A long tradition of psychological research has explored the distinction between characteristics that are part of the self and those that lie outside of it. Recently, a surge of research has begun examining a further distinction. Even among characteristics that are internal to the self, people pick out a subset as belonging to the true self. These factors are judged as making people who they really are, deep down. In this paper, we introduce the concept of the true self and (...) identify features that distinguish people’s understanding of the true self from their understanding of the self more generally. In particular, we consider recent findings that the true self is perceived as positive and moral, and that this tendency is actor-observer invariant and cross-culturally stable. We then explore possible explanations for these findings and discuss their implications for a variety of issues in psychology. (shrink)

According to Gawande, Lazaroff “chose badly.” Gawande suggests that physicians may be permitted to intervene in choices of this kind. What makes the temptation to intervene paternalistically in this and similar cases especially strong is that the patient’s choice contradicts his professed values. Paternalism appears less problematic in such cases because, in contradicting his values, the patient seems to sidestep his own autonomy. This chapter addresses the dangers of overextending this interpretation. I argue that it is not so easy to (...) judge when a person is not genuinely exercising autonomy, and that choosing contrary to one’s own values does not necessarily amount to sidestepping one’s autonomy. The key insight is to recognize the importance of the attitude of caring as an integral part of some expressions of autonomy. This will allow us to develop an alternative picture of minimal autonomy, according to which it is possible to choose against one’s values while genuinely exercising autonomy. For practical purposes, in medicine and elsewhere, this means that, in cases like Lazaroff’s, those tempted toward paternalism must exercise particular caution before they deem a choice to be disen- gaged from autonomy: even if a choice contradicts the person’s own values, it might be rooted in caring, and then, despite initial appearances to the contrary, it may still command the highest level of protection against paternalism. (shrink)

Personal autonomy is often taken to consist in self-government or self-determination. Personal autonomy thus seems to require self-control. However, there is reason to think that autonomy is compatible with the absence of self-control. Akratic action, i.e., action performed against the agent’s better judgement, can be free. And it is also plausible to think that free actions require autonomy. It is only when you determine what you do yourself that you act freely. It follows that akratic actions can be autonomous. At (...) least in some cases, it is the agent herself, and not some alien part of her, who determines her akratic actions. But akratic actions are usually thought to be paradigm cases of self-control failure. Thus, we have reason both to conclude that autonomy requires self-control and that autonomy is compatible with the absence of self-control. My aim is to discuss the main solutions to this paradox. (shrink)

Williams argues that impartial moral theories undermine agents’ integrity by making them responsible for allowings as well as doings. I argue that in some cases of allowings, where there is an intervening agent, the agent has been coerced, and so is not fully responsible. I provide an analysis of coercion. Whether an agent is coerced depends on various things (the coercer must provide strong reasons, and the coercer must have a mens rea), and crucially, the coercee’s action is rendered less (...) than fully voluntary by the coercion. The attack on voluntariness is usually explained by limiting coercion to threats rather than offers. I argue that this approach cannot work. Instead I argue that non-voluntariness (and thus coercion) must be understood in terms of the subjective state of the victim. It is a necessary condition of coercion that the coercee actually suffers alienation from her own actions as a result of domination by the coercer. I defend this account and show that it provides an explanation for why agents who are coerced do not act in a fully voluntary way. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision on their behalf). (...) -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

Because there is no agreed use of the term 'self', or characteristic features or even paradigm cases of selves, there is no idea of "the self" to figure in philosophical problems. The term leads to troubles otherwise avoidable; and because legitimate discussions under the heading of 'self' are really about other things, it is gratuitous. I propose that we stop speaking of selves.

