In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will to (...) another’s authority or because it precludes the agent from acting effectively in pursuit of their ends. I shall argue that providing an agent with false beliefs is not inimical to their autonomy if they are only able to effectively pursue their autonomously chosen ends by virtue of holding those particular false beliefs. Finally, I show that deceptive placebo use need only involve this latter sort of deception. (shrink)

This book approaches ethical and legal issues in medicine from the patient's viewpoint and argues that many patients do not want the full burden of decision making that contemporary bioethics has thrust upon them.

Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)

It has been presumed within bioethics that the benefits and risks of treatments can be assessed independently of information disclosure to patients as part of the informed consent process. Research on placebo and nocebo effects indicates that this is not true for symptomatic treatments. The benefits and risks that patients experience from symptomatic treatments can be shaped powerfully by information about these treatments provided by clinicians. In this paper we discuss the implications of placebo and nocebo research for risk–benefit assessment (...) and informed consent. (shrink)

When we ask a decision maker to express her preferences, it is typically assumed that we are eliciting a pre-existing set of preferences. However, empirical research has suggested that our preferences are often constructed on the fly for the decision problem at hand. This paper explores the ramifications of this empirical research for our understanding of instrumental rationality. First, I argue that these results pose serious challenges for the traditional decision-theoretic view of instrumental rationality, which demands global coherence amongst all (...) of one's beliefs and desires. To address these challenges, I first develop a minimal notion of instrumental rationality that issues in localized, goal-relative demands of coherence. This minimal conception of instrumental rationality is then used to offer a more sophisticated account of the global aspects of instrumental rationality. The resulting view abandons all-or-nothing assessments of rationality and allows us to evaluate decision makers as being rational to varying degrees. My aim is to propose a theory that is both psychologically and normatively plausible. (shrink)

Some properties are causally relevant for a certain effect, others are not. In this paper we describe a problem for our understanding of this notion and then offer a solution in terms of the notion of a program explanation.

Fricker shows that virtue epistemology provides a general epistemological idiom in which these issues can be forcefully discussed.

Among medical researchers and clinicians the dominant view is that it is unethical to deceive patients by prescribing a placebo. This opinion is formalized in a recent policy issued by the American Medical Association (AMA [Chicago, IL]). Although placebos can be shown to be always safe, often effective, and sometimes necessary, doctors are now effectively prohibited from using them in clinical practice. I argue that the deceptive administration of placebos is not subject to the same moral objections that face other (...) forms of deception in clinical practice and medical research. Although deception is normally objectionable on the grounds that it limits autonomy and breaches trust, these grounds do not apply to placebos when they are prescribed within appropriate ethical limits. Patients have reason to prefer that doctors can prescribe placebos in ethically responsible ways. Hence, the AMA has an obligation to endorse and to promote the responsible use of deceptive placebos in clinical practice. (shrink)

Models in decision theory and game theory assume that preferences are determinate: for any pair of possible outcomes, a and b, an agent either prefers a to b, prefers b to a, or is indifferent as between a and b. Preferences are also assumed to be stable: provided the agent is fully informed, trivial situational influences will not shift the order of her preferences. Research by behavioral economists suggests, however, that economic and hedonic preferences are to some degree indeterminate and (...) unstable, which in turn suggests that other sorts of preferences may suffer the same problem. Even fully informed agents do not always determinately prefer a to b, prefer b to a, or feel indifferent as between a and b. Seemingly trivial situational influences rearrange the order of their preferences. One could respond that decision theory and game theory are not meant to describe actual behavior, and that they instead adumbrate an ideal of rationality from which human action diverges in various ways. When the divergences are small and systematic, they help us identify the heuristics that conspire to help people approximate rationality. One such heuristic, dubbed the Wilde heuristic, is explored. However, the divergences documented by behavioral economists threaten to be too large to handle through idealization. The Rum Tum Tugger Model, in which indifference is intransitive, is spelled out as one promising way for decision and game theory to retrench. Preferences may be locally unstable and indeterminate, but when the differences between options are sufficiently large, they approximate stability and determinacy. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Imre Lakatos' philosophical and scientific papers are published here in two volumes. Volume I brings together his very influential but scattered papers on the philosophy of the physical sciences, and includes one important unpublished essay on the effect of Newton's scientific achievement. Volume II presents his work on the philosophy of mathematics (much of it unpublished), together with some critical essays on contemporary philosophers of science and some famous polemical writings on political and educational issues. Imre Lakatos had an influence (...) out of all proportion to the length of his philosophical career. This collection exhibits and confirms the originality, range and the essential unity of his work. It demonstrates too the force and spirit he brought to every issue with which he engaged, from his most abstract mathematical work to his passionate 'Letter to the director of the LSE'. Lakatos' ideas are now the focus of widespread and increasing interest, and these volumes should make possible for the first time their study as a whole and their proper assessment. (shrink)

