Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of consent because valid (...) consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

There is too much that we do not know about COVID-19. The longer we take to find it out, the more lives will be lost. In this paper, we will defend a principle of risk parity: if it is permissible to expose some members of society (e.g. health workers or the economically vulnerable) to a certain level of ex ante risk in order to minimize overall harm from the virus, then it is permissible to expose fully informed volunteers to a (...) comparable level of risk in the context of promising research into the virus. We apply this principle to three examples of risky research: skipping animal trials for promising treatments, human challenge trials to speed up vaccine development, and low-dose controlled infection or “variolation.” We conclude that if volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research, there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks. (shrink)

David Lewis has argued that “having an experience is the best way or perhaps the only way, of coming to know what that experience is like”; when an experience is of a sufficiently new sort, mere science lessons are not enough. Developing this Lewisian line, L.A. Paul has suggested that some experiences are epistemically transformative. Until an individual has such an experience it remains epistemically inaccessible to her. No amount of stories and theories and testimony from others can teach her (...) what it is like to have it, nor is she able to achieve this knowledge by way of imaginative projection. It’s this last claim that is the focus of this paper. In particular, I explore the case for the claim that some experiences are in principle imaginatively inaccessible to someone who has not undergone the experience itself or one relevantly similar. As I will suggest, this case is not as strong as is often thought. Close attention to the mechanisms of imagination, and in particular, to cases of skilled imaginers, suggests how techniques of imaginative scaffolding can sometimes be used to give us epistemic access to experiences we have not had, even ones that are radically different from any that we have had before. As a result, considerably fewer experiences remain imaginatively out of reach than proponents of transformative experience would have us believe. Experience may well be the best teacher, but this paper aims to show that imagination comes in a close second. (shrink)

Laurie Paul has recently argued that transformative experiences pose a problem for decision theory. According to Paul, agents facing transformative experiences do not possess the states required for decision theory to formulate its prescriptions. Agents facing transformative experiences are impoverished relative to their decision problems, and decision theory doesn’t know what to do with impoverished agents. Richard Pettigrew takes Paul’s challenge seriously. He grants that decision theory cannot handle decision problems involving transformative experiences. To deal with the problems posed by (...) transformative experiences, Pettigrew proposes two alterations to decision theory. The first alteration is meant to handle the problem posed by epistemically transformative experiences, and the second alteration is meant to handle the problem posed by personally transformative experiences. I argue that Pettigrew’s proposed alterations are untenable. Pettigrew’s novel decision theory faces both formal and philosophical problems. It is doubtful that Pettigrew can formulate the sort of decision theory he wants, and further doubtful that he should want such a decision theory in the first place. Moreover, the issues with Pettigrew’s proposed alterations help reveal issues with Paul’s initial challenge to decision theory. I suggest that transformative experiences should not be taken to pose a problem for decision theory, but should instead be taken to pose a topic for ethics. (shrink)

It is often said that ‘what it is like’-knowledge cannot be acquired by consulting testimony or reading books [Lewis 1998; Paul 2014; 2015a]. However, people also routinely consult books like What It Is Like to Go to War [Marlantes 2014], and countless ‘what it is like’ articles and youtube videos, in the apparent hope of gaining knowledge about what it is like to have experiences they have not had themselves. This article examines this puzzle and tries to solve it by (...) appealing to recent work on knowing-wh ascriptions. In closing I indicate the wider significance of these ideas by showing how they can help us to evaluate prominent arguments by Paul [2014; 2015a] concerning transformative experiences. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

It is sometimes argued that autonomous decision-making requires that the decision-maker’s desires are authentic, i.e., “genuine,” “truly her own,” “not out of character,” or similar. In this article, it is argued that a method to reliably determine the authenticity (or inauthenticity) of a desire cannot be developed. A taxonomy of characteristics displayed by different theories of authenticity is introduced and applied to evaluate such theories categorically, in contrast to the prior approach of treating them individually. The conclusion is drawn that, (...) in practice, the authenticity of desires cannot be reliably determined. It is suggested that authenticity should therefore not be employed in informed consent practices in healthcare. (shrink)

