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)

I explore the relationship between psychiatric fictionalism and the attribution of moral responsibility. My central claim is as follows. If one is a psychiatric fictionalist, one should also strongly consider being a fictionalist about responsibility. This results in the ‘intrinsic view’, namely, the view that mental illness does not just happen to interfere with moral responsibility: that interference is an intrinsic part of the narrative. I end by discussing three illustrative examples.

This paper argues that, although moral agency and moral patiency are distinct concepts, we have pro tanto normative reasons to ascribe some moral agency to all moral patients. Assuming a practice-focused approach, moral agents are beings that participate in moral responsibility practices. When someone is a participant, we are warranted to take a participant stance toward them. Beings who lack moral agency are instead accounted for by an objective stance. As such, they are assumed to be exempted from moral responsibility (...) practices but may still be acknowledged as moral patients. In this paper, I question that a wholly objective stance is, in practice, compatible with proper sensitivity and responsiveness to moral considerations regarding the exempted moral patient. I claim that the participant stance involves a distinct other-regarding perspective, only available from within this stance. Recognizing others specifically as addressor participants induces a readiness for second-person interaction. Instead of merely seeing and treating the moral patient as an object of moral concern, we see them as a source or maker of moral claims and demands. This “you-perspective” appears to be necessary for perceiving a wider range of morally relevant facts and considerations in relation to them. Consequently, taking a wholly objective stance towards a moral patient may impede, or even corrupt, one’s moral sensitivity and responsiveness. Given a commitment to scaffold and cultivate moral agency, there are normative reasons to take an addressor participant stance to all moral patients, and never a wholly objective one. (shrink)

In our day-to-day lives, we form responsibility judgements about one another – but we are imperfect beings, and our judgments can be mistaken. This paper suggests that we get things wrong not merely by chance, but predictably and systematically. In particular, these miscues are common when we are dealing with large gaps in social status and power. That is, when we form judgements about those who are much more or less socially powerful than ourselves, it is increasingly likely that “epistemic (...) distorters” will reliably disrupt our reasoning. In response to this situation, I argue for the introduction of a new norm concerning blame and social status: “Powerful Restraint.” This norm suggests that the socially powerful ought to blame the socially dispossessed less frequently, and that social pressure be applied to achieve that compliance. I argue that such a norm is justified given the pernicious down-stream moral effects of the up-stream epistemic distortion I describe. I defend it against objections that it suggests a normative solution to an epistemic problem, that it is paternalistic, and that it involves a kind of disrespect to the less socially powerful. (shrink)

This paper investigates agents’ blameworthiness when they are part of a group that does harm. We analyse three factors that affect the scope of an agent’s blameworthiness in these cases: shared intentionality, interpersonal influence, and common knowledge. Each factor involves circumstantial luck. The more each factor is present, the greater is the scope of each agent’s vicarious blameworthiness for the other agents’ contributions to the harm. We then consider an agent’s degree of blameworthiness, as distinct from her scope of blameworthiness. (...) We suggest that an agent mostly controls her degree of blameworthiness—but even here, luck constrains what possible degrees of blameworthiness are open to her. (shrink)

Delusions are deeply evidence-resistant. Patients with delusions are unmoved by evidence that is in direct conflict with the delusion, often responding to such evidence by offering obvious, and strange, confabulations. As a consequence, the standard view is that delusions are not evidence-responsive. This claim has been used as a key argumentative wedge in debates on the nature of delusions. Some have taken delusions to be beliefs and argued that this implies that belief is not constitutively evidence-responsive. Others hold fixed the (...) evidenceresponsiveness of belief and take this to show that delusions cannot be beliefs. Against this common assumption, I appeal to a large range of empirical evidence to argue that delusions are evidence-responsive in the sense that subjects have the capacity to respond to evidence on their delusion in rationally permissible ways. The extreme evidence-resistance of delusions is a consequence of powerful masking factors on these capacities, such as strange perceptual experiences, motivational factors, and cognitive biases. This view makes room for holding both that belief is constitutively evidence-responsive and that delusions are beliefs, and it has important implications for the study and treatment of delusions. (shrink)

Philosophical views of responsibility often identify responsible agency with capacities like rationality and self-control. Yet in ordinary life, we frequently hold individuals responsible who are deficient in these capacities, such as children or people with mental illness. The existing literature that addresses these cases has suggested that we merely pretend to hold these agents responsible, or that they are responsible to a diminished degree. In this paper, I demonstrate that neither of these approaches is satisfactory, and offer an alternative focused (...) on the role relationships play in determining whether it is appropriate to hold someone responsible. I argue that relationships are sources of normative expectations about how parties in that relationship ought to behave, and that we can be responsible in virtue of being subject to these norms. This is so, not only for those who are impaired or immature, but for all of us. (shrink)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best (...) interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

