I consider the current best interests of patients who were once thought to be either completely unaware (to be in PVS) or only minimally aware (MCS), but who, because of advanced fMRI studies, we now suspect have much more “going on” inside their minds, despite no ability to communicate with the world. My goal in this chapter is twofold: (1) to set out and defend a framework that I think should always guide thinking about the best interests of highly cognitively (...) compromised patients, and then (2) to defend a particular conclusion that applies to this specific patient population. The framework requires us to ask two questions: Is the individual suffering? Is the individual gaining any benefit from life? There must be benefit of some sort for life to be worth preserving, and the benefit must outweigh any suffering (if there is suffering present). I then argue it would be best overall to allow these patients to die. Either these patients are not really very aware at all, in which case they are most likely not suffering, but not benefiting from life either, or they are mentally intact enough to make benefit a theoretical possibility, but in fact they are not benefiting because they cannot communicate with anyone. Such patients would most likely suffer. As there is no way currently to address their suffering, we should allow them to die. No matter the truth about their cognitive lives, death would either be a neutral event, or a blessing. (shrink)

Anyone familiar with Richard Kraut's work in ancient philosophy will be excited to see him putting aside the dusty tomes of the ancients and delving into ethics first-hand. He does not disappoint. His book is a lucid and wide-ranging discussion that provides at least the core of an ethical theory and an appealing set of answers to a range of ethical questions.Kraut aims to provide an alternative to utilitarianism that preserves the good-centred nature of that theory. He claims that all (...) justification ‘proceeds by way of good and bad’ and that the only way for something to be good or bad is for it to be good or bad for some living thing. He is adamant that this does not commit him to utilitarianism, nor to downplaying considerations such as promise-keeping or special relationships. On Kraut's view, such factors can make it the case that I have more reason to perform one action than another but it is a condition of my having any reason to perform an action that it does some good or impedes some harm. Kraut once seems to dissent from this, claiming that: ‘the strength of a practical reason varies according to …. (shrink)

Drawing on philosophy, political and social theory, decision-theory, economics, psychology, history and literature, Jon Elster's classic book Sour Grapes continues and complements the arguments of his acclaimed earlier book, Ulysses and the Sirens. Elster begins with an analysis of the notation of rationality, before tackling the notions of irrational behavior, desires and belief with highly sophisticated arguments that subvert the orthodox theories of rational choice. Presented in a fresh series livery and with a specially commissioned preface written by Richard Holton, (...) illuminating its continuing importance to philosophical enquiry, Sour Grapes has been revived for a new generation of readers. (shrink)

It will be seen how in place of the wealth and poverty of political economy come the rich human being and rich human need. The rich human being is simultaneously the human being in need of totality of human life-activities — the man in whom his own realization exists as an inner necessity, as need. Marx, Economic and Philosophical Manuscripts of 1844 Svetaketu abstained from food for fifteen days. Then he came to his father and said, `What shall I say?' (...) The father said: `Repeat the Rik, Yagus, and Saman verses.' He replied, `They do not occur to me, Sir.' The father said to him... `Go and eat! Then wilt thou understand me.' Then Svetaketu ate, and afterwards approached his father. And whatever his father asked him, he knew it all by heart.... After that, he understood what his father meant when he said: `Mind, my son, comes from food, breath from water, speech from fire.' He understood what he said, yea, he understood it. Chandogya-Upanishad, VI Prapathaka, 7 Kanda When you love a man you want him to live and when you hate him you want him to die. If, having wanted him to live, you then want him to die, this is a misguided judgment. `If you did not do so for the sake of riches, you must have done so for the sake of novelty.' Confucius, Analects, Book 12. 10. (shrink)

The concept of well-being is one of the oldest and most important topics in philosophy and ethics, going back to ancient Greek philosophy and Aristotle. Following the boom in happiness studies in the last few years it has moved to centre stage, grabbing media headlines and the attention of scientists, psychologists and economists. Yet little is actually known about well-being and it is an idea often poorly articulated. The Routledge Handbook of Philosophy of Well-Being provides a comprehensive, outstanding guide and (...) reference source to the key topics and debates in this exciting subject. Comprising over forty chapters by a team of international contributors, the Handbook is divided into six parts: well-being in the history of philosophy current theories of well-being, including hedonism, and perfectionism examples of well-being and its opposites, including friendship and virtue and pain and death theoretical issues such as well-being and value, harm, identity and well-being and children well-being in moral and political philosophy well-being and related subjects including law, economics, and medicine. Essential reading for students and researchers in ethics and political philosophy, it will also be an invaluable resource for those in related disciplines such as psychology, politics and sociology. (shrink)

Gwen Bradford presents the first systematic account of what achievements are, and why they are worth the effort. She argues that more things count as achievements than we might have thought, and offers a new perfectionist theory of value in which difficulty, perhaps surprisingly, plays a central part in characterizing achievements.

We use a new model of metarepresentational development to predict a cognitive deficit which could explain a crucial component of the social impairment in childhood autism. One of the manifestations of a basic metarepresentational capacity is a ‘ theory of mind ’. We have reason to believe that autistic children lack such a ‘ theory ’. If this were so, then they would be unable to impute beliefs to others and to predict their behaviour. This hypothesis was tested using Wimmer (...) and Perner’s puppet play paradigm. Normal children and those with Down’s syndrome were used as controls for a group of autistic children. Even though the mental age of the autistic children was higher than that of the controls, they alone failed to impute beliefs to others. Thus the dysfunction we have postulated and demonstrated is independent of mental retardation and specific to autism. (shrink)

So-called theories of well-being (prudential value, welfare) are under-represented in discussions of well-being. I do four things in this article to redress this. First, I develop a new taxonomy of theories of well-being, one that divides theories in a more subtle and illuminating way. Second, I use this taxonomy to undermine some misconceptions that have made people reluctant to hold objective-list theories. Third, I provide a new objective-list theory and show that it captures a powerful motivation for the main competitor (...) theory of well-being (the desire-fulfilment theory). Fourth, I try to defuse the worry that objective-list theories are problematically arbitrary and show how the theory can and should be developed. (shrink)

BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series (...) of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions. (shrink)

Marie-Aure´lie Bruno,1 Jan L Bernheim,2 Didier Ledoux,1 Fre´de´ric Pellas.