We regularly wield powers that, upon close scrutiny, appear remarkably magical. By sheer exercise of will, we bring into existence things that have never existed before. With but a nod, we effect the disappearance of things that have long served as barriers to the actions of others. And, by mere resolve, we generate things that pose significant obstacles to others' exercise of liberty. What is the nature of these things that we create and destroy by our mere decision to do (...) so? The answer: the rights and obligations of others. And by what seemingly magical means do we alter these rights and obligations? By making promises and issuing or revoking consent When we make promises, we generate obligations for ourselves, and when we give consent, we create rights for others. Since the rights and obligations that are affected by means of promising and consenting largely define the boundaries of permissible action, our exercise of these seemingly magical powers can significantly affect the lives and liberties of others. (shrink)

ABSTRACT It is accepted that treatment of previously competent, now incompetent patients can be limited if that is what the patient would desire, if she were now competent. Expressed past preferences or an advance directive are often taken to constitute sufficient evidence of what a patient would now desire. I distinguish between desires and rational desires. I argue that for a desire to be an expression of a person's autonomy, it must be or satisfy that person's rational desires. A person (...) rationally desires a course of action if that person desires it while being in possession of all available relevant facts, without committing relevant error of logic, and “vividly imagining” what its consequences would be like for her. I argue that some competent, expressed desires obstruct autonomy. I show that several psychological mechanisms operate to prevent a person rationally evaluating what future life in a disabled state would be like. Rational evaluation is difficult. However, treatment limitation, if it is to respect autonomy, must be in accord with a patient's rational desires, and not merely her expressed desires. I illustrate the implications of these arguments for the use of advance directives and for the treatment of competent patients. (shrink)

In this article, we seek to contribute to the debate on the requirement of disclosure in the context of informed consent for research. We defend the subjective standard of disclosure and describe ways to implement this standard in research practice. We claim that the researcher should make an effort to find out what kinds of information are likely to be relevant for those consenting to research. This invites researchers to take empirical survey information seriously, attempt to understand the cultural context, (...) talk to patients to be better able to understand what can be potentially different concerns and interests prevalent in the target population. The subjective standard of disclosure should be seen as a moral ideal that perhaps can never be perfectly implemented but still can and should be used as a normative ideal guiding research practice. In the light of these discussions, we call for more empirical research on what considerations are likely to be perceived as relevant by potential research participants recruited from different socio-economic and cultural groups. (shrink)

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

What happens when we consider transformative experiences from the perspective of gender transitions? In this paper I suggest that at least two insights emerge. First, trans* persons’ experiences of gender transitions show some limitations to L.A. Paul’s (forthcoming) decision theoretic account of transformative decisions. This will involve exploring some of the phenomenology of coming to know that one is trans, and in coming to decide to transition. Second, what epistemological effects are there to undergoing a transformative experience? By connecting some (...) experiences of gender transitions to feminist standpoint epistemology, I argue that radical changes in one’s identity and social location also radically affects one’s access to knowledge in ways not widely appreciated in contemporary epistemology. (shrink)

L.A. Paul has argued that an ordinary, natural way of making a decision -- by reflecting on the phenomenal character of the experiences one will have as a result of that decision -- cannot yield rational decision in certain cases. Paul's argument turns on the (in principle) epistemically inaccessible phenomenal character of certain experiences. In this paper I argue that, even granting Paul a range of assumptions, her argument doesn't work to establish its conclusion. This is because, as I argue, (...) the phenomenal character of an experience supervenes on epistemically accessible facts about its non-phenomenal character plus what the deciding agent is like. Because there are principles that link the non-phenomenal character of experiences (together with what a particular agent is like) to the phenomenal character of experiences, agents can reasonably form expectations about the valence of the phenomenal character of the experiences that they are deciding whether to undergo. These reasonable expectations are, I argue, enough to make the ordinary, natural way of making a decision yield rational decision. (shrink)

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)

Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which (...) other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law. (shrink)

