Edmund Gettier is Professor Emeritus at the University of Massachusetts, Amherst. This short piece, published in 1963, seemed to many decisively to refute an otherwise attractive analysis of knowledge. It stimulated a renewed effort, still ongoing, to clarify exactly what knowledge comprises.

Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information (...) regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences. (shrink)

Nomy Arpaly rejects the model of rationality used by most ethicists and action theorists. Both observation and psychology indicate that people act rationally without deliberation, and act irrationally with deliberation. By questioning the notion that our own minds are comprehensible to us--and therefore questioning much of the current work of action theorists and ethicists--Arpaly attempts to develop a more realistic conception of moral agency.

Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration of (...) other treatment options. (shrink)

S. 39: "My project in this paper is to develop the initial distinction which I have drawn between recognition and appraisal respect into a more detailed and specific account of each. These accounts will not merely be of intrinsic interest. Ultimately I will use them to illuminate the puzzles with which this paper began and to understand the idea of self-respect." 42 " Thus, insofar as respect within such a pursuit will depend on an appraisal of the participant from the (...) perspective of whatever standards are held to be appropriate to the pursuit, such respect will depend on a judgement to which excellences of character are thought relevant. Note that exactly what aspect of the person's character is thought to be relevant in this instance is his recognition respect (or lack of it) for the standards of the pursuit." 44 "This attitude fails of being appraisal respect in that my having it toward the person is conditional on those traits being such as to make him server a particular purpose that I happen to have" 44 - 45 "To sum up: Appraisal respect is an attitude of positibe appraisal of a person either judged as a person or as engaged in some more specific pursuit. In the first case, the appropriate grounds are features of the person's character: dispositions to act for particular reasons or a higher-level disposition to act for the best reasons. In the second case, though features of character do not exhaust the appropriate grounds for appraisal respect, some such character traits will be relevant (recognition respect for the standards of a particular pursuit). Also, the other features which constitute the appoprate excellences of the pursuit must be related to traits of character in the way specified. In both cases, the positive appraisal of the person, and of his traits, must be categorical. It cannot depend on the fact that the person, because of his traits, serves an interest or purpose of one's own." 45 "To have recognition respect for someone as a person is to give appropriate weight to the fact that he or she is a person by being willing to constrain one's behaviour in ways required by that fact." 45 "This is rather different from having an attitude of appraisal respect for someone as a person. The latter is a positive appraisal oif an individual made with regard ti those features which are excellences of persons. As such, it is not owed to everone, for it may or may not be merited. When it is, what is merited is just the positive appraisal itself." 47 "Second, the only beings who are approriate objects of appraisal respect are those who are capable of acting for reasons and hence capable of conceiving of various facts as meriting more or less consideration in deliberation.". (shrink)

In the subsequent pages, I want to develop a distinction between wanting and valuing which will enable the familiar view of freedom to make sense of the notion of an unfree action. The contention will be that, in the case of actions that are unfree, the agent is unable to get what he most wants, or values, and this inability is due to his own "motivational system." In this case the obstruction to the action that he most wants to do (...) is his own will. It is in this respect that the action is unfree: the agent is obstructed in and by the very performance of the action. (shrink)

Russian translation of Gettier E. L. Is Justified True Belief Knowledge? // Analysis, vol. 23, 1963. Translated by Lev Lamberov with kind permission of the author.

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

This is the first volume in which an account of personal autonomy is developed that both captures the contours of this concept as it is used in social philosophy and bioethics, and is theoretically grounded in, and a part of, contemporary autonomy theory. James Stacey Taylor’s account is unique as it is explicitly a political one, recognizing that the attribution of autonomy to agents is dependent in part on their relationships with others and not merely upon their own mental states. (...) The volume is distinctive in its examples, which touch on the ethics of using inducements to encourage persons to participate in medical research, the ethical issues associated with the use of antibiotics, and the ethical basis for both patient confidentiality and informed consent. (shrink)

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)

Patients with the controversial diagnosis of body integrity identity disorder report an emotional discomfort with having a body part that they feel should not be there. This discomfort is so strong that it interferes with routine functioning and, in a majority of cases, BIID patients are motivated to seek amputation of the limb. Although patient requests to receive the best available treatment are generally respected, BIID demands for amputation, at present, are not. However, what little has been said in the (...) ethics literature on the subject tends to favour doing so in cases of BIID. The general argument is that BIID demands should be respected, first, because of the importance that is already placed on respecting autonomy in medical decision-making contexts and second, because of the potential harm of not providing amputation coupled with the fact that no alternative means of relieving suffering exists. The defence of the right to self-demanded amputation is thus typically supported by the use of analogies with other unproblematical cases in order to show that the denial of BIID patient demands is inconsistent with conventional medical norms and practices. This paper criticises the appropriateness of the particular analogies that are thought to shed light on the allegedly unproblematical nature of BIID demands and argues that a proper understanding of the respect for autonomy in the medical decision-making context prohibits agreeing to BIID demands for amputation. (shrink)

The prelims comprise: Introduction Controversial Choices Kinds of Normative Reasons for Action Limits on Respect for Autonomy Children and Controversial Choice Controversial Choices and the Duty to Strive Toward Perfection and Full Autonomy Acknowledgments Notes References.

