I summarize the main argument of Transformative Experience (OUP 2014). The book develops familiar examples from classical philosophical debates, as well as original examples, to argue that an agent’s decision to undergo a transformative experience—an experience constituted by radical personal and epistemic change for the agent—must either be authentic or irrational, but not both. The Precis of Transformative Experience walks the reader through the main ideas involved in epistemically and personally transformative experiences, the problems they pose for rational decision-making, and (...) discusses a number of key original examples of transformative experiences. (shrink)

This paper proposes a way to understand transformative choices, choices that change ‘who you are.’ First, it distinguishes two broad models of transformative choice: 1) ‘event-based’ transformative choices in which some event—perhaps an experience—downstream from a choice transforms you, and 2) ‘choice-based’ transformative choices in which the choice itself—and not something downstream from the choice—transforms you. Transformative choices are of interest primarily because they purport to pose a challenge to standard approaches to rational choice. An examination of the event-based transformative (...) choices of L. A. Paul and Edna Ullman-Margalit, however, suggests that event-based transformative choices don’t raise any difficulties for standard approaches to rational choice. An account of choice-based transformative choices—and what it is to be transformed—is then proposed. Transformative choices so understood not only capture paradigmatic cases of transformative choice but also point the way to a different way of thinking about rational choice and agency. (shrink)

This paper is part of a book symposium for L. A. Paul (2014) Transformative Experience (OUP).

It seems natural to choose whether to have a child by reflecting on what it would be like to actually have a child. I argue that this natural approach fails. If you choose to become a parent, and your choice is based on projections about what you think it would be like for you to have a child, your choice is not rational. If you choose to remain childless, and your choice is based upon projections about what you think it (...) would be like for you to have a child, your choice is not rational. This suggests we should reject our ordinary conception of how to make this life-changing decision, and raises general questions about how to rationally approach important life choices. (shrink)

According to Paul (Transformative experience, 1st edn, Oxford University Press, 2014), transformative experiences pose a challenge to decision theory since their value cannot be anticipated. Building on Pettigrew’s (in: Lambert, Schwenkler (eds) Becoming someone new: essays on transformative experience, choice, and change, Oxford University Press, pp 100–121, 2020) redescription, this paper presents a new approach to how and when transformative decisions can nevertheless be made rationally. Thanks to fundamental higher-order facts that apply to any kind of experience, an agent always (...) at least knows the general shape of the utility space. This in combination with the knowledge about the non-transformative alternative in the choice set can enable rational decision-making despite the presence of a transformative experience. For example, this paper’s approach provides novel arguments for why gender transition (cf. McKinnon in Res Philosophica 92(2):419–440, 2015) or staying childfree (cf. Barnes in Philos Phenomenol Res 91(3):775–786, 2015) can be rational. (shrink)

This article described three heuristics that are employed in making judgements under uncertainty: representativeness, which is usually employed when people are asked to judge the probability that an object or event A belongs to class or process B; availability of instances or scenarios, which is often employed when people are asked to assess the frequency of a class or the plausibility of a particular development; and adjustment from an anchor, which is usually employed in numerical prediction when a relevant value (...) is available. These heuristics are highly economical and usually effective, but they lead to systematic and predictable errors. A better understanding of these heuristics and of the biases to which they lead could improve judgements and decisions in situations of uncertainty. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact (...) that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

This article is an attempt to analyse the experience of embodiment in illness. Drawing upon Heidegger' sphenomenology and the suggestion that illness can be understood as unhomelike being-in-the-world, I try to show how the way we live our own bodies in illness is experienced precisely as unhomelike. The body is alien, yet, at the same time, myself. It involves biological processes beyond my control, but these processes still belong to me as lived by me. This a priori otherness of the (...) body presents itself in illness in an uncanny and merciless way. The unhomelike breakdown of our everyday being-in-the-world suffered in illness is explored through Heidegger's notion of the world being a “totality of relevance”, a pattern of meaning played out between different “tools”. The lived body is compared to a broken tool that alters and obstruct sour way of being “thrown” and “projecting” ourselves in the meaning patterns of the world through feelings,thoughts and actions. The similarities and differences between this unhomelikeness of illness and the specific unhomelikeness of authentic understanding,reached according to Heidegger in existential anxiety,are discussed. In order to illustrate how the lived body can present itself as “broken” and “other” to its owner, and in what way this unhomelike experience calls for help from health-care professionals, I make use of a clinical example of a severe and common disease: stroke. (shrink)

