It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

Ranging over central issues of morals and politics and the nature of freedom and authority, this study examines the role of value-neutrality, rights, equality, ...

Virtually any appraisal of a person’s welfare, integrity, or moral status, as well as the moral and political theories built on such appraisals, will rely crucially on the presumption that her preferences and values are in some important sense her own. In particular, the nature and value of political freedom is intimately connected with the presupposition that actions one is left free to do flow from desires and values that are truly an expression of the ‘self-government’ of the agent. However, (...) we all know that no person is self-made in the sense of being a fully formed and intact ‘will’ blossoming out of nowhere. Our values and preferences are explained by essential reference to a variety of influences that have come to bear on our development throughout our personal histories. What is needed, then, is to establish an account of self-determination or autonomy that would help determine just when and if the values and preferences we find ourselves with deserve the centrality that moral and political theories place on them. (shrink)

Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)

Are liberalism and perfectionism compatible? In this study Steven Wall presents and defends a perfectionist account of political morality that takes issue with many currently fashionable liberal ideas but retains the strong liberal commitment to the ideal of personal autonomy. He begins by critically discussing the most influential version of anti-perfectionist liberalism, examining the main arguments that have been offered in its defence. He then clarifies the ideal of personal autonomy, presents an account of its value and shows that a (...) strong commitment to personal autonomy is fully compatible with an endorsement of perfectionist political action designed to promote valuable pursuits and discourage base ones. (shrink)

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead (...) of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

ABSTRACTThis paper introduces the category of ‘non-deceptive manipulation that causes false beliefs’, analyzes how it narrows the traditional scope of ‘deception’, and draws moral implications.

Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a nudge is any influence that is expected to predictably alter a person’s behaviour without restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent. I assume informed consent requires (...) that a physician tells her patient the truth about her options and argue that nudging is incompatible with truth-telling. Instead, nudging satisfies Harry Frankfurt’s account of bullshit. (shrink)

While the concept of adaptive preferences is an important tool for criticizing injustice, it is often claimed that using the concept involves showing disrespect for persons judged to have adaptive preferences. In this paper, I propose an account of adaptive preferences that does the relevant political work while still showing persons two centrally important kinds of respect. My account is based in what I call an indirect substantive account of autonomy, which places substantive requirements on the options available to a (...) person, rather than on the option that she ultimately prefers. This allows us to pinpoint cases in which a person's circumstances have rendered her insufficiently autonomous, without saying that any conception of the good must be non-autonomous tout court. (shrink)

In this paper we analyze the non-coercive ways in which researchers can use knowledge about the decision-making tendencies of potential participants in order to motivate them to consent to research enrollment. We identify which modes of influence preserve respect for participants’ autonomy and which disrespect autonomy, and apply the umbrella term of manipulation to the latter. We then apply our analysis to a series of cases adapted from the experiences of clinical researchers in order to develop a framework for thinking (...) through the ethics of manipulating people into research participation. All manipulation disrespects autonomy and is therefore pro tanto wrong. However, only deceptive manipulation invalidates the consent that results from it. Use of the other forms of manipulation can be permissible, but only if the outcome of using manipulation is sufficiently good and if the research cannot be carried out using ethically preferable means to obtain consent. (shrink)

The nocebo effect, the mirror-phenomenon to the placebo effect, is when the expectation of a negative outcome precipitates the corresponding symptom or leads to its exacerbation. One of the basic ethical duties in health care is to obtain informed consent from patients before treatment; however, the disclosure of information regarding potential complications or side effects that this involves may precipitate a nocebo effect. While dilemmas between the principles of respect for patient autonomy and of nonmaleficence are recognized in medical ethics, (...) there has not yet been an ethical discussion focused on the potential dilemma raised by the nocebo effect of informed consent. This dilemma is especially pernicious, since it involves a direct causality of harm by the caregiver that is unparalleled by other potential harmful effects of information disclosure. This paper articulates the dilemma of the NEIC and offers a seminal ethical analysis. (shrink)

Frames and framing make one dimension of a decision problem particularly salient. In the simplest case, framesprimeresponses (as in, e.g., the Asian disease paradigm, where the gain frame primes risk-aversion and the loss frame primes risk-seeking). But in more complicated situations frames can function reflectively, by making salient particular reason-giving aspects of a thing, outcome, or action. For Shakespeare's Macbeth, for example, his feudal commitments are salient in one frame, while downplayed in another in favor of his personal ambition. The (...) role of frames in reasoning can give rise torational framing effects. Macbeth can prefer fulfilling his feudal duty to murdering the king, while also preferring bravely taking the throne to fulfilling his feudal duty, knowing full well that bravely taking the throne just is murdering the king. Such patterns ofquasi-cyclicalpreferences can be correct and appropriate from the normative perspective of how one ought to reason. The paper explores three less dramatic types of rational framing effects: (1) Consciously framing and reframing long-term goals and short-term temptations can be important tools for self-control. (2) In the prototypical social interactions modeled by game theory, allowing for rational framing effects solves longstanding problems, such as the equilibrium selection problem and explaining the appeal of non-equilibrium solutions (e.g., the cooperative solution in the Prisoner's Dilemma). (3) Processes for resolving interpersonal conflicts and breaking discursive deadlock, because they involve internalizing multiple and incompatible ways of framing actions and outcomes, in effect create rational framing effects. (shrink)

