Heroin prescription involves the medical provision of heroin in the treatment of heroin addiction. Rudimentary clinical trials on that treatment modality have been carried out and others are currently underway or in development. However, it is questionable whether subjects considered for such trials are mentally competent to consent to them. The problem has not been sufficiently appreciated in ethical and clinical discussions of the topic. The challenges involved throw new light on the role of value and accountability in contemporary discussions (...) of mental competence. (shrink)

For many years G. E. Moore asked himself what was wrong with sentences like ‘I went to the pictures last Tuesday, but I don't believe that I did’, or ‘I believe that he has gone out, but he has not’. He discussed the problem in 1912 in his Ethics , and was still discussing it in 1944 in a paper to the Moral Sciences Club at Cambridge—an event we know about from a letter of Wittgenstein that I shall quote in (...) a moment. Throughout these years of pondering, Moore retained a remarkably stable vocabulary for setting out his solution. Briefly, he held this: saying ‘I went to the pictures last Tuesday, but I don't believe that I did’ is absurd, but not self-contradictory. Not self-contradictory, because ‘it may quite well be true’; yet absurd, because the speaker expressly repudiates, in the second part of the sentence, a belief which he implies by uttering the first part. The panoply of distinctions which subtends this doctrine—sentence v. utterance of sentence, saying v. implying, contradiction v. absurdity—was subjected to keen scrutiny a generation or so ago, and much of it has now passed into philosophical lore as a discussion of ‘Moore's Paradox’. (shrink)

The official model of explanation proposed by the logical empiricists, the covering law model, is subject to familiar objections. The goal of the present paper is to explore an unofficial view of explanation which logical empiricists have sometimes suggested, the view of explanation as unification. I try to show that this view can be developed so as to provide insight into major episodes in the history of science, and that it can overcome some of the most serious difficulties besetting the (...) covering law model. (shrink)

My concern in this paper will be to explore and develop a version of nonsocratic skepticism about weakness of will. In my view, socratism is incorrect, but like Socrates, I think that the common understanding of weakness of will raises serious problems. Contrary to socratism, it is possible for a person knowingly to act contrary to his or her better judgment. But this description does not exhaust the common view of weakness. Also implicit in this view is the belief that (...) actions which are contrary to one's better judgment are free in the sense that the agent could have done otherwise. To take seriously the possibility of acting contrary to one's better judgment is at the same time to raise problems about the distinction between weakness and compulsion. I argue that the common view, according to which the differentiating feature is that the weak are able to conform their behavior to their practical judgments, is unjustified. Instead, I have proposed that weakness of will involves the failure to develop certain normal capacities of self-control, whereas compulsion involves desires which even the possession of such capacities would not enable one to resist. (shrink)

Four current accounts of theory reduction are presented, first informally and then formally: (1) an account of direct theory reduction that is based on the contributions of Nagel, Woodger, and Quine, (2) an indirect reduction paradigm due to Kemeny and Oppenheim, (3) an "isomorphic model" schema traceable to Suppes, and (4) a theory of reduction that is based on the work of Popper, Feyerabend, and Kuhn. Reference is made, in an attempt to choose between these schemas, to the explanation of (...) physical optics by Maxwell's electromagnetic theory, and to the revisions of genetics necessitated by partial biochemical reductions of genetics. A more general reduction schema is proposed which: (1) yields as special cases the four reduction paradigms considered above, (2) seems to be in better accord with both the canons of logic and actual scientific practice, and (3) clarifies the problems of meaning variance and ontological reduction. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained (...) by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (shrink)

According to the doctrine of the guise of the good, all that is desired is seen by the subject as good to some extent. As a claim about action, the idea is that intentional action, or acting for a reason, is action that is seen as good by the agent. I explore the thesis' main attractions: it provides an account of intentional behavior as something that makes sense to the agent, it paves the way for various views in meta-ethics and (...) normative ethics, and it offers a unified account of practical and theoretical reason. In response to common objections, I examine points of current debate: what is it for something to appear as good? Is value or normative reasons the basic concept at work? How to explain akrasia, perversity in action, and expressive action? I conclude with an overview of alternatives to the guise of the good. (shrink)

Richard Holton has developed a view of the nature of weak-willed actions, and I have done the same for akratic actions. How well does this view of mine fare in the sphere of weakness of will? Considerably better than Holton’s view. That is a thesis of this article. The article’s aim is to clarify the nature of weak-willed actions. Holton reports that he is "trying to give an account of our ordinary notion of weakness of will" (1999, p. 262). One (...) way to get evidence about ordinary notions is to conduct survey studies with ordinary people. I conducted four such studies on weakness of will. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than one route to (...) go meet her dealer. (shrink)

Addiction of the variety discussed in this chapter, is a condition that by its very nature compromises decision-making capacity across the decisional spectrum. The impairment is present not only at moments of withdrawal and intoxication, but at all stages of the active addictive cycle, as long as the pathological dispositions to overvalue addictive drugs remain entrenched and operative. In light of this entrenched and pervasive reorientation in pathological values, it seems reasonable to question the unilateral presumption of capacity for cases (...) of this sort. The reason is that there is an important, but restricted, sense in which the addicted individuals in question are not ‘responsible’ for their decisions regarding drug use. The high likelihood of relapse means that, as a clinical matter of fact, they are usually not accountable. At the same time, clinical experience also suggests that we should treat addicted individuals as if they are responsible because that empowerment is crucial to their recovery. In the end, there is probably only one safe course of action to take when faced with such a difficult situation. This is to suspend the unilateral global presumption of capacity and instead assess decision-making capacity on a case-by-case basis, with careful monitoring and encouragement. (shrink)

Addicts often are portrayed as agents driven by irresistible desires in the philosophical literature on free will. Although this portrayal is faithful to a popular conception of addiction, that conception has encountered opposition from a variety of quarters (e.g., Bakalar & Grinspoon, 1984; Becker & Murphy, 1988; Peele, 1985 and 1989; Szasz, 1974). My concern here is some theoretical issues surrounding a strategy for self-control of potential use to addicts on the assumption that their pertinent desires fall short of irresistibility. (...) I offer no defense of this assumption; rather, I treat it as a point of departure for one approach to understanding addiction in action. I begin by sketching some conceptual and theoretical background and then turn to a proposal of George Ainslie's (1992) about temptation and self-control and to some reservations that Michael Bratman (1966) has expressed about it. I will argue that in some scenarios typical of addicts, Ainslie's proposal survives Bratman's objections. My guiding question is this: How can behavior exhibiting self-control or its contrary in addicts who are concerned to resist relevant temptations be accommodated in a general theory of human action that features a broad array of so-called "intentional attitudes" as important explanatory items? The attitudes that primarily concern me here are desire, intention, belief, and a species of evaluative judgment. (shrink)