I defend the widely-held view that morally worthy action need not be motivated by a desire to promote rightness as such. Some have recently come to reject this view, arguing that desires for rightness as such are necessary for avoiding a certain kind of luck thought incompatible with morally worthy action. I show that those who defend desires for rightness as such on the basis of this argument misunderstand the relationship between moral worth and the kind of luck that their (...) argument employs. Consequently, the argument provides no reason to doubt the popular view that a desire for rightness as such is no part of virtue. I conclude by suggesting that a family of worries about merely accidentally right action presuppose one side of the recent debate about objectivism and perspectivism about moral rightness. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy to the all-or-nothing (...) problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

The chapter introduces and characterizes the notion of fittingness. It charts the history of the relation and its relevance to contemporary debates in normative and metanormative philosophy and proceeds to survey issues to do with fittingness covered in the volume’s chapters, including the nature and epistemology of fittingness, the relations between fittingness and reasons, the normativity of fittingness, fittingness and value theory, and the role of fittingness in theorizing about responsibility. The chapter concludes with a brief discussion of issues to (...) do with fittingness that aren’t covered extensively by the volume’s chapters in order to indicate avenues for further research. (shrink)

This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the (...) public about the health risks and benefits of products it regulates, it also has other roles that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. (shrink)

I argue that Davidson's conception of motivating reasons as belief-desire pairs suggests a model of normative reasons for action that is superior to the orthodox conception according to which normative reasons are propositions, facts, or the truth-makers of such facts.

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are 'black boxes'. The initial response in the literature was a demand for 'explainable AI'. However, recently, several authors have suggested that making AI more explainable or 'interpretable' is likely to be at the cost of the accuracy of these systems and that prioritising interpretability in medical AI may constitute a 'lethal prejudice'. In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realised. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems , may itself constitute a form of lethal prejudice that may diminish the benefits of AI to - and perhaps even harm - patients. (shrink)

While it is tempting to suppose that an act has moral worth just when and because it is motivated by sufficient moral reasons, philosophers have, largely, come to doubt this analysis. Doubt is rooted in two claims. The first is that some facts can motivate a given act in multiple ways, not all of which are consistent with moral worth. The second is the orthodox view that normative reasons are facts. I defend the tempting analysis by proposing and defending a (...) heterodox account of both normative and motivating reasons that is inspired by Donald Davidson’s primary reasons. We should adopt the heterodox view, I argue, because it addresses an overlooked but fatal defect in the orthodox conception of reasons, of which challenges to the tempting analysis are a special case. (shrink)

Throughout his career, Derek Parfit made the bold suggestion, at various times under the heading of the "Normativity Objection," that anyone in possession of normative concepts is in a position to know, on the basis of their competence with such concepts alone, that reductive realism in ethics is not even possible. Despite the prominent role that the Normativity Objection plays in Parfit's non-reductive account of the nature of normativity, when the objection hasn't been ignored, it's been criticized and even derided. (...) We argue that the exclusively negative attention that the objection has received has been a mistake. On our reading, Parfit's Normativity Objection poses a serious threat to reductivism, as it exposes the uneasy relationship between our a priori knowledge of a range of distinctly normative truths and the typical package of semantic commitments that reductivists have embraced since the Kripkean revolution. (shrink)

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating that (...) one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

Philosophers have recently come to focus on explaining the phenomenon of ​bad beliefs,​ beliefs that are apparently true and well-evidenced but nevertheless objectionable. Despite this recent focus, a consensus is already forming around a particular explanation of these beliefs’ badness called ​moral encroachment​, according to which, roughly, the moral stakes engendered by bad beliefs make them particularly difficult to justify. This paper advances an alternative account not just of bad beliefs but of bad attitudes more generally according to which bad (...) beliefs’ badness originates not in a failure of sufficient evidence but in a failure to respond adequately to reasons. I motivate this alternative account through an analogy to recent discussions of moral worth centered on the well-known grocer case from Kant’s ​Groundwork​, and by showing that this analogy permits the proposed account to generalize to bad attitudes beyond belief. The paper concludes by contrasting the implications of moral encroachment and of the proposed account for bad attitudes’ blameworthiness. (shrink)