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

Interventions that modify a person’s motivations through chemically or physically influencing the brain seem morally objectionable, at least when they are performed nonconsensually. This chapter raises a puzzle for attempts to explain their objectionability. It first seeks to show that the objectionability of such interventions must be explained at least in part by reference to the sort of mental interference that they involve. It then argues that it is difficult to furnish an explanation of this sort. The difficulty is that (...) these interventions seem no more objectionable, in terms of the kind of mental interference that they involve, than certain forms of environmental influence that many would regard as morally innocuous. The argument proceeds by comparing a particular neurointervention with a comparable environmental intervention. The author argues, first, that the two dominant explanations for the objectionability of the neurointervention apply equally to the environmental intervention, and second, that the descriptive difference between the environmental intervention and the neurointervention that most plausibly grounds the putative moral difference in fact fails to do so. The author concludes by presenting a trilemma that falls out of the argument. (shrink)

This essay contends that the constitutive elements of well-being are plural, partly objective, and separable. The essay argues that these elements are pleasure, friendship, significant achievement, important knowledge, and autonomy, but not either the appreciation of beauty or the living of a morally good life. The essay goes on to attack the view that elements of well-being must be combined in order for well-being to be enhanced. The final section argues against the view that, because anything important to say about (...) well-being could be reduced to assertions about these separable elements, the concept of well-being or personal good is ultimately unimportant. (shrink)

Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. -/- Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective (...) states and values in decision making at later stages of the illness. Evidence points to the hypothesis that anorexia nervosa may be a distinct affective syndrome that organizes feelings and emotions in accordance with a fixed idea. -/- Summary There has been impressive progress in empirical ethics research on anorexia nervosa, with important implications for ethical and conceptual issues that surround decision-making capacity and our understanding of the illness. (shrink)

According to what Douglas calls ‘the consent requirement’, neuro-correctives can only permissibly be provided with the valid consent of the offender who will undergo the intervention. Some of those who endorse the consent requirement have claimed that even though the requirement prohibits the imposition of mandatory neurocorrectives on criminal offenders, it may yet be permissible to offer offenders the opportunity to consent to undergoing such an intervention, in return for a reduction to their penal sentence. I call this the neurocorrective (...) offer. In this chapter I consider the coercion-based objection to the neurocorrective offer, which claims that offenders cannot provide valid consent to undergoing a neurocorrective on the basis of this offer because it is inherently coercive. Having outlined early formulations of this argument, I point out that there are in fact two different versions of this objection, which appeal to different understandings of the concepts of coercion, consent and voluntariness. (shrink)

Voluntariness of consent to research has not been sufficiently explored through empirical research. The aims of this study were to develop a more comprehensive approach to assessing voluntariness and to generate preliminary data on the extent and correlates of limitations on voluntariness. We developed a questionnaire to evaluate subjects’ reported motivations and constraints on voluntariness. 88 subjects in five different areas of clinical research—substance abuse, cancer, HIV, interventional cardiology, and depression—were assessed. Subjects reported a variety of motivations for participation. Offers (...) of financial incentives were common but not influential, pressures from others were rare, and no threats were reported. However, certain financial incentives and—paradoxically—altruistic motivations led some subjects to feel more constrained. Consistent with previous studies, no one pattern of motivation was common to all research subjects. There was little evidence of constrained voluntariness, but some suggestion of areas of concern. Voluntariness appears to be susceptible to systematic empirical investigation. (shrink)

In this paper I attempt a general explanation of the role played by the reasonable person in law, especially but not only in the common law. I relate my explanation to some problems about the very nature of law, and some problems about the ideal of the rule of law.

This paper discusses the puzzle of blackmail, i.e. the way in which the threat of an otherwise legally permissible action can in some cases constitute blackmail. It argues that the key to understanding blackmail is in terms of coercion and threats, and the effect such threats have on the validity of a victim’s consent. The nature of coercion and of coercive threats is considered in detail to support the thesis that threats are prima facie impermissible, though often justified all-things-considered. The (...) puzzle of blackmail arises due to the fact that the law rarely has regard to an agent’s motives in acting, whereas this is the focus of the puzzling cases. (shrink)