or deciding to become a parent? Despite the commonness of the question in daily life, several philosophers have argued lately against its usefulness. We reconstruct four arguments from recent literature on regret, transformative experience and the use of imagination in deliberation. After analysis of these arguments we conclude that the prospect of regret (...) remains a useful deliberative heuristic, provided four conditions are fulfilled. If the prospect of regret is arrived at via reflection on one’s values, in a non-coercive context, when well-informed about factual circumstances, and in a process of self-commitment, the question of what one will regret is a helpful device to get in touch with one’s deepest concerns that give reasons to act in a particular way. (shrink)

Ordinary judgments about personal identity are complicated by the fact that phrases like “same person” and “different person” have multiple uses in ordinary English. This complication calls into question the significance of recent experimental work on this topic. For example, Tobia (2015) found that judgments of personal identity were significantly affected by whether the moral change described in a vignette was for the better or for the worse, while Strohminger and Nichols (2014) found that loss of moral conscience had more (...) of an effect on identity judgments than loss of biographical memory. In each case, however, there are grounds for questioning whether the judgments elicited in these experiments engaged a concept of numerical personal identity at all (cf. Berniūnas and Dranseika 2016; Dranseika 2017; Starmans and Bloom 2018). In two pre-registered studies we validate this criticism while also showing a way to address it: instead of attempting to engage the concept of numerical identity through specialized language or the terms of an imaginary philosophical debate, we should consider instead how the identity of a person is described through the connected use of proper names, definite descriptions, and the personal pronouns “I”, “you”, “he”, and “she”. When the experiments above are revisited in this way, there is no evidence that the differences in question had an effect on ordinary identity judgments. (shrink)

The article critically engages Menachem Fisch’s account of normative frameworks, in particular of (rational) transitions between them. I argue, first, that exposure to the normative criticism leveled at us by other human beings is indeed “capable of destabilizing normative commitment” to one’s own underlying framework beliefs and standards, as Fisch holds; however, closer scrutiny reveals that such exposure is neither sufficient nor necessary but rather accidental in this respect. Second, I will try to show that Søren Kierkegaard’s account of how (...) people fundamentally change their mind provides resources for both a substantial critique of Fisch and a more adequate understanding of the transitions in question. The article argues, third, that Fisch’s framework model – though meaningful, in fact heuristically indispensable in and as of itself – has robust transcendental implications which as such are being ignored, if not directly denied by Fisch and, precisely by being ignored or denied, unnecessarily weaken the overall plausibility of his account. Finally, and ex post, I will address an important objection raised by some commentators. (shrink)

This essay presents the conditional probability of co-contribution account of the individuation of cognitive systems (CPC) and argues that CPC provides an attractive basis for a theory of the cognitive self. The argument proceeds in a largely indirect way, by emphasizing empirical challenges faced by an approach that relies entirely on predictive processing (PP) mechanisms to ground a theory of the cognitive self. Given the challenges faced by PP-based approaches, we should prefer a theory of the cognitive self of the (...) sort CPC offers, one that accommodates variety in the kinds of mechanism that, when integrated, constitute a cognitive system (and thus the cognitive self), to a theory according to which the cognitive self is composed of essentially one kind of thing, for instance, prediction-error minimization mechanisms. The final section focuses on one of the central functions of the cognitive self: to engage in conscious reasoning. It is argued that the phenomenon of conscious, deliberate reasoning poses an apparently insoluble problem for a PP-based view, one that seems to rest on a structural limitation of predictive-processing models. In a nutshell, conscious reasoning is a single-stream phenomenon, but, in order for PP to apply, two streams of activity must be involved, a prediction stream and an input stream. Thus, with regard to the question of the nature of the self, PP-based views must yield to an alternative approach, regardless of whether proponents of the predictive processing, as a comprehensive theory of cognition, can handle the various empirical challenges canvassed in the preceding section. (shrink)

Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: 1) the person genuinely feels his age differs significantly from his chronological age and 2) the person’s biological age is recognized to be significantly different from his chronological age and 3) age change would likely prevent, (...) stop or reduce ageism, discrimination due to age, he would otherwise face. I also consider some objections against the view that people should be allowed to change their legal age and find them lacking. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as its concrete practice, (...) I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