Next SectionThis article argues against two dominant accounts of the nature of nostalgia. These views assume that nostalgia depends, in some way, on comparing a present situation with a past one. However, neither does justice to the full range of recognizably nostalgic experiences available to us – in particular, ‘Proustian’ nostalgia directed at involuntary autobiographical memories. Therefore, the accounts in question fail. I conclude by considering an evaluative puzzle raised by Proustian nostalgia when it is directed at memories that the (...) nostalgist herself regards as non-veridical. (shrink)

I propose and defend a novel view called “de se consequentialism,” which is noteworthy for two reasons. First, it demonstrates—contra Doug Portmore, Mark Schroeder, Campbell Brown, and Michael Smith, among others—that agent-neutral consequentialism is consistent with agent-centered constraints. Second, it clarifies the nature of agent-centered constraints, thereby meriting attention from even dedicated nonconsequentialists. Scrutiny reveals that moral theories in general, whether consequentialist or not, incorporate constraints by assessing states in a first-personal guise. Consequently, de se consequentialism enacts constraints through the (...) very same feature that nonconsequentialist theories do. (shrink)

A major point of debate about morally good motives concerns an ambiguity in the truism that good and strong-willed people desire to do what is right. This debate is shaped by the assumption that “what’s right” combines in only two ways with “desire,” leading to distinct de dicto and de re readings of the truism. However, a third reading of such expressions is possible, first identified by Janet Fodor, which has gone wholly unappreciated by philosophers in this debate. I identify (...) Fodor’s nonspecific reading of “desire to do what’s right” and briefly discuss its merits. (shrink)

We often find ourselves in situations where it is up to us to make decisions on behalf of others. How can we determine whether such decisions are morally justified, especially if those decisions may change who it is these others end up becoming? In this paper, I will evaluate one plausible kind of justification that may tempt us: we may want to justify our decision by appealing to the likelihood that the other person will be glad we made that specific (...) choice down the line. Although it is tempting, I ultimately argue that we should reject this sort of appeal as a plausible justification for the moral permissibility of our vicarious decisions. This is because the decisions that we make on behalf of another may affect the interests and values that that person will hold in the future. As I will show, this complicates the justificatory relationship between present decisions and future attitudes, since the latter can depend on the former. This is not to say that the predicted future attitudes of others can play no significant role in justifying our decisions on others’ behalf. Rather, appealing to the future attitudes in our moral justifications may play an important role in our practical thinking but only when we consider the future attitudes of all relevant possible futures. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

The wrong kind of reason (WKR) problem is a problem for attempts to analyze normative properties using only facts about the balance of normative reasons, a style of analysis on which the ‘Reasons First’ programme depends. I argue that this problem cannot be solved if the orthodox view of reasons is true --- that is, if each normative reason is numerically identical with some fact, proposition, or state-of-affairs. That’s because solving the WKR problem requires completely distinguishing between the right- and (...) wrong-kind reasons for an attitude. I argue that some facts give both right- and wrong-kind reasons for an attitude. Consequently, no such distinction between the two types of reasons is complete if reasons are facts or the like. I conclude by suggesting that reasons and facts are related by constitution, not identity. (shrink)

