According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these powers, my (...) version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

In the book’s first chapter, the topic of practical mind is approached via a brief survey of a number of important positions in the history of philosophy. The founding question for a philosophy of practical mind is raised by Aristotle when he asks what it is in the soul that originates movement. I discuss the answers to this question proposed by Plato, Aristotle himself, Hobbes and Hume, before rounding off the historical survey with a look at the introduction of the (...) notion of “pro-attitude” in the last century. The key question put to the various proposals concerns their capacity to give a unitary account of what it is that “moves” agents. Put in terms of the last of the suggestions discussed: is there a single pro-component that unites the diverse ways of being for something under one genus? And if so, is that pro-component the feature that moves us? (shrink)

Defenders of the extended mind thesis say that it is possible that some of our mental states may be constituted, in part, by states of the extra-bodily environment. Often they also add that such extended mentation is a commonplace phenomenon. I argue that extended mentation, while not impossible, is either nonexistent or far from widespread. Genuine beliefs as they occur in normal biologically embodied systems are informationally integrated with each other, and sensitive to changes in the person.

This paper discusses two perspectives, each of which recognises the importance of environmental resources in enhancing and amplifying our cognitive capacity. One is the Clark–Chalmers model, extended further by Clark and others. The other derives from niche construction models of evolution, models which emphasise the role of active agency in enhancing the adaptive fit between agent and world. In the human case, much niche construction is epistemic: making cognitive tools and assembling other informational resources that support and scaffold intelligent action. (...) I shall argue that extended mind cases are limiting cases of environmental scaffolding, and while the extended mind picture is not false, the niche construction model is a more helpful framework for understanding human action. (shrink)

The paper develops ethical guidelines for the development and usage of persuasive technologies (PT) that can be derived from applying discourse ethics to this type of technologies. The application of discourse ethics is of particular interest for PT, since ‘persuasion’ refers to an act of communication that might be interpreted as holding the middle between ‘manipulation’ and ‘convincing’. One can distinguish two elements of discourse ethics that prove fruitful when applied to PT: the analysis of the inherent normativity of acts (...) of communication (‘speech acts’) and the Habermasian distinction between ‘communicative’ and ‘strategic rationality’ and their broader societal interpretation. This essay investigates what consequences can be drawn if one applies these two elements of discourse ethics to PT. (shrink)

Self-tracking devices point to a future in which individuals will be more involved in the management of their health and will generate data that will benefit clinical decision making and research. They have thus attracted enthusiasm from medical and public health professionals as key players in the move toward participatory and personalized healthcare. Critics, however, have begun to articulate a number of broader societal and ethical concerns regarding self-tracking, foregrounding their disciplining, and disempowering effects. This paper has two aims: first, (...) to analyze some of the key promises and concerns that inform this polarized debate. I argue that far from being solely about health outcomes, this debate is very much about fundamental values that are at stake in the move toward personalized healthcare, namely, the values of autonomy, solidarity, and authenticity. The second aim is to provide a framework within which an alternative approach to self-tracking for health can be developed. I suggest that a practice-based approach, which studies how values are enacted in specific practices, can open the way for a new set of theoretical questions. In the last part of the paper, I sketch out how this can work by describing various enactments of autonomy, solidarity, and authenticity among self-trackers in the Quantified Self community. These examples show that shifting attention to practices can render visible alternative and sometimes unexpected enactments of values. Insofar as these may challenge both the promises and concerns in the debate on self-tracking for health, they can lay the groundwork for new conceptual interventions in future research. (shrink)

Public health communications often attempt to persuade their audience to adopt a particular belief or pursue a particular course of action. To a large extent, the ethical defensibility of persuasion appears to be assumed by public health practitioners; however, a handful of academic treatments have called into question the ethical defensibility of persuasive risk- and health communication. In addition, the widespread use of persuasive tactics in public health communications warrants a close look at their ethical status, irrespective of previous critiques. (...) In this article, we review some ethical objections previously advanced against the use of persuasion in public health communications, and also consider some novel but potentially relevant objections. We conclude that persuasion is ethically problematic in some circumstances and attempt to clarify what these circumstances are. However, whereas persuasion may be ethically problematic in some circumstances, it need not be viewed as intrinsically problematic. (shrink)

In our philosophical tradition and our wider culture, we tend to think of persons as agents. This agential conception is flattering, but in this paper I will argue that it conceals a more complex truth about what persons are. In 1. I set the issues in context. In 2. I critically explore four features commonly presented as fundamental to personhood in versions of the agential conception: action, capability, choice and independence. In 3. I argue that each of these agential features (...) presupposes a non-agential feature: agency presupposes patiency, capability presupposes incapability, choice presupposes necessity and independence presupposes dependency. In 4. I argue that such non-agential features, as well as being implicit within the agential conception, are as apt to be constitutive of personhood as agential features, and in 5. I conclude. (shrink)