On the standard Paulian definition of epistemically transformative experiences (ETE), we can’t know what an ETE is like before we have it. ETEs are new kinds of experiences and, importantly, can’t be imagined—this is why they have a unique ability to teach us what a particular experience is like. Contra Paul, some philosophers (Sharadin, 2015; Wilkenfeld, 2016; Ismael, 2019; Kind, 2020; Daoust, 2021; Cath, 2022) have argued that transformative experiences can be imagined. A neglected consequence of this argument is that (...) if transformative experiences can in fact be imagined, then it is unclear how they could be epistemically transformative. What do they teach us if we can imagine what they’re like in advance? I will argue not only that imaginable experiences can be transformative, but that experiences of a kind which an agent is experientially acquainted with can also be transformative. This latter kind of transformative experiences, which I will call familiar transformative experiences, are transformative not because the agent learns what a new kind of experience is like—by definition, they are not new kinds of experiences—but because the transformativeness of the experience is brought out by features of the agent experiencing them. Epistemic transformation in these cases may be explained by facts about the agent’s perspective and social environment, which allow them to appreciate elements of the experience they did not previously. (shrink)

Amplifying Bernard Williams’ critique of the Nietzschean project of a revaluation of values, this paper mounts a critique of the idea that whether values will help us to live can serve as a criterion for choosing which values to live by. I explore why it might not serve as a criterion and highlight a number of further difficulties faced by the Nietzschean project. I then come to Nietzsche's defence, arguing that if we distinguish valuations from values, there is at least (...) one form of the project which overcomes those difficulties. Finally, however, I show that even on this reading, the project must either fall prey to ‘Saint-Just's illusion’ or fall back into the problems it was supposed to escape. This highlights important difficulties faced by the Nietzschean project and its descendants while also explaining why Williams, who was so Nietzschean in other respects, remained wary of the revaluation of values as a project. (shrink)

This paper argues that contemporary philosophical literature on meaning in life has important implications for the debate about our obligations to non-human animals. If animal lives can be meaningful, then practices including factory farming and animal research might be morally worse than ethicists have thought. We argue for two theses about meaning in life: that the best account of meaningful lives must take intentional action to be necessary for meaning—an individual’s life has meaning if and only if the individual acts (...) intentionally in ways that contribute to finally valuable states of affairs; and that this first thesis does not entail that only human lives are meaningful. Because non-human animals can be intentional agents of a certain sort, our account yields the verdict that many animals’ lives can be meaningful. We conclude by considering the moral implications of these theses for common practices involving animals. (shrink)

The dispute in philosophical decision theory between causalists and evidentialists remains unsettled. Many are attracted to the causal view’s endorsement of a species of dominance reasoning, and to the intuitive verdicts it gets on a range of cases with the structure of the infamous Newcomb’s Problem. But it also faces a rising wave of purported counterexamples and theoretical challenges. In this paper I will describe a novel decision theory which saves what is appealing about the causal view while avoiding its (...) most worrying objections, and which promises to generalize to solve a set of related problems in other normative domains. (shrink)

This paper is part of a book symposium for L. A. Paul (2014) Transformative Experience (OUP).

When is it legitimate for a government to ‘nudge’ its citizens, in the sense described by Thaler and Sunstein (2008)? In their original work on the topic, Thaler and Sunstein developed the _‘as judged by themselves’ (or AJBT) test_ to answer this question (Thaler and Sunstein 2008, p. 5). In a recent paper, Paul and Sunstein (2019) raised a concern about this test: it often seems to give the wrong answer in cases in which we are nudged to make a (...) decision that leads to what Paul calls a _personally transformative experience_, that is, one that results in our values changing (Paul 2014). In those cases, the nudgee will judge the nudge to be legitimate after it has taken place, but only because their values have changed as a result of the nudge. In this paper, I take up the challenge of finding an alternative test. I draw on my _aggregate utility account_ of how to choose in the face of what Ullmann-Margalit (2006) calls _big decisions_, that is, decisions that lead to these personally transformative experiences (Pettigrew 2019, Chapters 6 and 7). (shrink)

Anticipation of future decisions can be important for individuals at risk for diseases to maintain autonomy over time. For future treatment and care decisions, advance care planning is accepted as a useful anticipation tool. As research with persons with dementia seems imperative to develop disease-modifying interventions, and with changing regulations regarding research participation in Germany, advance research directives (ARDs) are considered a solution to include persons with dementia in research in an ethically sound manner. However, little is known about what (...) affected people deem anticipatable.This contribution provides a critical reflection of the literature on anticipation and of a qualitative study on the assessment of ARDs with persons with cognitive impairment in Germany. It combines theoretical and empirical reflections to inform the ethical-legal discourse.Anticipation involves the conceptual separation of the past, the present, and the future. Including dimensions such as preparedness, injunction, and optimization helps in establishing a framework for anticipatory decision-making. While dementia may offer a window of time to consider future decisions, individual beliefs about dementia including fears about stigma, loss of personhood, and solitude strongly impact anticipating sentiments. Concepts of anticipation can be useful for the examination of uncertainty, changing values, needs, and preferences interconnected with the dementia trajectory and can serve as a means to make an uncertain future more concrete. However, fears of losing one’s autonomy in the process of dementia also apply to possibilities of anticipation as these require cognitive assessment and reassessment of an imagined future with dementia. (shrink)