On the standard Paulian definition of epistemically transformative experiences (ETE), we can’t know what an ETE is like before we have it. ETEs are new kinds of experiences and, importantly, can’t be imagined—this is why they have a unique ability to teach us what a particular experience is like. Contra Paul, some philosophers (Sharadin, 2015; Wilkenfeld, 2016; Ismael, 2019; Kind, 2020; Daoust, 2021; Cath, 2022) have argued that transformative experiences can be imagined. A neglected consequence of this argument is that (...) if transformative experiences can in fact be imagined, then it is unclear how they could be epistemically transformative. What do they teach us if we can imagine what they’re like in advance? I will argue not only that imaginable experiences can be transformative, but that experiences of a kind which an agent is experientially acquainted with can also be transformative. This latter kind of transformative experiences, which I will call familiar transformative experiences, are transformative not because the agent learns what a new kind of experience is like—by definition, they are not new kinds of experiences—but because the transformativeness of the experience is brought out by features of the agent experiencing them. Epistemic transformation in these cases may be explained by facts about the agent’s perspective and social environment, which allow them to appreciate elements of the experience they did not previously. (shrink)

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

L.A. Paul argues that interesting issues for rational choice theory are raised by epistemically transformative experiences: experiences which provide access to knowledge that could not be known without the experience. Consideration of the epistemic effects of pregnancy has important implications for our understanding of epistemically transformative experiences and for debate about the ethics of abortion and applied ethics more generally. Pregnancy is epistemically transformative both in Paul’s narrow sense and in a wider sense: those who have not been pregnant face (...) significant barriers to acquiring the knowledge made accessible through pregnancy. This knowledge is crucial for engaging with the ethics of abortion. The epistemically transformativeWIDE nature of pregnancy may require us to use new methods to try to partially grasp what pregnancy is like such as for example, significant engagement with narrative literature. Because pregnancy is also epistemically transformative in a narrow sense, we need to work out how to engage in ethical reasoning when relevant knowledge is not fully accessible to all. This argument has implications beyond the debate about abortion. Philosophers in many areas of applied ethics will need to work out how to respond appropriately to epistemically transformative experiences. (shrink)

Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; and (...) third, participants’ understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies. (shrink)

In “What you can’t expect when you’re expecting,” I argue that, if you don’t know what it’s like to be a parent, you cannot make this decision rationally—at least, not if your decision is based on what you think it would be like for you to become a parent. My argument hinges on the idea that becoming a parent is a transformative experience. This unique type of experience often transforms people in a deep and personal sense, and in the process, (...) changes their preferences. In section 1, I will explain transformative experience in terms of radical first-personal epistemic and self change. In section 2, I’ll explain the notion of subjective value that I use to develop the decision problem. In section 3, I will discuss the way we ordinarily combine our introspective assessments with testimony and evidence. In section 4, I will discuss the problems for rational decision-making. In section 5, I will explore the problem of first-personally transformed future selves. In section 6, I will engage with the main themes and arguments and ideas of the authors of the papers contributed to this volume. (shrink)

In this paper, we explore the link between understanding and transformative decisions. Paul (2014) suggests that one important aspect of making some decisions is that we make them not just on the basis of what data from other people tell us, but based on our own acquaintance with how the decision affects us. In this paper, we draw out a parallel between the sort of reasoning that Paul argues is required for authentic decision making and the sort of epistemic grasp (...) of a subject matter that is required for understanding. The central claim of this paper is that one’s ability to make a decision authentically is proportional to one’s ability to model what it is like to have the possible resultant experience. We endorse a broad notion according to which one can model something by thinking about relevantly similar things. (shrink)

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)

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads to the very (...) uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny. (shrink)

In the last seven years, philosophers have discussed the topic of transformative experiences. In this paper, we contribute to a crucial issue that is currently under-researched: transformative experiences' influence on cognitive modelling. We argue that cognitive modelling can be operationalized as affective forecasting, and we compare transformative and non-transformative experiences with respect to the ability of affective forecasting. Our finding is that decision-makers’ performance in cognitively modelling transformative experiences does not systematically differ from decision-makers’ performance in cognitively modelling non-transformative experiences. (...) This claim stands in strict opposition to L.A. Paul’s main argument. (shrink)

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering ‘deep’ reality or God. In addition to symptom relief, (...) psychedelic experiences often lead to significant changes in a patient’s personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process–one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

I begin my analysis of consent by agreeing with Professor Hurd that consent functions as a “moral transformative” by altering the obligations and permissions that determine the Tightness of others' actions. I further agree with her that consent is intimately related to the capacity for autonomous action; one who cannot alter others' obligations through consent is not fully autonomous. I cannot improve on her elaboration of these points.