Some rules seem more important than others. The moral rule to keep promises seems more important than the aesthetic rule not to wear brown with black or the pool rule not to scratch on the eight ball. A worrying number of metaethicists are increasingly tempted to explain this difference by appealing to something they call “authoritative normativity” – it’s because moral rules are “authoritatively normatively” that they are especially important. The authors of this chapter argue for three claims concerning “authoritative (...) normativity”: (1) that motivation for it originates in a parochial conception of “normative flavours”; (2) that arguments against alternative ways of explaining e.g., morality’s importance are overblown; and (3) that there are strong reasons against theorizing in terms of “authoritative normativity”. The overarching aim is not to show that “authoritative normativity” is incoherent or entirely unmotivated. Rather, it is to discuss some of “authoritative normativity’s” deeper commitments to correct the impression that is it largely benign or that it is entailed by familiar and popular “metanormative” positions. Authoritative normativity, it seems to us, is a solution in search of a problem. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Many people view disabilities as misfortunes, call this the standard view. In this paper, I examine one criticism that has been launched against the Standard View. Rather than determine in advance whether having a disability is good or bad for a person, some critics argue that the Standard View is reflective of and brings about inappropriate emotional responses toward people with disabilities and their circumstances. For instance, philosophers have recently argued that in holding the standard view, we become prone to (...) a destructive kind of unwarranted pity or that the view leads us to hold certain untenable or inappropriate hopes for our children and for our society. I think this sort of challenge to the Standard View has a lot of appeal, but I worry that if it is not properly articulated, the approach is vulnerable to what has been known as “The Wrong Kind of Reason” problem. The paper highlights and addresses this worry. (shrink)

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are “black boxes.” The initial response in the literature was a demand for “explainable AI.” However, recently, several authors have suggested that making AI more explainable or “interpretable” is likely to be at the cost of the accuracy of these systems and that prioritizing interpretability in medical AI may constitute a “lethal prejudice.” In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realized. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems, may itself constitute a form of lethal prejudice that may diminish the benefits of AI to—and perhaps even harm—patients. (shrink)

There’s a long but relatively neglected tradition of attempting to explain why many researchers working on the nature of phenomenal consciousness think that it’s hard to explain.1 David Chalmers argues that this “meta-problem of consciousness” merits more attention than it has received. He also argues against several existing explanations of why we find consciousness hard to explain. Like Chalmers, we agree that the meta-problem is worthy of more attention. Contra Chalmers, however, we argue that there’s an existing explanation that is (...) more promising than his objections suggest. We argue that researchers find phenomenal consciousness hard to explain because phenomenal concepts are complex demonstratives that encode the impossibility of explaining consciousness as one of their application conditions. (shrink)

What is a philosophy class like? What roles do teachers and students play? Questions like these have been answered time and again by philosophers using images and metaphors. As philosophers continue to develop pedagogical approaches in a more conscious way, it is worth evaluating traditional metaphors used to understand and structure philosophy classes. In this article, we examine two common metaphors—the sage on the stage, and philosophy as combat—and show why they fail pedagogically. Then we propose five metaphors—teaching philosophy as (...) world-traveling, wondering, conducting an orchestra, storytelling, and coaching—that can better respond to the needs of increasingly diverse student bodies. Further, these metaphors find their ground in long-standing beliefs about what philosophy is, how it is done, and what it can do for those willing to engage in it. While no single one of them is comprehensive, we think that these models can help us enliven our own thinking about our teaching and the roles we and our students play in our classrooms. (shrink)

Since the publication of Kenneth Howard’s 2017 article, “The Religion Singularity: A Demographic Crisis Destabilizing and Transforming Institutional Christianity,” there has been an increasing demand to understand the root causes and historical foundations for why institutional Christianity is in a state of de-institutionalization. In response to Howard’s research, a number of authors have sought to provide a contextual explanation for why the religion singularity is currently happening, including studies in epistemology, church history, psychology, anthropology, and church ministry. The purpose of (...) this article is to offer a brief survey and response to these interactions with Howard’s research, identifying the overall implications of each researcher’s perspective for understanding the religion singularity phenomenon. It explores factors relating to denominational switching in Jeshua Branch’s research, social memory in John Lingelbach’s essay, religious politics in Kevin Seybold’s survey, scientific reductionism in Jack David Eller’s position paper, and institutional moral failure in Brian McLaren’s article. (shrink)