This encyclopedia entry provides an overview of the field of public health ethics. It focuses on what distinguishes public health ethics from other nearby subfields—especially biomedical ethics. It also frames the problems of public health ethics in terms of the concepts of justice and political legitimacy.

Deep Brain Stimulation (DBS) is an invasive therapeutic method involving the implantation of electrodes and the electrical stimulation of specific areas of the brain to modulate their activity. DBS brings therapeutic benefits, but can also have adverse side effects. Recently, neuroethicists have recognized that DBS poses a threat to the very fabric of human existence, namely, to the selves of patients. This article provides a review of the neuroethical literature examining this issue, and identifies the crucial dimensions related to the (...) self which DBS may endanger—personal identity, authenticity, and autonomy. The most influential theories accounting for these dimensions are analyzed herein, and it is argued that most of these theories require further refinement. This paper also demonstrates the interrelation between personal identity, authenticity, and autonomy, and concludes that one can only fully understand the impact of DBS on the self when all of these factors are taken into account. (shrink)

Some thinkers argue that our best scientific theories about the world prove that free will is an illusion. Others disagree. The concept of free will is profoundly important to our self-understanding, our interpersonal relationships, and our moral and legal practices. If it turns out that no one is ever free and morally responsible, what would that mean for society, morality, meaning, and the law? Just Deserts brings together two philosophers – Daniel C. Dennett and Gregg D. Caruso – to debate (...) their respective views on free will, moral responsibility, and legal punishment. In three extended conversations, Dennett and Caruso present their arguments for and against the existence of free will and debate their implications. Dennett argues that the kind of free will required for moral responsibility is compatible with determinism – for him, self-control is key; we are not responsible for becoming responsible, but are responsible for staying responsible, for keeping would-be puppeteers at bay. Caruso takes the opposite view, arguing that who we are and what we do is ultimately the result of factors beyond our control, and because of this we are never morally responsible for our actions in the sense that would make us truly deserving of blame and praise, punishment and reward. These two leading thinkers introduce the concepts central to the debate about free will and moral responsibility by way of an entertaining, rigorous and sometimes heated philosophical dialogue. What emerges is a clear account of the latest thinking on free will, and what is at stake for our moral and legal practices. (shrink)

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

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

This 1988 volume is a collection of thirteen seminal essays on ethics, free will, and the philosophy of mind. The essays deal with such central topics as freedom of the will, moral responsibility, the concept of a person, the structure of the will, the nature of action, the constitution of the self, and the theory of personal ideals. By focusing on the distinctive nature of human freedom, Professor Frankfurt is able to explore fundamental problems of what it is to be (...) a person and of what one should care about in life. (shrink)

In Freedom Within Reason, Susan Wolf charts a course between incompatibilism, or the notion that freedom and responsibility require causal and metaphysical independence from the impersonal forces of nature, and compatibilism, or the notion that people are free and responsible as long as their actions are governed by their desires. Wolf argues that some of the forces which are beyond our control are friends to freedom rather than enemies of it, enabling us to see the world for what it is. (...) The freedom we want is not independence from the world, but independence from the forces that prevent us from choosing how to live in the light of a sufficient appreciation of the world. (shrink)

This book provides a comprehensive, systematic theory of moral responsibility. The authors explore the conditions under which individuals are morally responsible for actions, omissions, consequences, and emotions. The leading idea in the book is that moral responsibility is based on 'guidance control'. This control has two components: the mechanism that issues in the relevant behavior must be the agent's own mechanism, and it must be appropriately responsive to reasons. The book develops an account of both components. The authors go on (...) to offer a sustained defense of the thesis that moral responsibility is compatible with causal determinism. (shrink)

According to Dewey, we are responsible for our conduct because it is “ourselves objectified in action”. This idea lies at the heart of an increasingly influential deep self approach to moral responsibility. Existing formulations of deep self views have two major problems: They are often underspecified, and they tend to understand the nature of the deep self in excessively rationalistic terms. Here I propose a new deep self theory of moral responsibility called the Self-Expression account that addresses these issues. The (...) account is composed of two parts. The first part answers the question, What is a deep self? Theorists have tended to favor cognitive views that understand the deep self in terms of rationally formed evaluative judgment. I propose instead a conative view that says one’s deep self consists of a distinctive kind of pro-attitude, cares, and I provide an account of cares in terms of their distinctive psychological functional role. The second part answers the question, When does an action express one’s deep self? I criticize the agentially demanding conditions set out in existing views and propose a more minimalist alternative. I show that the Self-Expression account handles issues that bedeviled traditional deep self views, including how to explain moral responsibility for spontaneous, out of character, and weak-willed actions. (shrink)

David Shoemaker presents a new pluralistic theory of responsibility, based on the idea of quality of will. His approach is motivated by our ambivalence to real-life cases of marginal agency, such as those caused by clinical depression, dementia, scrupulosity, psychopathy, autism, intellectual disability, and poor formative circumstances. Our ambivalent responses suggest that such agents are responsible in some ways but not others. Shoemaker develops a theory to account for our ambivalence, via close examination of several categories of pancultural emotional responsibility (...) responses and their appropriateness conditions. The result is three distinct types of responsibility, each with its own set of required capacities: attributability, answerability, and accountability. Attributability is about the having and expressing of various traits of character, and it is the target of a range of aretaic sentiments and emotional practices organized around disdain and admiration. Answerability is about one’s capacity to govern one’s actions and attitudes by one’s evaluative judgments about the worth of various practical reasons, and it is the target of a range of sentiments and emotional practices organized around regret and pride. Accountability is about one’s ability to regard others, both evaluatively and emotionally, and it is the target of a range of sentiments and emotional practices organized around anger and gratitude. In Part One of the book, this tripartite theory is developed and defended. In Part Two of the book, the tripartite theory’s predictions about specific marginal cases are tested, once certain empirical details about the nature of those agents have been filled in and discussed. (shrink)

Neil Levy presents a new theory of freedom and responsibility. He defends a particular account of consciousness--the global workspace view--and argues that consciousness plays an especially important role in action. There are good reasons to think that the naïve assumption, that consciousness is needed for moral responsibility, is in fact true.