Communication and cultivation accounts of responsibility argue that blaming has an important communicative and agency-cultivating function when addressed at someone we consider to be deserving of blame. On these accounts, responsible agents are agents who can understand negative reactive attitudes and are sensitive to their moral-agency cultivating function. In this paper I examine our reproachful engagements with agents whose moral agency is underdeveloped or compromised. I discuss how these engagements compare to blaming on CC accounts and argue reproachful engagements can (...) have an important communicative and agency-cultivating pointe. I then go on to propose an addition to CC-accounts that explains how underdeveloped and compromised agents can be held responsible. I will show how this addition resolves ambiguities in accounts from McKenna, Vargas and McGeer. I conclude the paper by anticipating an objection CC accounts could raise: that reproach and blame are co-extensive. (shrink)

I develop and defend the view that subjects are necessarily psychologically able to revise their beliefs in response to relevant counter-evidence. Specifically, subjects can revise their beliefs in response to relevant counter-evidence, given their current psychological mechanisms and skills. If a subject lacks this ability, then the mental state in question is not a belief, though it may be some other kind of cognitive attitude, such as a supposition, an entertained thought, or a pretense. The result is a moderately revisionary (...) view of belief: while most mental states we thought were beliefs are beliefs, some mental states which we thought were beliefs are not beliefs. The argument for this view draws on two key claims: First, subjects are rationally obligated to revise their beliefs in response to relevant counter-evidence. Second, if some subject is rationally obligated to revise one of her mental states, then that subject can revise that mental state, given her current psychological mechanisms and skills. Along the way to defending these claims, I argue that rational obligations can govern activities which reflect on one’s rational character, whether or not those activities are under one’s voluntary control. I also show how the relevant version of epistemic ‘ought’ implies ‘can’ survives an objection which plagues other variants of the principle. (shrink)

In the last few decades, the literature on moral responsibility has been increasingly populated by scientific studies. Studies in neuroscience and psychology, in particular, have been claimed to be relevant for discussions about moral responsibility in a number of ways. And at the same time, there is not yet a systematic understanding of the sort of questions a science of moral responsibility is supposed to answer. This paper is an attempt to move toward such an understanding. I discuss three models (...) for framing scientific questions relevant to an investigation of moral responsibility. The favored model—the Enhancement model—proposes that a science of moral responsibility has two descriptive tasks. First, science can describe the causes and effects of the many sorts of responses that constitute the human practices of moral responsibility, such as praise, blame, and punishment. And, second, science can describe how modifications aiming at the improvement of such practices can be achieved. Relatively to the other models to be considered, the Enhancement model is broader in scope and less tied to the traditional philosophical agenda on moral responsibility. (shrink)

This article uses Marc Lewis’ work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease (...) nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis’ call for a third stage in the governing image of addiction. (shrink)

Drug use and drug addiction are severely stigmatised around the world. Marc Lewis does not frame his learning model of addiction as a choice model out of concern that to do so further encourages stigma and blame. Yet the evidence in support of a choice model is increasingly strong as well as consonant with core elements of his learning model. I offer a responsibility without blame framework that derives from reflection on forms of clinical practice that support change and recovery (...) in patients who cause harm to themselves and others. This framework can be used to interrogate our own attitudes and responses, so that we can better see how to acknowledge the truth about choice and agency in addiction, while avoiding stigma and blame, and instead maintaining care and compassion alongside a commitment to working for social justice and good. (shrink)

According to one contemporary formulation of infallibilism, probability 1 infallibilism, if a subject knows that p, then the probability of p on her evidence is 1. To avoid an implausible scepticism about knowledge, probability 1 infallibilism needs to allow that, in a wide range of cases, a proposition can be evidence for itself. However, such infallibilism needs to explain why it is typically infelicitous to cite p as evidence for p itself. I argue that probability 1 infallibilism has no explanation (...) of this infelicity and should be rejected. (shrink)