In Tess of the d’Urbervilles, the innocent Tess is the object of Alec d’Urberville’s dishonorable intentions. Alec uses every wile he can think of to seduce the poor and ignorant Tess, who works keeping hens in his mother’s house: he flatters her, he impresses her with a show of wealth, he gives help to her family to win her gratitude, and he reacts with irritation and indignation when she nonetheless continues to repulse his advances, causing her to feel shame at (...) her own ingratitude and confusion as to what is right. Tess, anchored both by her own sense of virtue and her distrust of Alec’s character, continues to hold out until one fatal night when, through Alec’s machinations, they are lost together in a wood. At Tess’s insistence Alec leaves her to scout out the path home. When he returns, he finds her asleep under a tree. Hardy does not go into detail at this critical juncture. Rather, he reflects “why it was that upon this beautiful feminine tissue, sensitive as gossamer, and practically blank as snow as yet, there should have been traced such a coarse pattern as it was doomed to receive; why so often the coarse appropriates the finer thus, the wrong man the woman, the wrong woman the man, many thousand years of analytical philosophy have failed to explain to our sense of order.”. (shrink)

I use the psychological phenomenon of ‘attribute framing’ as a case study for exploring philosophical conceptions of semantics and the semantics-pragmatics divide. Attribute frames are pairs of sentences that use contradictory expressions to predicate the same property of an individual or object. Despite their equivalence, pairs of attribute frames have been observed to induce systematic variability in hearers’ responses. One explanation of such framing effects appeals to the distinct ‘reference point information’ conveyed by alternative frames. Although this information is taken (...) to be pragmatic, a live debate in the philosophy of language concerns the extent to which pragmatic information can really be held apart from semantics. Therefore, in this article I examine whether – and how – reference point information might be thought to intrude on the semantics of an attribute frame. I describe two ways in which the information might be considered broadly semantic, due to its being directly communicated or conventional. However, I argue that the framing data in fact support a narrower conception of semantics, and a semantics-pragmatics distinction that separates standing sentence meaning from enriched communicated meaning. (shrink)

In this article I will argue first that if ignorance poses a problem for valid consent in medical contexts then framing effects do too, and second that the problem posed by framing effects can be solved by eliminating those effects. My position is thus a mean between two mistaken extremes. At one mistaken extreme, framing effects are so trivial that they never impinge on the moral force of consent. This is as mistaken as thinking that ignorance is so trivial that (...) it never impinges on the moral force of consent. At the other mistaken extreme, framing effects are so serious that their existence shows that consent has no independent moral force. This is as mistaken as the idea that ignorance is so serious that its existence shows that consent has no independent moral force. I will argue that, instead of endorsing either of these mistaken extreme views, we should instead endorse a moderate view according to which framing effects sometimes pose a serious challenge for the validity of consent, just as ignorance does, but one which we can solve by eliminating the effect, just as we can solve the problem of ignorance by eliminating it. (shrink)

Human judgements are affected by the words in which information is presented —or ‘framed’. According to the standard gloss, ‘framing effects’ reveal counter-normative reasoning, unduly affected by positive/negative language. One challenge to this view suggests that number expressions in alternative framing conditions are interpreted as denoting lower-bounded (minimum) quantities. However, it is unclear whether the resulting explanation is a rationalising one. I argue that a number expression should only be interpreted lower-boundedly if this is what it actually means. I survey (...) how number expressions might be assigned lower-bounded meanings, due to their conventional semantics or pragmatic enrichment in context. I argue that deciding between these possibilities requires foundational philosophical input. (shrink)

It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulative health promotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful defences of (...) counter-manipulative health promotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulative health promotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulative health promotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

Our decision-making is often subject to framing effects: alternative but equally informative descriptions of the same options elicit different choices. When a decision-maker is vulnerable to framing, she may consent under one description of the act, which suggests that she has waived her right, yet be disposed to dissent under an equally informative description of the act, which suggests that she has not waived her right. I argue that in such a case the decision-maker’s consent is simply irrelevant to the (...) permissibility of proceeding. I then consider two alternative views. According to the first, people susceptible to framing are able to give valid consent so long as they are sufficiently informed. This suggestion, I argue, maintains an overly narrow focus on mere quantity of information to the exclusion of other choice-affecting factors. A second response, which appeals to hypothetical consent, is likewise of little use in resolving the moral problem posed by framing effects. I conclude that if susceptibility to framing undermines the validity of consent, we may have good reason to reconsider whether consent has the rights-waiving function commonly attributed to it. (shrink)

An original examination of the relevance of behavioral economics for the practice of medical ethics.