This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that—even with (...) respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy and substantive-relational autonomy. While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation. (shrink)

This essay offers a start on sorting out the relationships of argumentation and persuasion by identifying two systematic ways in which definitions of argumentation differ, namely, their descriptions of the ends and of the means involved in argumentative discourse. Against that backdrop, the traditional “conviction-persuasion” distinction is reassessed. The essay argues that the traditional distinction correctly recognizes the difference between the end of influencing attitudes and that of influencing behavior—but that it misanalyzes the means of achieving the latter (by focusing (...) on emotional arousal) and that it mistakenly contrasts “rational” and “emotional” means of influence. The larger conclusion is that understanding the relationships of the phenomena of argumentation and persuasion will require close attention to characterizations of communicative ends and means. (shrink)

The concept of privacy by design is becoming increasingly popular among regulators of information and communications technologies. This paper aims at analysing and discussing the ethical implications of this concept for personal health monitoring. I assume a privacy theory of restricted access and limited control. On the basis of this theory, I suggest a version of the concept of privacy by design that constitutes a middle road between what I call broad privacy by design and narrow privacy by design. The (...) key feature of this approach is that it attempts to balance automated privacy protection and autonomously chosen privacy protection in a way that is context-sensitive. In personal health monitoring, this approach implies that in some contexts like medication assistance and monitoring of specific health parameters one single automatic option is legitimate, while in some other contexts, for example monitoring in which relatives are receivers of health-relevant information rather than health care professionals, a multi-choice approach stressing autonomy is warranted. (shrink)

The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of autonomy as derived from the right persons have to respect, as agents who can argue, persuade and be persuaded in matters of utmost personal significance such as decisions about medical care. (...) Hence, autonomy should and could be respected only after such an attempt has been made. Understanding suffering to a significant degree is a prerequisite to sincere efforts of persuasion. It is claimed that a modified and pragmatic form of discourse is the necessary framework for understanding suffering and for compassionately interacting with the frail. (shrink)

Many contemporary eudaimonists emphasize the role of agency in the good life. Mark LeBar, for example, characterizes his own eudaimonist view this way: “It is agentist, not patientist, because it emphasizes that our lives go well in virtue of what we do, rather than what happens, to us or otherwise”. Nicholas Wolterstorff, however, has argued that this prioritizing of agency over patiency is a fatal flaw in eudaimonist accounts of well-being. Eudaimonism must be rejected, Wolterstorff argues, because many life-goods are (...) “passivities” that are out of a person’s hands, including how she is treated by others. In this paper, I defend eudaimonism against this passivities objection. I argue that eudaimonism can maintain its agentist character while also capturing the element of truth in the passivities objection—namely, that human well-being is vulnerable and social. I also argue that eudaimonists should avail themselves of the notion of receptivity to capture important aspects of the good life. (shrink)

This paper critically engages with new self-tracking technologies. In particular, it focuses on a conceptual tension between the idea that disclosing personal information increases one’s autonomy and the idea that informational privacy is a condition for autonomous personhood. I argue that while self-tracking may sometimes prove to be an adequate method to shed light on particular aspects of oneself and can be used to strengthen one’s autonomy, self-tracking technologies often cancel out these benefits by exposing too much about oneself to (...) an unspecified audience, thus undermining the informational privacy boundaries necessary for living an autonomous life. (shrink)

Relatively new and now ubiquitous, smartphones and tablet computers are changing our lives by asking us to rethink the ways that we conduct business, form and maintain relationships, and read books and magazines. In the same capacity, mobile devices are redefining how health care is administered, monitored, and delivered through specialized technologies called medical apps (applications). In general, apps are pieces of software that can be installed and run on a variety of hardware platforms, including smartphones, tablets, laptops, and desktop (...) computers. Medical apps, in particular, refer to a wide variety of software that focuses on health care (loosely defined). Whether these apps target the health-care .. (shrink)

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. (...) In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

The distinction between acting and suffering underlies any theory of agency. Among contemporary writers, Fred Dretske is one of the few who has attempted to explicate this distinction without restricting the notion of action to intentional action alone. Aristotle also developed a global account of agency, one which is deeper and more detailed than Dretske's, and it is to Aristotle's account (with some modifications) that the bulk of this paper is devoted. Dretske's sketchier theory faces at least two ground-level problems. (...) It is shown in the course of the paper how these can be handled by the Aristotelian account, in a way which is friendly to Dretske's approach. 1 An earlier, and fuller, version of this paper was presented at the international conference “Supervenience, Causality, Mind and Action”, Université de Provence (Aix-Marseille 1), Aix-en-Provence, 9-11 May 1999. I would like to thank Thorsteinn Gylfason, Logi Gunnarsson, Torfi Sigurdsson, Andri Björnsson and Lynne Rudder Baker for their helpful comments and criticisms. My research on causality and explanation, which forms the background for this paper, has been supported by the Icelandic Council of Science and the Research Fund of the University of Iceland. (shrink)