There is a lively debate over who is to blame for the harms arising from unhealthy behaviours, like overeating and excessive drinking. In this paper, I argue that given how demanding the conditions required for moral responsibility actually are, we cannot be highly confident that anyone is ever morally responsible. I also adduce evidence that holding people responsible for their unhealthy behaviours has costs: it undermines public support for the measures that are likely to have the most impact on these (...) harms. I claim that these two facts—the fact that we cannot be highly confident that anyone is morally responsible and the fact that holding people responsible for their unhealthy behaviours has costs—interact. Together they give us a powerful reason for believing, or acting as if we believed, that ordinary people are not in fact responsible for their unhealthy behaviours. (shrink)

Following Strawson, many philosophers have claimed that holding someone responsible necessitates its being appropriate to feel or express the negative reactive attitudes (e.g., resentment) toward her. This view, while compelling, is unable to capture the full range of cases in which we hold others responsible in ordinary life. Consider the parent who holds her five-year-old responsible for not teasing his sister, or the therapist who holds her patient responsible for avoiding self-injurious behavior. Holding responsible in such cases requires enforcing normative (...) expectations, but these norms can (and typically should) be enforced without involving the negative reactive attitudes. To demonstrate this, I consider how responsibility attributions function in psychotherapy, as well as in other contexts where the negative reactive attitudes do not have a natural home. (shrink)

The Limits of Blame, by KellyErin I. Cambridge, MA: Harvard University Press, 2018. Pp. 221.

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

I clarify some ambiguities in blame-talk and argue that blame's potential for irrationality and propensity to sting vitiates accounts of blame that identify it with consciously accessible, personal-level judgements or beliefs. Drawing on the cognitive psychology of emotion and appraisal theory, I develop an account of blame that accommodates these features. I suggest that blame consists in a range of hostile, negative first-order emotions, towards which the blamer has a specific, accompanying second-order attitude, namely, a feeling of entitlement—a feeling that (...) these hostile, negative first-order emotions are what the blamed object deserves. (shrink)

Punishment is a grave intrusion into individual liberty, yet in most liberal criminal justice systems, including England and Wales, those punished are rarely directly engaged in determining their sentence. Consequently, the offender’s agency in respect of sentence—i.e. the offender’s capacity to play an active part in the sentencing process—is limited. Drawing on existing theories of punishment, the article argues that there may be justifications and scope for allowing offenders to exercise agency in a state-centred sentencing process, even though this scope (...) is inevitably limited. It aims to develop a conceptual account of an ‘agentic’ sentencing system, arguing this should be based on the paradigm of a dialogue between the judge and offender. To preserve the state’s fundamental role in sentencing, constraints should be placed on the exercise of agency. The proposed model embodies a conception of sentencing as a decision-making process to be done _with_ offenders, rather than _to_ offenders. Nonetheless, while some objections can be rebutted, others demonstrate the gap between the theoretical ideal of respecting the offender’s agency at sentencing and how an agentic sentencing system might function in practice. (shrink)

In a welcome broadening of the discussion surrounding responsibility in healthcare, Rebecca Brown and Julian Savulescu propose that standard philosophical accounts of responsibility are too narrow to be useful. Although these accounts of course differ with respect to the exact conditions they posit as necessary and sufficient for responsibility, they are nonetheless relatively united in their focus on a single individual at a single moment in time. Suppose a subject S performs an action a at a time t that has (...) harmful consequences for their health. Is S responsible for a and derivatively their condition? Brown and Savulescu argue that answers to this question that fail to consider both what S was or was not doing at times other than t and what people other than S were doing to encourage or discourage S from performing a cannot do justice to actions which are habitual and socially influenced—such as unhealthy patterns of eating, exercise and substance use. Given that it is precisely these kinds of patterns of behaviour that typically inflame the discussion of responsibility in healthcare, Brown and Savulescu’s insistence on the need for a diachronic and socially contextualised account of responsibility is essential— if we are to consider the issue of responsibility in healthcare at all. But should we and, if so, why? With respect to this question, Brown and Savulescu hope to sit on the fence. This is both because they recognise the complexity and balance of arguments for and against the view …. (shrink)

James Lasdun’s memoir of being stalked, Give Me Everything You Have, has provoked considerable controversy. Whilst the quality of the writing is widely praised, some critics object to the way Lasdun documents in unsparing detail his experiences without taking any account of the stalker’s apparent mental health problems. There are ethical and conceptual problems with Lasdun’s approach, but side-stepping medical knowledge and relying on what we might call common sense help Lasdun to find ways to interpret his stalker’s actions as (...) meaningful and human. I suggest three interlinked implications concerning: medicalization, stigma, and the relationship between ethics and scientific knowledge. (shrink)