The purpose of this paper is to provide a justification of punishment which can be endorsed by free will skeptics, and which can also be defended against the "using persons as mere means" objection. Free will skeptics must reject retributivism, that is, the view that punishment is just because criminals deserve to suffer based on their actions. Retributivists often claim that theirs is the only justification on which punishment is constrained by desert, and suppose that non-retributive justifications must therefore endorse (...) treating the people punished as mere means to social ends. Retributivists typically presuppose a monolithic conception of desert: they assume that action-based desert is the only kind of desert. But there are also personhood-based desert claims, that is, desert claims which depend not on facts about our actions, but instead on the more abstract fact that we are persons. Since personhood-based desert claims do not depend on facts about our actions, they do not depend on moral responsibility, so free will skeptics can appeal to them just as well as retributivists. What people deserve based on the mere fact of their personhood is to be treated as they would rationally consent to be treated if all they had in view was the mere fact of their personhood. We can work out the implications of this view for punishment by developing a hypothetical consent justification in which we select principles of punishment in the Rawlsian original position, so long as we are careful not to smuggle in the retributivist assumption that it is under our control whether we end up as criminals or as law-abiding citizens once we raise the veil of ignorance. (shrink)

Each of the following claims has been defended in the scientific literature on free will and consciousness: your brain routinely decides what you will do before you become conscious of its decision; there is only a 100 millisecond window of opportunity for free will, and all it can do is veto conscious decisions, intentions, or urges; intentions never play a role in producing corresponding actions; and free will is an illusion. In Effective Intentions Alfred Mele shows that the evidence offered (...) to support these claims is sorely deficient. He also shows that there is strong empirical support for the thesis that some conscious decisions and intentions have a genuine place in causal explanations of corresponding actions. In short, there is weighty evidence of the existence of effective conscious intentions or the power of conscious will. Mele examines the accuracy of subjects' reports about when they first became aware of decisions or intentions in laboratory settings and develops some implications of warranted skepticism about the accuracy of these reports. In addition, he explores such questions as whether we must be conscious of all of our intentions and why scientists disagree about this. Mele's final chapter closes with a discussion of imaginary scientific findings that would warrant bold claims about free will and consciousness of the sort he examines in this book. (shrink)

Within the criminal justice system, one of the most prominent justifications for legal punishment is retributivism. The retributive justification of legal punishment maintains that wrongdoers are morally responsible for their actions and deserve to be punished in proportion to their wrongdoing. This book argues against retributivism and develops a viable alternative that is both ethically defensible and practical. Introducing six distinct reasons for rejecting retributivism, Gregg D. Caruso contends that it is unclear that agents possess the kind of free will (...) and moral responsibility needed to justify this view of punishment. While a number of alternatives to retributivism exist - including consequentialist deterrence, educational, and communicative theories - they have ethical problems of their own. Moving beyond existing theories, Caruso presents a new non-retributive approach called the public health-quarantine model. In stark contrast to retributivism, the public health-quarantine model provides a more human, holistic, and effective approach to dealing with criminal behavior. (shrink)

In Free Will, Agency, and Meaning in Life, Derk Pereboom proposes an optimistic model of life that follows on the rejection of both libertarian and compatibilist beliefs in free will, moral responsibility, and desert. I criticize his views, focusing on punishment. Pereboom responds to my earlier argument that hard determinism must seek to revise the practice of punishment in the direction of funishment, whereby the incarcerated are very generously compensated for the deprivations of incarceration. I claimed that funishment is a (...) practical reductio: of hard determinism. Pereboom replies, but I claim that he misses a key component of my reductio, the idea that moving in the direction of funishment will considerably weaken the deterrence of potential criminals so that hard determinism becomes self-defeating in practice. Beyond the challenge of funishment, I raise various other difficulties with Pereboom’s model, concerning its deeply unintuitive implications, the harm it does to the motivation of potential criminals, its weakness in resisting utilitarian-like dangers, and more. Our conclusions should lead to a re-evaluation of the compatibilist interpretation of moral life, as a richer, more plausible, and safer interpretation than hard determinism. This needs to be combined with a true hard determinist acknowledgment of the deep injustice and tragedy involved in punishment in light of the absence of libertarian free will. Such a complex view will come closer to doing justice to notions of justice, morality, and decency. (shrink)

Derk Pereboom articulates and defends an original, forward-looking conception of moral responsibility. He argues that although we may not possess the kind of free will that is normally considered necessary for moral responsibility, this does not jeopardize our sense of ourselves as agents, or a robust sense of achievement and meaning in life.

In this book the author examines the stubborn philosophical belief in moral responsibility, surveying the philosophical arguments for it, but focusing on the system that supports these arguments: powerful social and psychological factors that hold the belief in moral responsibility firmly in place.--Publisher's description.

This paper suggests that public health, due to its community orientation, may be ignoring certain ethical principles--namely the rights of individuals and communities to self-determination. The expectation of individual rights as a member of a community is reviewed and the additional right of a community for self-determination is proposed. The influences on ethical evaluations by the legal and economic environments are suggested, using US examples. The conclusion argues that as the focus of health-care delivery changes, it will become more important (...) to consider these questions of group ethics. (shrink)