The illusion that Kant respects persons comes from ascribing contemporary meanings to purely technical terms within his second formulation of the categorical imperative, “[A]ct so that you treat humanity, whether in your own person or in that of another, always as an end and never as a means only”. When we realize that “humanity” means rational nature and “person” means the supersensible self (homo noumenon), we find that we are to respect, not human selves in all their diversity (homo phaenomenon), (...) but rational selves in all their sameness, in their unvarying conformity to the universal principles of pure practical reason. Contemporary individualism gets no support from Kant. (shrink)

I argue that despite it being said often that the concept of personal autonomy is important for grounding moral responsibility and in applied ethics, a certain type of theories of autonomy and identification, descended from the work of Harry Frankfurt starting 1971, are not relevant in an obvious way to either moral responsibility or applied ethics.

Respect, Pluralism, and Justice is a series of essays which sketches a broadly Kantian framework for moral deliberation, and then uses it to address important social and political issues. Hill shows how Kantian theory can be developed to deal with questions about cultural diversity, punishment, political violence, responsibility for the consequences of wrongdoing, and state coercion in a pluralistic society.

In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties (...) to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

Controversy swept the U.K. in January of 2000 over public disclosure of the fact that a Scottish surgeon named Robert Smith had amputated the limbs of two able-bodied individuals who reportedly suffered from a condition known as apotemnophilia. The patients, both of whom had sought and consented to the surgery, claimed they had desperately desired for years to live as amputees and had been unable, despite considerable efforts, to reconcile themselves psychologically to living with the bodies with which they were (...) born. Both surgeries were successful, and both patients, who had undergone psychiatric evaluation prior to the amputations, subsequently reported having no regrets. In the wake of a wave of sensationalistic stories in the media, the hospital at which the surgeries had been performed, the Falkirk and District Royal Infirmary, banned any future surgeries of the kind. Outraged local politicians promptly announced their intention to pass laws banning the procedure outright. One member of Scottish Parliament declared the surgery obscene and asserted that the whole thing is repugnant and legislation needs to be brought in now to outlaw this. (shrink)

The principle of autonomy presupposes Patient Decision Making Competence (PDMC). For a few decades a considerable amount of empirical research has been done into PDMC. In this contribution that research is explored. After a short exposition on four qualities involved in PDMC, different approaches to assess PDMC are distinguished, namely a negative and a positive one. In the negative approach the focus is on identifying psychopathologic conditions that impair sound decision making; the positive one attempts to assess whether a patient (...) actually has the required abilities and qualities. Characteristic of the latter approach is the use of (or development of) test-like instruments for PDMC assessment. Some of these tests are discussed and commented on. Although they may be useful in investigating aspects of PDMC, none of the described approaches and tests offers a reliable and valid method for PDMC assessment. In response to a potential misuse of tests, the concept of a supportive situation is briefly introduced in order to draw attention to the risk of prematurely deeming patients incompetent on the basis of low test scores, whereas their insufficient performance may be (partly) attributable to alack of situational support. Also, the need for and possibility of an emotionalist concept of PDMC are suggested, as an alternative to the more common rationalist one. In this regard,the legitimacy of competence being conceived as a presumption or fiction of law, deserves further investigation. (shrink)

In the course of that critical study he discusses the work of many of the most influential lawyers and philosophers of the era, including Isaiah Berlin, Richard ...

In 1997, a Scottish surgeon by the name of Robert Smith was approached by a man with an unusual request: he wanted his apparently healthy lower left leg amputated. Although details about the case are sketchy, the would-be amputee appears to have desired the amputation on the grounds that his left foot wasn’t part of him – it felt alien. After consultation with psychiatrists, Smith performed the amputation. Two and a half years later, the patient reported that his life had (...) been transformed for the better by the operation [1]. A second patient was also reported as having been satisfied with his amputation [2]. (shrink)

The rare phenomenon in which a person desires amputation of a healthy limb, now often termed body integrity identity disorder, raises central questions for biomedical ethics. Standard bioethical discussions of surgical intervention in such cases fail to address the meaning of bodily integrity, which is intrinsic to a theological understanding of the goodness of the body. However, moral theological responses are liable to assume that such interventions necessarily represent an implicitly docetic manipulation of the body. Through detailed attention to the (...) ethics of mutilation and of surgery for psychiatric disorders, this article explores the theological and ethical significance of the body for human identity. (shrink)

Philosophers’ intuitions about what constitutes autonomy are largely driven by the exemplars or paradigms that we recognize. There are indefinitely many exemplars, inasmuch as there are relatively private personae that serve as autonomy exemplars such as our parents, third grade teacher, or, for the megalomaniac, oneself. But among Western philosophers there are doubtless some exemplars that are widely shared and broadly influential. Philosophical exemplars include Socrates, Aristotle’s magnanimous man, Kant’s noumenal self that is perfectly attuned to the moral law, Mill’s (...) anti-authoritarian non-conformist, Marx’s manin-society, Nietzsche’s Zarathustra, and Sartre’s authentic youth who must decide whether to join the French resistance or stay at home for the sake of his mother. Exemplars from outside of philosophy include Antigone, Christ, Faust, Ibsen’s Enemy of the People, Winston Churchill, and even figures from popular culture such as the baseball player Ted Williams, the free spirited flower children of the 1960s, and practically any character that John Wayne ever played. (shrink)