In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

My strategy is to examine a recent trend in philosophical discussions of responsibility, a trend that tries, but I think ultimately fails, to give an acceptable analysis of the conditions of responsibility. It fails due to what at first appear to be deep and irresolvable metaphysical problems. It is here that I suggest that the condition of sanity comes to the rescue. What at first appears to be an impossible requirement for responsibility---the requirement that the responsible agent have created her- (...) or himself---turns out to be the vastly more mundane and non controversial requirement that the responsible agent must, in a fairly standard sense, be sane. (shrink)

Luck egalitarians think that considerations of responsibility can excuse departures from strict equality. However critics argue that allowing responsibility to play this role has objectionably harsh consequences. Luck egalitarians usually respond either by explaining why that harshness is not excessive, or by identifying allegedly legitimate exclusions from the default responsibility-tracking rule to tone down that harshness. And in response, critics respectively deny that this harshness is not excessive, or they argue that those exclusions would be ineffective or lacking in justification. (...) Rather than taking sides, after criticizing both positions I also argue that this way of carrying on the debate – i.e. as a debate about whether the harsh demands of responsibility outweigh other considerations, and about whether exclusions to responsibility-tracking would be effective and/or justified – is deeply problematic. On my account, the demands of responsibility do not – in fact, they can not – conflict with the demands of other normative considerations, because responsibility only provides a formal structure within which those other considerations determine how people may be treated, but it does not generate its own practical demands. (shrink)

Opponents of biomedical enhancement often claim that, even if such enhancement would benefit the enhanced, it would harm others. But this objection looks unpersuasive when the enhancement in question is a moral enhancement — an enhancement that will expectably leave the enhanced person with morally better motives than she had previously. In this article I (1) describe one type of psychological alteration that would plausibly qualify as a moral enhancement, (2) argue that we will, in the medium-term future, probably be (...) able to induce such alterations via biomedical intervention, and (3) defend future engagement in such moral enhancements against possible objections. My aim is to present this kind of moral enhancement as a counter-example to the view that biomedical enhancement is always morally impermissible. (shrink)

When it was first published in France in 1961 as Folie et Déraison: Histoire de la Folie à l'âge Classique , few had heard of a thirty-four year old philosopher by the name of Michel Foucault. By the time an abridged English edition was published in 1967 as Madness and Civilization , Michel Foucault had shaken the intellectual world. This translation is the first English edition of the complete French texts of the first and second edition, including all prefaces and (...) appendices, some of them unavailable in the existing French edition. History of Madness begins in the Middle Ages with vivid descriptions of the exclusion and confinement of lepers. Why, Foucault asks, when the leper houses were emptied at the end of the Middle Ages, were they turned into places of confinement for the mad? Why, within the space of several months in 1656, was one out of every hundred people in Paris confined? Shifting brilliantly from Descartes and early Enlightenment thought to the founding of the Hôpital Général in Paris and the work of early psychiatrists Philippe Pinel and Samuel Tuke, Foucault focuses throughout, not only on scientific and medical analyses of madness, but also on the philosophical and cultural values attached to the mad. He also urges us to recognize the creative and liberating forces that madness represents, brilliantly drawing on examples from Goya, Nietzsche, Van Gogh and Artaud. The History of Madness is an inspiring and classic work that challenges us to understand madness, reason and power and the forces that shape them. (shrink)

In many recent discussions of the morality of actions where both good and bad consequences foreseeably ensue, the moral significance of the distinction between intended and foreseen consequences is rejected. This distinction is thought to bear on the moral status of actions by those who support the Doctrine of Double Effect. According to this doctrine, roughly speaking, to perform an action intending to bring about a particular bad effect as a means to some commensurate good end is impermissible, while performing (...) an action where one intends only this good end and merely foresees the bad as an unintended sideeffect may be permissible. Consequentialists argue that this is a distinction which makes no moral difference to the evaluation of the initial act in the two cases, given that the overall consequences are the same in each case. In this paper we aim to show that a standard consequentialist line of argument against the moral relevance of the intention/foresight distinction fails. Consequentialists commonly reject the moral relevance of this distinction on the grounds that there is no asymmetry in moral responsibility between intending and foreseeing evil. We argue that even if this claim about moral responsibility is correct, it does not entail, as many Consequentialists believe, that there is no moral asymmetry between acts of intended and foreseen evil. We go on to argue that those consequentialists who do concede the moral relevance of the intention/foresight distinction at the level of agent evaluations cannot consistently make such a concession, and that such a position is in any case untenable, because it entails a complete severance of important conceptual connections between act and agent evaluations. (shrink)

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence of (...) this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients’ informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm. (shrink)

This article centres around two somewhat contrasting case histories: one involving a person with dementia; the other a person with mild mania.

The assessment of chronic pain is a highly unmet medical need. Chronic pain is also the subject of a large and costly category of legal claims. Yet, with pain cases, the jury always face a doubt: is the claimant faking or malingering? How can we be assured that the claimant is 'really' in pain? Most recently, several new neuroimaging technologies are promising to solve these questions, by rendering pain visible, measurable and, to some degree, verifiable. The results of these advancements (...) have prompted us to think of pain in a different way, i.e. as an altered brain state in which functional connections are modified, with components of degenerative aspects. But, does this imply the stronger claim that these technologies allow us to 'know', or to literally 'see', the pain of others? Is the pain being objectified by these techniques? And if so, what might the law do differently, or do better? (shrink)