According to the most important theories of justice, personal dignity is closely related to independence, and the care that people with disabilities receive is seen as a way for them to achieve the greatest possible autonomy. However, human beings are naturally subject to periods of dependency, and people without disabilities are only “temporarily abled.” Instead of seeing assistance as a limitation, we consider it to be a resource at the basis of a vision of society that is able to account (...) for inevitable dependency relationships between “unequals” ensuring a fulfilling life both for the carer and the cared for.**. (shrink)

Recent work in neuroimaging suggests that some patients diagnosed as being in the persistent vegetative state are actually conscious. In this paper, we critically examine this new evidence. We argue that though it remains open to alternative interpretations, it strongly suggests the presence of consciousness in some patients. However, we argue that its ethical significance is less than many people seem to think. There are several different kinds of consciousness, and though all kinds of consciousness have some ethical significance, different (...) kinds underwrite different kinds of moral value. Demonstrating that patients have phenomenal consciousness — conscious states with some kind of qualitative feel to them — shows that they are moral patients, whose welfare must be taken into consideration. But only if they are subjects of a sophisticated kind of access consciousness — where access consciousness entails global availability of information to cognitive systems — are they persons, in the technical sense of the word employed by philosophers. In this sense, being a person is having the full moral status of ordinary human beings. We call for further research which might settle whether patients who manifest signs of consciousness possess the sophisticated kind of access consciousness required for personhood. (shrink)

Sour Grapes aims to subvert orthodox theories of rational choice through the study of forms of irrationality. Dr Elster begins with an analysis of the notation of rationality, to provide the background and terms for the subsequent discussions, which cover irrational behaviour, irrational desires and irrational belief. These essays continue and complement the arguments of Jon Elster's earlier book, Ulysses and the Sirens. That was published to wide acclaim, and Dr Elster shows the same versatility here in drawing on philosophy, (...) political and social theory, decision-theory, economics and psychology, as well as history and literature. (shrink)

An adaptive preference is a preference that is regimented in response to an agent’s set of feasible options. The fabled fox in the sour grapes story undergoes an adaptive preference change. I consider adaptive preferences more broadly, to include adaptive preference formation as well. I argue that many adaptive preferences that other philosophers have cast out as irrational sour-grapes-like preferences are actually fully rational preferences worthy of pursuit. I offer a means of distinguishing rational and worthy adaptive preferences from irrational (...) and unworthy ones. The distinction is based on the agent’s own appraisal of the adaptive preference. (shrink)

Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (shrink)

This chapter contains sections titled: The Concept of Brain Death and its Appeal A Critique of Brain Death What Kind of Entity Are We? Persistent Vegetative State References Further Reading.

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

Tension and suspense are powerful emotional experiences that occur in a wide variety of contexts (e.g., in music, film, literature, and everyday life). The omnipresence of tension experiences suggests that they build on very basic cognitive and affective mechanisms. However, the psychological underpinnings of tension experiences remain largely unexplained, and tension and suspense are rarely discussed from a general, domain-independent perspective. In this paper, we argue that tension experiences in different contexts (e.g., musical tension or suspense in a movie) build (...) on the same underlying psychological processes. We discuss key components of tension experiences and propose a domain-independent model of tension and suspense. According to this model, tension experiences originate from states of conflict, instability, dissonance, or uncertainty that trigger predictive processes directed at future events of emotional significance. We also discuss possible neural mechanisms underlying experiences of tension. The model provides a theoretical framework that can inform future empirical research on tension phenomena. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

I argue that character planning differs from sour grapes in that the former but not the latter leaves the agent with a coherent preference structure.

How should we treat patients diagnosed as being in a persistent vegetative state (PVS) or minimally conscious state (MCS)? More specifically, should we treat them as having the full moral status of persons? Yes, or so we argue. First, we introduce the medical conditions of PVS, MCS, and the related conditions of Locked-in Syndrome and covert awareness. Second, we characterize the main argument for thinking diagnosed PVS patients are not persons. Third, we contend that this argument is defeated by mounting (...) empirical evidence for the considerable uncertainty of PVS diagnoses. Fourth, we characterize a new argument for PVS non-personhood suggested by Neil Levy and Julian Savulescu, one intended to accommodate the diagnostic uncertainty. According to this argument, even if diagnosed PVS patients are in fact MCS, it makes no difference because MCS patients are probably not persons either. Fifth, we challenge the new argument by assembling reasons for doubting the claim that MCS patients are not persons. The outcome is that it is fairly uncertain whether diagnosed PVS and MCS patients are persons or not. What should we do in light of this uncertainty? Sixth, we develop and support a guiding precautionary principle, which we call Precautionary Personhood. Finally, we apply the principle to the case of diagnosed PVS and MCS patients: we argue that given substantial uncertainty about their personhood we should go ahead and treat these patients as if they are persons. (shrink)

An argument against the bias towards the near; how a defence of temporal neutrality is not a defence of S; an appeal to inconsistency; why we should reject S and accept CP.