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions (...) and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted. (shrink)

Book reviewed in this article: Beginning Lives, by Rosalind Hursthouse. On Moral Medicine:Theological Perspectives in Medical Ethics, edited by Stephen E. Lammers and Allen Verhey. Quantitative Risk Assessment, edited by James M. Humber and Robert F. A Theory of Value and Obligation, by Robin Attfield. Ethical Issues at the Outset of Life, edited by William B. Weil Jr. and Martin Benjamin. Legal Frontiers of Death and Dying by Norman L. Cantor Having Your Baby By Donor Insemination:A Complete Resource Guide, by (...) Elizabeth Noble. (shrink)

In this article, I argue that persons suffering from Body Integrity Identity Disorder (BIID) can give informed consent to surgical measures designed to treat this disorder. This is true even if the surgery seems radical or irrational to most people. The decision to have surgery made by a BIID patient is not necessarily coerced, incompetent or uninformed. If surgery for BIID is offered, there should certainly be a screening process in place to insure informed consent. It is beyond the scope (...) of this work, however, to define all the conditions that should be placed on the availability of surgery. However, I argue, given the similarities between BIID and gender dysphoria and the success of such gatekeeping measures for the surgical treatment of gender dysphoria, it is reasonable that similar conditions be in place for BIID. Once other treatment options are tried and gatekeeping measures satisfied, A BIID patient can give informed consent to radical surgery. (shrink)

Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

In this paper, I explore the role that regret does and should play in medical decision-making. Specifically, I consider whether the possibility of a patient experiencing post-treatment regret is a good reason for a clinician to counsel against that treatment or to withhold it. Currently, the belief that a patient may experience post-treatment regret is sometimes taken as a sufficiently strong reason to withhold it, even when the patient makes an explicit, informed request. Relatedly, medical researchers and practitioners often understand (...) a patient’s post-treatment regret to be a significant problem, one that reveals a mistake or flaw in the decision-making process. Contrary to these views, I argue that the possibility of post-treatment regret is not necessarily a good reason for withholding the treatment. This claim is justified by appealing to respect for patient autonomy. Furthermore, there are occasions when the very reference to post-treatment regret during medical decision-making is inappropriate. This, I suggest, is the case when the decision concerns a “personally transformative treatment”. This is a treatment that alters a person’s identity. Because the treatment is transformative, neither clinicians nor the patient him/herself can ascertain whether post-treatment regret will occur. Consequently, I suggest, what matters in determining whether to offer a personally transformative treatment is whether the patient has sufficiently good reasons for wanting the treatment at the time the decision is made. What does not matter is how the patient may subsequently be changed by undergoing the treatment. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (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)

ABSTRACT Is uncertainty about preferences rationally possible? And if so, does it matter for rational decision? It is argued that uncertainty about preferences is possible and should play the same role in rational decision-making as uncertainty about worldly facts. The paper develops this hypothesis and defends it against various objections.

According to L. A. Paul (2014), transformative experiences pose a challenge for decision theory, as their subjective value is not epistemically accessible. However, several authors propose that the subjective values of options are often irrelevant to their ranking; in many cases, all we need for rational transformative decision-making are the known non-subjective values. This stance is in conflict with Paul’s argument that the subjective value can always swamp the non-subjective value. The approach presented in this paper takes Paul’s argument into (...) account and shows how potential swamping can be controlled given that one desires the transformative outcome: If one knows from previous decisions that desired transformative outcomes are associated with positive subjective value and if, in addition, testimony confirms this association for the current decision situation, one can infer that a desired outcome’s expected subjective value has a positive valence. Accordingly, one can rationally choose the desired transformative option if its non-subjective value is no lower than the overall value of any other option. (shrink)

Some decisions we make—such as becoming a parent or moving to a different part of the world—are transformative. According to L. A. Paul, transformative decisions pose a major problem to us because they fall outside the realm of rationality. Her argument for that conclusion rests on the premise that subjective value is central in transformative decisions. This paper challenges that premise and hence the overall conclusion that transformative decisions usually are not rational. In the theoretical part of the paper, we (...) specify conditions under which transformative decisions are possibly rational and likely rational. The data we present in the empirical part of the paper reveal that subjective value often plays only a minor role in people’s decision-making process. Putting both parts together, we argue that people have a great chance of making rational transformative choices. (shrink)

The prelims comprise: References Additional Reading.