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to honor (...) many advance directives survive the move to a transformative experience framework. (shrink)

Philosophy and Phenomenological Research, EarlyView.

Commentary on Walsh, E. 2020. Cognitive transformation, dementia, and the moral weight of advance directives. The American Journal of Bioethics. 20(8): 54–64.

It seems natural to choose whether to have a child by reflecting on what it would be like to actually have a child. I argue that this natural approach fails. If you choose to become a parent, and your choice is based on projections about what you think it would be like for you to have a child, your choice is not rational. If you choose to remain childless, and your choice is based upon projections about what you think it (...) would be like for you to have a child, your choice is not rational. This suggests we should reject our ordinary conception of how to make this life-changing decision, and raises general questions about how to rationally approach important life choices. (shrink)

Contemporary social-scientific research seeks to identify specific causal mechanisms for outcomes of theoretical interest. Experiments that randomize populations to treatment and control conditions are the “gold standard” for causal inference. We identify, describe, and analyze the problem posed by transformative treatments. Such treatments radically change treated individuals in a way that creates a mismatch in populations, but this mismatch is not empirically detectable at the level of counterfactual dependence. In such cases, the identification of causal pathways is underdetermined in a (...) previously unrecognized way. Moreover, if the treatment is indeed transformative it breaks the inferential structure of the experimental design. Transformative treatments are not curiosities or “corner cases,” but are plausible mechanisms in a large class of events of theoretical interest, particularly ones where deliberate randomization is impractical and quasi-experimental designs are sought instead. They cast long-running debates about treatment and selection effects in a new light, and raise new methodological challenges. (shrink)

Summary of Transformative Experience by L.A. Paul and replies to symposiasts. Discussion of undefined values, preference change, authenticity, experiential value, collective minds, mind control.

In “What you can’t expect when you’re expecting,” I argue that, if you don’t know what it’s like to be a parent, you cannot make this decision rationally—at least, not if your decision is based on what you think it would be like for you to become a parent. My argument hinges on the idea that becoming a parent is a transformative experience. This unique type of experience often transforms people in a deep and personal sense, and in the process, (...) changes their preferences. In section 1, I will explain transformative experience in terms of radical first-personal epistemic and self change. In section 2, I’ll explain the notion of subjective value that I use to develop the decision problem. In section 3, I will discuss the way we ordinarily combine our introspective assessments with testimony and evidence. In section 4, I will discuss the problems for rational decision-making. In section 5, I will explore the problem of first-personally transformed future selves. In section 6, I will engage with the main themes and arguments and ideas of the authors of the papers contributed to this volume. (shrink)

I summarize the main argument of Transformative Experience (OUP 2014). The book develops familiar examples from classical philosophical debates, as well as original examples, to argue that an agent’s decision to undergo a transformative experience—an experience constituted by radical personal and epistemic change for the agent—must either be authentic or irrational, but not both. The Precis of Transformative Experience walks the reader through the main ideas involved in epistemically and personally transformative experiences, the problems they pose for rational decision-making, and (...) discusses a number of key original examples of transformative experiences. (shrink)

I argue that we can understand the de se by employing the subjective mode of presentation or, if one’s ontology permits it, by defending an abundant ontology of perspectival personal properties or facts. I do this in the context of a discussion of Cappelen and Dever’s recent criticisms of the de se. Then, I discuss the distinctive role of the first personal perspective in discussions about empathy, rational deference, and self-understanding, and develop a way to frame the problem of lacking (...) prospective access to your future self as a problem with your capacity to imaginatively empathize with your future selves. (shrink)

A long‐standing aim of cinema – in particular of ‘extreme’, ‘unwatchable’ or ‘feel‐ bad’ cinema – has been to acquaint viewers with extreme suffering. In this article I first offer an explication of that aim in terms of recent work in philosophy of mind, then exploit the resulting framework to examine claims to the effect that a new technological development, Virtual Reality, provides cinema's best shot at achieving that aim.