In this eye-opening look at the doctor-patient decision-making process, physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance. Historically, the doctor-patient relationship has been based on a one-way trust -- despite recent judicial attempts to give patients a greater voice through the doctrine of informed consent. Katz criticizes doctors for encouraging patients to relinquish their autonomy, and demonstrates the detrimental effect their silence has on good patient care. Seeing a growing (...) need in this age of medical science and sophisticated technology for more honest and complete communication between physician and patients, he advocates a new, informed dialogue that respects the rights and needs of both sides. In a new foreword to this edition of The Silent World of Doctor and Patient , Alexander Morgan Capron outlines the changes in medical ethics practice that have occurred since the book was first published in 1984, paying particular attention to the hotly debated issues of physician-assisted suicide and informed consent in managed care. (shrink)

Everyone wants to be virtuous, but recent psychological investigations suggest that this may not be possible. Mark Alfano challenges this theory and asks, not whether character is empirically adequate, but what characters human beings could have and develop. Although psychology suggests that most people do not have robust character traits such as courage, honesty and open-mindedness, Alfano argues that we have reason to attribute these virtues to people because such attributions function as self-fulfilling prophecies - children become more studious if (...) they are told that they are hard-working and adults become more generous if they are told that they are generous. He argues that we should think of virtue and character as social constructs: there is no such thing as virtue without social reinforcement. His original and provocative book will interest a wide range of readers in contemporary ethics, epistemology, moral psychology and empirically informed philosophy. (shrink)

Khader offers a deliberative perfectionist approach to identifying and responding to adaptive preferences-- deprived people's preferences that perpetuate their deprivation.

Consciousness and Mind presents David Rosenthal's influential work on the nature of consciousness. Central to that work is Rosenthal's higher-order-thought theory of consciousness, according to which a sensation, thought, or other mental state is conscious if one has a higher-order thought that one is in that state. The first four essays develop various aspects of that theory. The next three essays present Rosenthal's homomorphism theory of mental qualities and qualitative consciousness, and show how that theory fits with and helps sustain (...) the HOT theory. A crucial feature of homomorphism theory is that it individuates and taxonomizes mental qualities independently of the way we're conscious of them, and indeed independently of our being conscious of them at all. So the theory accommodates the qualitative character not only of conscious sensations and perceptions, but also of those which fall outside our stream of consciousness. Rosenthal argues that, because this account of mental qualities makes no appeal to consciousness, it enables us to dispel such traditional quandaries as the alleged conceivability of undetectable quality inversion, and to disarm various apparent obstacles to explaining qualitative consciousness and understanding its nature. Six further essays build on the HOT theory to explain various important features of consciousness, among them the complex connections that hold in humans between consciousness and speech, the self-interpretative aspect of consciousness, and the compelling sense we have that consciousness is unified. Two of the essays, one an extended treatment of homomorphism theory, appear here for the first time. There is also a substantive introduction, which draws out the connections between the essays and highlights their implications. (shrink)

I said that the cure itself is a certain leaf, but in addition to the drug there is a certain charm, which if someone chants when he makes use of it, the medicine altogether restores him to health, but without the charm there is no profit from the leaf.