The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (shrink)

In her very interesting ‘First-personal modes of presentation and the problem of empathy’, L. A. Paul argues that the phenomenon of empathy gives us reason to care about the first person point of view: that as theorists we can only understand, and as humans only evince, empathy by appealing to that point of view. We are skeptics about the importance of the first person point of view, although not about empathy. The goal of this paper is to see if we (...) can account for empathy without the ideology of the first person. We conclude that we can. (shrink)

Summary of Transformative Experience by L.A. Paul and replies to symposiasts. Discussion of undefined values, preference change, authenticity, experiential value, collective minds, mind control.

We develop a broader, more fine-grained taxonomy of forms of ‘transformative experience’ inspired by the work of L.A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

Some experiences are transformative in that it is impossible to imagine experiencing them until one experiences them. It has been argued that pregnancy and parenthood are like that, and that therefore one cannot make a rational decision whether to become a mother. I argue that pregnancy and parenthood are not like that; but that if even if they are, a woman can still make a rational decision by relying on testimony about the value of these experiences. I then discuss an (...) objection that such testimony will be unreliable because parents will reflect on their being glad that their children exist, and will not realize that it’s reasonable to be glad their children exist even if the parents’ lives are thereby worse. I argue that despite this possible route to unreliable testimony, in general it is reasonable to rely on others’ testimony about the value of their lives. (shrink)

Although there are many variations on the theme, so much is made of the good of moral autonomy that it is difficult not to suppose that there is everything to be said for being morally autonomous and nothing at all to be said for being morally nonautonomous. However, this view of moral autonomy cannot be made to square with the well-received fact that most people are morally nonautonomous — not, at any rate, unless one is prepared to maintain that most (...) people are irrational in this respect. I am not. Thus, I reject what I take to be the prevailing view of moral autonomy. I argue that it is false that (1) moral autonomy is such that it is rational for every person to prefer being morally autonomous to being morally nonautonomous, but true that (2) moral autonomy is such that if anyone is morally autonomous, then it is rational for him to prefer being morally autonomous to being morally nonautonomous. (shrink)

Advance care planning has been shown to improve patient outcomes and is recommended as part of routine care for people with a life-limiting illness. Nevertheless, developing an advance care plan can be complex and challenging for both patients and family members, and the clinicians who support them. One complexity is that illness and its treatments often cannot be deeply understood without lived experience. In this paper, we explore this idea, highlighting how lived experience can bring about unpredictable changes in an (...) individual’s values and preferences. We examine the implications of such ‘transformative experiences’ for advance care planning, using the hypothetical case study of Jean, an older person with advanced kidney disease. Finally, we consider consequences for clinical practice and how an understanding of transformative experience might enhance current approaches to advance care planning. (shrink)

This paper explores the impact that developments in the field of neuroprosthetics will have on the ethical viability of healthy limb amputation, specifically in cases of Body Integrity Identity Dis...

Liberal societies are built on a foundation of personal rights, including the right to make decisions about the medical treatment that one will receive or decline to receive. So essential to the liberal project is the power of individual choice that it will be abrogated only in the most extreme situations, in which persons seem to be unable to make rational decisions and thereby to protect their interests. A small number of decision-related abilities have been identified as relevant to the (...) determination of when a person will be deemed decisionally incapable: understanding, appreciation, reasoning, and choice. It would seem prudent to tinker with these standards cautiously—if at all.... (shrink)