A story does more than recount events; it recounts events in a way that renders them intelligible, thus conveying not just information but also understanding. We might therefore be tempted to describe narrative as a genre of explanation. When the police invite a suspect to “tell his story,” they are asking him to explain the blood on his shirt or his absence from home on the night of the murder; and whether he is judged to have a “good story” will (...) depend on its adequacy as an explanation. Can we account for the explanatory force of narrative with the models of explanation available in the philosophy of science? Or does narrative convey a different kind of understanding, which requires a different model and perhaps even a term other than ‘explanation’? (shrink)

What kind of life best ensures human welfare? Since the ancient Greeks, this question has been as central to ethical philosophy as to ordinary reflection. But what exactly is welfare? This question has suffered from relative neglect. And, as Stephen Darwall shows, it has done so at a price. Presenting a provocative new "rational care theory of welfare," Darwall proves that a proper understanding of welfare fundamentally changes how we think about what is best for people.Most philosophers have assumed that (...) a person's welfare is what is good from her point of view, namely, what she has a distinctive reason to pursue. In the now standard terminology, welfare is assumed to have an "agent-relative normativity." Darwall by contrast argues that someone's good is what one should want for that person insofar as one cares for her. Welfare, in other words, is normative, but not peculiarly for the person whose welfare is at stake. In addition, Darwall makes the radical proposal that something's contributing to someone's welfare is the same thing as its being something one ought to want for her own sake, insofar as one cares. Darwall defends this theory with clarity, precision, and elegance, and with a subtle understanding of the place of sympathetic concern in the rich psychology of sympathy and empathy. His forceful arguments will change how we understand a concept central to ethics and our understanding of human bonds and human choices. (shrink)

This beautifully written book by one of the world's leading moral philosophers argues that the key to a fulfilled life is to pursue wholeheartedly what one cares about, that love is the most authoritative form of caring, and that the purest form of love is, in a complicated way, self-love. Harry Frankfurt writes that it is through caring that we infuse the world with meaning. Caring provides us with stable ambitions and concerns; it shapes the framework of aims and interests (...) within which we lead our lives. The most basic and essential question for a person to raise about the conduct of his or her life is not what he or she should care about but what, in fact, he or she cannot help caring about. The most important form of caring, Frankfurt writes, is love, a nonvoluntary, disinterested concern for the flourishing of what is loved. Love is so important because meaningful practical reasoning must be grounded in ends that we do not seek only to attain other ends, and because it is in loving that we become bound to final ends desired for their own sakes. Frankfurt argues that the purest form of love is self-love. This sounds perverse, but self-love--as distinct from self-indulgence--is at heart a disinterested concern for whatever it is that the person loves. The most elementary form of self-love is nothing more than the desire of a person to love. Insofar as this is true, self-love is simply a commitment to finding meaning in our lives. (shrink)

The author argues that the key to a fulfilled life is to pursue what one cares about, that love is the most authoritative form of caring, and that the purest form of love is, in a complicated way, self-love.

While some lament the slide of Western culture into relativism and nihilism and others celebrate the trend as a liberating sort of progress, Charles Taylor calls on us to face the moral and political crises of our time, and to make the most ...

The result is nothing less than a fundamental reorientation of moral theory that enables it at last to account for morality's supreme authority--an account that ...

Autonomous decisions are decisions that reflect the self who makes them. Since patients in need of surrogate decision making can no longer enjoy the dignity of being free to express who they are through choice and action, surrogates should strive to, at least, make sure that decisions on behalf of the patient reflects that patient's self. Concepts of the self, then, underlie views about the role autonomy should play in surrogate decision making. Alzheimer's disease (AD) complicates the situation because it (...) is a disease which effects the self and theorists disagree about which aspect of the AD self the decision should reflect. This disagreement has led to a seemingly irresolvable split between those who favor the then self and those who favor the now self. The debate has stalled because while both of these views are attractive, neither seems adequate. That is, neither view is complete because each focuses only on one aspect of a whole self. In this paper, I argue that a good mode of surrogate decision making is one that focuses on the whole self and I offer practical advice concerning how we can begin to think about how such a decision might be made. (shrink)

A being has moral standing if it or its interests matter intrinsically, to at least some degree, in the moral assessment of actions and events. For instance, animals can be said to have moral standing if, other things being equal, it is morally bad to intentionally cause their suffering. This essay focuses on a special kind of moral standing, what I will call “full moral standing” (FMS), associated with persons. In contrast to the var- ious accounts of what ultimately grounds (...) FMS in use in the philosophical literature, I will propose that the emotional capacity to care is a sufficient condition of an individual’s FMS as a person. In developing this account, I will appeal to a set of intuitions not previously mined for this purpose: those generated by conflicts of interests between different life phases of a single individual. (shrink)

In his work on internality, identification, and caring, Harry Frankfurt attempts to delineate the organization of agency peculiar to human beings, while avoiding the traditional overintellectualized emphasis on the human capacity to reason about action. The focal point of Frankfurt’s alternative picture is our capacity to make our own motivation the object of reflection. Building upon the observation that marginal agents (such as young children and Alzheimer’s patients) are capable of caring, I show that neither caring nor internality need to (...) depend on the phenomena of reflectiveness. I develop alternative interlocking accounts of caring and internality that are independent of both reflectiveness and evaluation, but that can still do justice to the central role of carings in the organization of agency characteristic of human persons. (shrink)

We are purposive agents; but we—adult humans in a broadly modern world—are more than that. We are reflective about our motivation. We form prior plans and policies that organize our activity over time. And we see ourselves as agents who persist over time and who begin, develop, and then complete temporally extended activities and projects. Any reasonably complete theory of human action will need in some way to advert to this trio of features—to our reflectiveness, our planfulness, and our conception (...) of our agency as temporally extended. These are, further, features that have great significance for the kinds of lives we can live. For these two reasons I will say that these are among the core features of human agency. A theory of human action needs to say what these core features consist in and how they are related to each other. And such a theory needs also to clarify the relation between these core features of our agency and the possibility that we are fully embedded in an event causal order. (shrink)

Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians (...) should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients. (shrink)

The rise in the recent Western pattern of surrogate decision making is not a necessary result of an increase in the number of elderly with decreased competence; it may rather manifest the dominant Western vision of human life and relations. From a comparative philosophical standpoint, the Western pattern of medical decision making is individualistic, while the Chinese is familistic. These two distinct patterns may reflect two different comprehensive perspectives on human life and relations, disclosing a foundational difference that can be (...) seen in the Aristotelian account of friendship and the Confucian account of humanity. The contemporary development of surrogate decision making in the West may illustrate a general tendency toward the Aristotelian account, while the Chinese approaches are congruent with the Confucian view. Also explored are some merits of the Chinese approach to family decision making for health care. (shrink)

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal (...) identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else. (shrink)

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

According to bioethics orthodoxy, the question, “What would the patient choose?” is a question about the patient's autonomy. is at stake. In fact, what underpins the moral force of that question is a value different from either autonomy or best interests. This is the value of doing things in a way that is authentic to the person.