According to a familiar (alleged) requirement on practical reason, one must believe a proposition if one is to take it for granted in reasoning about what to do. This paper explores a related requirement, not on thinking but on acting—that one must accept a goal if one is to count as acting for its sake. This is the acceptance requirement. Although it is endorsed by writers as diverse as Christine Korsgaard, Donald Davidson, and Talbot Brewer, I argue that it is (...) vulnerable to counterexamples, in which agents act in light of ends that they do not accept but are still merely considering. For instance, a young professional may keep a job option open not because she definitely wants or intends to take it, but just because she is considering taking it. I try to show that such examples are not easily resisted; that they present challenges specifically for Brewer, Davidson, and especially Korsgaard; and that the examples also raise fresh, non-partisan questions in action theory. What is considering, exactly? How could it fall short of acceptance while still guiding behaviour? How can we act for an end before thinking it through? (shrink)

Abolitionism is the view that if no one is responsible, then we ought to abandon the reactive attitudes. Proponents suggest that reactive attitudes can be replaced in our emotional repertoire by non-reactive analogues. In this paper, I dispute and reject a common challenge to abolitionism according to which the reactive attitudes are necessary for protesting unfairness and maintaining social harmony. While other abolitionists dispute the empirical basis of this objection, I focus on its implications. I argue that even if non-reactive (...) analogues cannot perform the interpersonal and social functions of reactive attitudes, it does not follow that the losses of abandoning them outweigh the gains of retaining them. The force of the challenge rests on a mistake, identified by John Stuart Mill among others, that is common when evaluating entrenched social practices. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

In this paper, I explore the role that regret does and should play in medical decision-making. Specifically, I consider whether the possibility of a patient experiencing post-treatment regret is a good reason for a clinician to counsel against that treatment or to withhold it. Currently, the belief that a patient may experience post-treatment regret is sometimes taken as a sufficiently strong reason to withhold it, even when the patient makes an explicit, informed request. Relatedly, medical researchers and practitioners often understand (...) a patient’s post-treatment regret to be a significant problem, one that reveals a mistake or flaw in the decision-making process. Contrary to these views, I argue that the possibility of post-treatment regret is not necessarily a good reason for withholding the treatment. This claim is justified by appealing to respect for patient autonomy. Furthermore, there are occasions when the very reference to post-treatment regret during medical decision-making is inappropriate. This, I suggest, is the case when the decision concerns a “personally transformative treatment”. This is a treatment that alters a person’s identity. Because the treatment is transformative, neither clinicians nor the patient him/herself can ascertain whether post-treatment regret will occur. Consequently, I suggest, what matters in determining whether to offer a personally transformative treatment is whether the patient has sufficiently good reasons for wanting the treatment at the time the decision is made. What does not matter is how the patient may subsequently be changed by undergoing the treatment. (shrink)

In this paper, I develop and defend the ‘Justified Decision Perspective’ in answer to the question of when we should regret the things we have done. I claim that one should not regret a past decision one has made so long as it was justified in relation to the kind of person one was at the time of acting. On this time-indexing account, judging a decision to be justified – at least for the purposes of assessing one’s regrets – is (...) a matter of identifying the practical reasons that were epistemically available to the agent when she was deliberating about what to do. Accordingly, when responding to her regrets, an agent should not invoke reasons that existed but were epistemically unavailable to her when she was deliberating; or reasons that only came into existence after she acted. The JDP has important implications for prospective regret. In particular, it implies we should worry less about experiencing regret in the future than many of us do. Thus, my overall aim is to show that we often have reason to reject our regrets, which means that regret should play a less prominent and painful role in our lives than it does currently. (shrink)

Since the 1970’s epidemiological measures focusing on “health-related quality of life” or simply “quality of life” have figured increasingly as endpoints in clinical trials. Before the 1970’s these measures were known, generically, as performance measures or health status measures. Relabeled as “quality of life measures” they were first used in cancer trials. In the early 2000’s they were relabeled again as “patient-reported outcome measures” or PROMs, in their service to the FDA to support drug labeling claims. To the limited degree (...) that the philosophical literature addresses these measures, it tends to associate them with two major theories of well-being: subjective well-being and the capabilities approach. In this paper, I argue that philosophers ought to treat quality of life measures/proms as a distinct from these theories. I argue that quality of life/proms serve healthcare as vehicles for patient-centered care and this has important consequences for how we theorize these measures. To this end, two requirements set them apart from measures of subjective well-being and the capabilities approach: quality of life/proms need to be patient-directed and inclusive. (shrink)