The distinction between acting and suffering underlies any theory of agency. Among contemporary writers, Fred Dretske is one of the few who has attempted to explicate this distinction without restricting the notion of action to intentional action alone. Aristotle also developed a global account of agency, one which is deeper and more detailed than Dretske's, and it is to Aristotle's account (with some modifications) that the bulk of this paper is devoted. Dretske's sketchier theory faces at least two ground-level problems. (...) It is shown in the course of the paper how these can be handled by the Aristotelian account, in a way which is friendly to Dretske's approach. (shrink)

Medical clinicians – doctors, nurses, nurse practitioners etc. – are charged to act for the good of their patients. But not all ways of acting for a patient's good are on par: some are paternalistic; others are not. What does it mean to act paternalistically, both in general and specifically in a medical context? And when, if ever, is it permissible for a clinician to act paternalistically? In Medical Paternalism Part 1, I answered the first question. This paper answers the (...) second. The place of paternalism in clinical medicine is best understood, I argue, in terms of the potential for conflict between the autonomy principle and the beneficence principle. The first enjoins clinicians to respect the decisions of patients with respect to their (the patients') own care. The second enjoins clinicians to act for the good of their patients. Clinicians act paternalistically, I argue, when they act on the beneficence principle to the exclusion of the autonomy principle. Understanding just what these principles amount to (particularly the autonomy principle) reveals that the autonomy principle defeasibly trumps the beneficence principle and that, as a result, acting paternalistically (at least when it comes to competent patients) is presumptively impermissible. (shrink)

Several influential characterizations of paternalism or its distinctive wrongness emphasize a belief or judgement that it typically involves—namely, 10 the judgement that the paternalized is likely to act irrationally, or some such. But it's not clear what about such a belief can be morally objectionable if it has the right epistemic credentials (if it is true, say, and is best supported by the evidence). In this paper, I elaborate on this point, placing it in the context of the relevant epistemological (...) discussions. I explain how 15 evidentialism is opposed to such thoughts; I show that possible ways of rejecting evidentialism (along lines analogous to those of pragmatic encroachment) won't work; and I sketch an account of the wrongness of paternalism that doesn't depend on any flaw in the belief about others' likely behaviour. (shrink)

I take as my starting point the “one very simple principle” proclaimed by Mill in On Liberty … “That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. He cannot rightfully be compelled to do (...) or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right.”. (shrink)

In this book, Mark LeBar develops Virtue Eudaimonism, which brings the philosophy of the ancient Greeks to bear on contemporary problems in metaethics, especially the metaphysics of norms and the nature of practical rationality.

What experimental game theorists may have demonstrated is not that people are systematically irrational but that human rationality is heavily scaffolded. Remove the scaffolding, and we do not do very well. People are able to get on because they “offload” an enormous amount of practical reasoning onto their environment. As a result, when they are put in novel or unfamiliar environments, they perform very poorly, even on apparently simple tasks. -/- This observation is supported by recent empirically informed shifts in (...) philosophy of mind toward a view of cognition as (to cite the current slogan) “embodied, embedded, enactive, extended.” Andy Clark and others have made a very plausible case for the idea that a proper assessment of human cognitive competence must include environmental components. To limit our attention to what lies within the skin-skull boundary is, in effect, to miss the big story on human rationality. Insofar as we are rational, it is often because of our ingenuity at developing “work-arounds” to the glitches in the fast-and-frugal heuristic problem-solving capabilities that natural selection has equipped us with. And these work-arounds often involve a detour through the environment (so-called offloading of cognitive burdens). -/- When it comes to practical rationality, things are no different. Yet in many discussions of “the will,” there is still a tendency to put too much emphasis on what goes on inside the agent’s head. Our objective in this chapter is to articulate this conception of “the extended will” more clearly, using the strategies that people employ to overcome procrastination for the central set of examples. Procrastination, in our view, constitutes a particular type of self-control problem, one that is particularly amenable to philosophical reflection, not only because of the high volume of psychological research on the subject but also because of the large quantity of “self-help” literature in circulationa literature that provides an invaluable perspective on the everyday strategies that people use in order to defeat (or, better yet, circumvent) this type of self-defeating behavior pattern. In general, what we find is that the internalist bias that permeates discussions of the will gives rise to a set of practical recommendations that overemphasize changing the way one thinks about a task, while ignoring the much richer set of strategies that are available in the realm of environmental scaffolding. In the concluding section, we highlight some of the policy implications of this, particularly regarding social trends involving the dismantling of support structures. (shrink)