It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

This volume will collect Tom Beauchamp's 15 most important published articles in bioethics, most of which were published over the last 25 years, and most of ...

The classic, influential essay in 'descriptive metaphysics' by the distinguished English philosopher.

Harry Frankfurt’s Unwilling Addict and Willing Addict cases accomplish something fairly unique: they pull apart the predictions of control-based views of moral responsibility and competing self-expression views. The addicts both lack control over their actions but differ in terms of expression of their respective selves. Frankfurt’s own view is that—in line with the predictions of self-expression views—the unwilling addict is not morally responsible for his drug-directed actions while the willing addict is. But is Frankfurt right? In this essay, I put (...) together a systematic defence of Frankfurt’s position. (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)

In some criminal cases a forensic psychiatrist is asked to make an assessment of the state of mind of the defendant at the time of the legally relevant act. A considerable number of people seem to hold that the basis for this assessment is that free will is required for legal responsibility, and that mental disorders can compromise free will. In fact, because of the alleged relationship between the forensic assessment and free will, researchers in forensic psychiatry also consider the (...) complicated metaphysical discussions on free will relevant to the assessment. At the same time, there is concern about the lack of advancement with respect to clarifying the nature of the forensic assessment. In this paper I argue that, even if free will is considered relevant, there may be no need for forensic researchers to engage into metaphysical discussions on free will in order to make significant progress. I will do so, drawing a parallel between the assessment of criminal responsibility on the one hand, and the medical practice of obtaining informed consent on the other. I argue that also with respect to informed consent, free will is considered relevant, or even crucial. This is the parallel. Yet, researchers on informed consent have not entered into metaphysical debates on free will. Meanwhile, research on informed consent has made significant progress. Based on the parallel with respect to free will, and the differences with respect to research, I conclude that researchers on forensic assessment may not have to engage into metaphysical discussions on free will in order to advance our understanding of this psychiatric practice. (shrink)

In this essay I present what is, I contend, the free-will problem properly thought through, or at least presented in a form in which it is possible to think about it without being constantly led astray by bad terminology and confused ideas. Bad terminology and confused ideas are not uncommon in current discussions of the problem. The worst such pieces of terminology are "libertarian free will" and "compatibilist free will." The essay consists partly of a defense of the thesis that (...) the use of these phrases by writers on the problem of free will can only generate conceptual confusion and partly of a formulation of the problem that does not make use of them. I contend that this formulation is neutral with respect to the historically important positions on free will (e. g., compatibilism and incompatibilism). (shrink)

In this essay I present what is, I contend, the free-will problem properly thought through, or at least presented in a form in which it is possible to think about it without being constantly led astray by bad terminology and confused ideas. Bad terminology and confused ideas are not uncommon in current discussions of the problem. The worst such pieces of terminology are “libertarian free will” and “compatibilist free will.” The essay consists partly of a defense of the thesis that (...) the use of these phrases by writers on the problem of free will can only generate conceptual confusion and partly of a formulation of the problem that does not make use of them. I contend that this formulation is neutral with respect to the historically important positions on free will (e.g., compatibilism and incompatibilism). (shrink)

In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many (...) acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves. (shrink)

What renders some mentally disordered patients incapable of informed consent to medical interventions? It is argued that a patient is incapable of giving informed consent owing to mental disorder, if a mental disorder prevents a patient from understanding what s/he consents to; if a mental disorder prevents a patient from choosing decisively; if a mental disorder prevents a patient from communicating his/her consent; or if a mental disorder prevents a patient from accepting the need for a medical intervention. This paper (...) holds that a patient's capacity to give informed consent should be assessed clinically by using these conditions necessary for informed consent, and should be assessed specifically for each intervention and specifically at the time when the consent has to be given. The paper considers patients' incapacity to give informed consent to treatment, to give informed consent to be examined clinically, and to give informed consent to participate in research. (shrink)

The assessment of patients' decision-making capacity (DMC) has become an important area of clinical practice, and since it provides the gateway for a consideration of non-consensual treatment, has major ethical implications. Tests of DMC such as under the Mental Capacity Act (2005) for England and Wales aim at supporting autonomy and reducing unwarranted paternalism by being ‘procedural’, focusing on how the person arrived at a treatment decision. In practice, it is difficult, especially in problematic or borderline cases, to avoid a (...) consideration of beliefs and values; that is, of the substantive content of ideas rather than simple ‘cognitive’ or procedural abilities. However, little attention has been paid to how beliefs and values might be assessed in the clinical context and what kind of ‘objectivity’ is possible. We argue that key aspects of Donald Davidson's ideas of ‘Radical Interpretation’ and the ‘Principle of Charity’ provide useful guidance as to how clinicians might approach the question of whether an apparent disturbance in a person's thinking about beliefs or values undermines their DMC. A case example is provided, and a number of implications for clinical practice are discussed. (shrink)

Since its publication in 1959, Individuals has become a modern philosophical classic. Bold in scope and ambition, it continues to influence debates in metaphysics, philosophy of logic and language, and epistemology. Peter Strawson's most famous work, it sets out to describe nothing less than the basic subject matter of our thought. It contains Strawson's now famous argument for descriptive metaphysics and his repudiation of revisionary metaphysics, in which reality is something beyond the world of appearances. Throughout, Individuals advances some highly (...) influential and controversial ideas, such as 'non-solipsistic consciousness' and the concept of a person a 'primitive concept'. (shrink)