Within contemporary penal philosophy, the view that punishment can only be justified if the offender is a moral agent who is responsible and hence blameworthy for their offence is one of the few areas on which a consensus prevails. In recent literature, this precept is associated with the retributive tradition, in the modern form of ‘just deserts’. Turning its back on the rehabilitative ideal, this tradition forges a strong association between the justification of punishment, the attribution of responsible agency in (...) relation to the offence, and the appropriateness of blame. By contrast, effective clinical treatment of disorders of agency employs a conceptual framework in which ideas of responsibility and blameworthiness are clearly separated from what we call ‘affective blame’: the range of hostile, negative attitudes and emotions that are typical human responses to criminal or immoral conduct. We argue that taking this clinical model of ‘responsibility without blame’ into the legal realm offers new possibilities. Theoretically, it allows for the reconciliation of the idea of ‘just deserts’ with a rehabilitative ideal in penal philosophy. Punishment can be reconceived as consequences—typically negative but occasionally not, so long as they are serious and appropriate to the crime and the context—imposed in response to, by reason of, and in proportion to responsibility and blameworthiness, but without the hard treatment and stigma typical of affective blame. Practically, it suggests how sentencing and punishment can better avoid affective blame and instead further rehabilitative and related ends, while yet serving the demands of justice. (shrink)

This article starts from a paradox and aims to solve it. On the one hand, although Drug Courts (DCs) are one of the most interesting penal innovations in recent years, running counter to the dominant retributive approach and the rival approach based on deterrence, they have surprisingly not attracted the attention of philosophers and therefore lack a solid philosophical foundation. On the other hand, although Pickard's ‘responsibility without blame’ approach looks very convincing on paper, its practical applications remain unclear outside (...) the clinical context. I argue that Pickard's approach is the theoretical framework that DCs need and that they are a compelling application of it: DCs do ascribe to participants various forms of responsibility (criminal ‘liability-responsibility’, responsibility of choice, responsibility for progress or failure, responsibility as answerability, tort liability) while striving to keep ‘affective blame’ at bay in order to help them regain their autonomy. However, I argue that some of the limitations of both this approach and DCs become apparent once we consider the ‘outer limits’ of DCs, in other words those who are terminated from DCs and those who refuse to enter DCs in the first place. (shrink)

Moral and legal philosophy are too entangled: moral philosophy is prone to model interpersonal moral relationships on a juridical image, and legal philosophy often proceeds as if the criminal law is an institutional reflection of juridically imagined interpersonal moral relationships. This article challenges this alignment and in so doing argues that the function of the criminal law lies not fundamentally in moral blame, but in regulation of harmful conduct. The upshot is that, in contrast to interpersonal relationships, the criminal law (...) cannot lose its standing to blame through institutional analogues of hypocrisy, complicity, and meddling. Rather, certain forms of structural and severe historical and contemporary injustice point to the question of the overall legitimacy of state authority. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in a detached (...) sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)

My aim in this paper is to provide a conceptual elucidation of the notion of constitutive normativity, which is central to Constitutivism as a first-order theory of agency, as well as to its metanormative ambitions. After introducing and clarifying the origins and scope of Constitutivism (Section 2), I focus on Christine M. Korsgaard’s version thereof (Section 3), which provides an explicit articulation of the notion of constitutive norms. Despite Korsgaard’s explicit acknowledgement that the concepts of action and agency come in (...) degree, one problematic consequence of her account is the tension between the simultaneously descriptive and normative character of constitutive norms (their double nature), and another component of Korsgaard’s constitutivist account (her Authorship View). Cases of a specific variety of “disorders of agency” are used to show that while an agent’s individual actions might fail to display Korsgaard’s required pattern of consistency, self-reflection, and self-unification (and often, morality), her agency does not fade nor is disrupted (Section 4). After discussing those cases, I suggest that Korsgaard’s acknowledgement that the notions of action and agency come in degree and her relational notion of responsibility be strengthened via the adoption of a thorough interactionist and scalar approach. While for Korsgaard the constitutive norms governing agency amount to the norms governing practical reasoning and morality, I contend that the constitutive normativity pertaining to human agency is not ‘homogeneous’ in kind: there are more norms governing agency than just the norms for practical reasoning—and, in particular, that agency necessarily involves social norms distinct from any notion of practical reasoning. I draw on a theoretical framework on the metaphysics of normativity developed within the philosophy of biology to distinguish two varieties of constitutive normativity (socially-generated and non-practice-based) (Section 5), and provide a preliminary articulation of the socially-generated constitutive normativity inspired by the speech-act-theoretical account of the performative dimension of language (Section 6). (shrink)