Autonomy is a fundamental though contested concept both in philosophy and the broader intellectual culture of today’s liberal societies. For instance, most of us place great value on the opportunity to make our own decisions and to lead a life of our own choosing. Yet, there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared to other commitments. For example, the success of every group project requires that group (...) members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy; however, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or the social stigma that often attaches to it. This book is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates in philosophy and psychiatry. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics. (shrink)

In this largely antimetaphysical treatment of free will and determinism, Mark Balaguer argues that the philosophical problem of free will boils down to an open scientific question about the causal histories of certain kinds of neural events. In the course of his argument, Balaguer provides a naturalistic defense of the libertarian view of free will. The metaphysical component of the problem of free will, Balaguer argues, essentially boils down to the question of whether humans possess libertarian free will. Furthermore, he (...) argues that, contrary to the traditional wisdom, the libertarian question reduces to a question about indeterminacy--in particular, to a straightforward empirical question about whether certain neural events in our heads are causally undetermined in a certain specific way; in other words, Balaguer argues that the right kind of indeterminacy would bring with it all of the other requirements for libertarian free will. Finally, he argues that because there is no good evidence as to whether or not the relevant neural events are undetermined in the way that's required, the question of whether human beings possess libertarian free will is a wide-open empirical question. (shrink)

Harry G. Frankfurt begins his inquiry by asking, “What is it about human beings that makes it possible for us to take ourselves seriously?” Based on The Tanner Lectures in Moral Philosophy, Taking Ourselves Seriously and Getting It Right delves into this provocative and original question. The author maintains that taking ourselves seriously presupposes an inward-directed, reflexive oversight that enables us to focus our attention directly upon ourselves, and “[it] means that we are not prepared to accept ourselves just as (...) we come. We want our thoughts, our feelings, our choices, and our behavior to make sense. We are not satisfied to think that our ideas are formed haphazardly, or that our actions are driven by transient and opaque impulses or by mindless decisions. We need to direct ourselves—or at any rate to believe that we are directing ourselves—in thoughtful conformity to stable and appropriate norms. We want to get things right.” The essays delineate two features that have a critical role to play in this: our rationality, and our ability to love. Frankfurt incisively explores the roles of reason and of love in our active lives, and considers the relation between these two motivating forces of our actions. The argument is that the authority of practical reason is less fundamental than the authority of love. Love, as the author defines it, is a volitional matter, that is, it consists in what we are actually committed to caring about. Frankfurt adds that “The object of love can be almost anything—a life, a quality of experience, a person, a group, a moral ideal, a nonmoral ideal, a tradition, whatever.” However, these objects and ideals are difficult to comprehend and often in conflict with each other. Moral principles play an important supporting role in this process as they help us develop and elucidate a vision that inspires our love. The first section of the book consists of the two lectures, which are entitled “Taking Ourselves Seriously” and “Getting It Right.” The second section consists of comments in response by Christine M. Korsgaard, Michael E. Bratman, and Meir Dan-Cohen. The book includes a preface by Debra Satz. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

“Free Will” is a philosophical term of art for a particular sort of capacity of rational agents to choose a course of action from among various alternatives. Which sort is the free will sort is what all the fuss is about. (And what a fuss it has been: philosophers have debated this question for over two millenia, and just about every major philosopher has had something to say about it.) Most philosophers suppose that the concept of free will is very (...) closely connected to the concept of moral responsibility. Acting with free will, on such views, is just to satisfy the metaphysical requirement on being responsible for one's action. (Clearly, there will also be epistemic conditions on responsibility as well, such as being aware—or failing that, being culpably unaware—of relevant alternatives to one's action and of the alternatives' moral significance.) But the significance of free will is not exhausted by its connection to moral responsibility. Free will also appears to be a condition on desert for one's accomplishments (why sustained effort and creative work are praiseworthy); on the autonomy and dignity of persons; and on the value we accord to love and friendship. (See Kane 1996, 81ff. and Clarke 2003, Ch.1.). (shrink)

Philosophical work on free will, contemporary as well as historical, is inevitably framed by the problem of free will and determinism. One of my goals in what follows is to give a feel for the main lines of that debate in philosophy today. I will also be outlining a particular perspective on free will. Many working philosophers consider themselves Compatibilists; the perspective outlined, building on a number of arguments in the recent literature, is a contemporary form of such a view. (...) It cannot, however, claim to be the contemporary philosophical perspective. There is no such thing. Against a background of the perennial problem of free will and determinism, through ongoing argument and debate, philosophers continue to try to work toward an understanding of precisely what it means for an action to be free. (shrink)

Obsessive-compulsive disorder (OCD) is considered to be one of the more common serious mental disorders, with a prevalence rate of about 1% (Heyman et al. 2006). It is characterized by obsessions, or compulsions, or both. According to the DSM-IV (American Psychiatric Association 1994), obsessions are “recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.” Compulsions, on the other hand, are repetitive behaviors (e.g., (...) hand washing, ordering, checking) or “mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied .. (shrink)