: Two major philosophers of the twentieth century, the German existential phenomenologist Martin Heidegger and the seminal Japanese Kyoto School philosopher Nishida Kitarō are examined here in an attempt to discern to what extent their ideas may converge. Both are viewed as expressing, each through the lens of his own tradition, a world in transition with the rise of modernity in the West and its subsequent globalization. The popularity of Heidegger's thought among Japanese philosophers, despite its own admitted limitation to (...) the Western "history of being," is connected to Nishida's opening of a uniquely Japanese path in its confrontation with Western philosophy. The focus is primarily on their later works (the post-Kehre Heidegger and the works of Nishida that have been designated "Nishida philosophy"), in which each in his own way attempts to overcome the subject-object dichotomy inherited from the tradition of Western metaphysics by looking to a deeper structure from out of which both subjectivity and objectivity are derived and which embraces both. For Heidegger, the answer lies in being as the opening of unconcealment, from out of which beings emerge, and for Nishida, it is the place of nothingness within which beings are co-determined in their oppositions and relations. Concepts such as Nishida's "discontinuous continuity," "absolutely self-contradictory identity" (between one and many, whole and part, world and things), the mutual interdependence of individuals, and the self-determination of the world through the co-relative self-determination of individuals, and Heidegger's "simultaneity" (zugleich) and "within one another" (ineinander) (of unconcealment and concealment, presencing and absencing), and their "between" (Zwischen) and "jointure" (Fuge) are examined. Through a discussion of these ideas, the suggestion is made of a possible "transition" (Übergang) of both Western and Eastern thinking, in their mutual encounter, both in relation to each other and each in relation to its own past history, leading to both a self-discovery in the other and to a simultaneous self-reconstitution. (shrink)

In a recent issue of Philosophy East and West Douglas Berger defends a new reading of Mūlamadhyamakakārikā XXIV : 18, arguing that most contemporary translators mistranslate the important term prajñaptir upādāya, misreading it as a compound indicating "dependent designation" or something of the sort, instead of taking it simply to mean "this notion, once acquired." He attributes this alleged error, pervasive in modern scholarship, to Candrakīrti, who, Berger correctly notes, argues for the interpretation he rejects.Berger's analysis, (...) and the reading of the text he suggests is grounded on that analysis, is insightful and fascinating, and certainly generates an understanding of Nāgārjuna's enterprise that is welcome .. (shrink)

This chapter reviews recent philosophical and neuroethical literature on the morality of moral neuroenhancements. It first briefly outlines the main moral arguments that have been made concerning moral status neuroenhancements. These are neurointerventions that would augment the moral status of human persons. It then surveys recent debate regarding moral desirability neuroenhancements: neurointerventions that augment that the moral desirability of human character traits, motives or conduct. This debate has contested, among other claims (i) Ingmar Persson and Julian Savulescu’s contention that there (...) is a moral imperative to pursue the development of moral desirability neuroenhancements, (ii) Thomas Douglas’ claim that voluntarily undergoing moral desirability neuroenhancements would often be morally permissible, and (iii) David DeGrazia’s claim that moral desirability neuroenhancements would often be morally desirable. The chapter discusses a number of concerns that have been raised regarding moral desirability neuroenhancements, including concerns that they would restrict freedom, would produce only a superficial kind of moral improvement, would rely on technologies that are liable to be misused, and would frequently misfire, resulting in moral deterioration rather than moral improvement. (shrink)

This thesis contends that the possession of a sense of humour would contribute considerably to the quality of human life. It is an exploration and discussion of some of the difficulties involved in justifying the development of humour in terms of a philosophy of education. In light of developments in the digital age with consequent changes in science, technology and society, the educated person of the future will have to be less concerned with the accumulated knowledge of the past than (...) with the development and interplay of social and natural environments. Such a person will need to have, more than ever, a sense of what is truly real and what is truly valuable in human life. If the primary purpose of education is the preparation of students for their future lives, educators are now faced with some challenging problems. Apart from the high social value of laughter, there is a recognized relationship between humour and intelligence. Knowing that the two are related proves to be a key factor in understanding the learning process and assuring that the development of a sense of humour in education is worthy of consideration. (shrink)

David Rosenthal explains conscious mentality in terms of two independent, though complementary, theories—the higher-order thought (“HOT”) theory of consciousness and quality-space theory (“QST”) about mental qualities. It is natural to understand this combination of views as constituting a kind of representationalism about experience—that is, a version of the view that an experience’s conscious character is identical with certain of its representational properties. At times, however, Rosenthal seems to resist this characterization of his view. We explore here whether and to what (...) extent it makes sense to construe Rosenthal’s views as representationalist. Our goal is not merely terminological—discerning how best to use the expression ‘representationalism’. Rather, we argue that understanding Rosenthal’s account as a kind of representationalism permits us not only to make sense of broader debates within the philosophy of mind, but also to extend and clarify aspects of the view itself. (shrink)

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsory medical interventions. (shrink)

When considering potential solutions to meaning-scepticism, Kripke (1982) did not consider a causal-theoretic approach. Kusch (2006) has argued that this is due to the qua-problem. I consider Kusch’s criticism of Maddy (1984) and McGinn (1984) before offering a different way to solve the qua-problem, one that is not susceptible to sceptical attack. If this solution is successful, at least one barrier to using a causal theory to refute Kripke’s scepticism is removed.

It is often said that the institutions of criminal justice ought or—perhaps more often—ought not to rehabilitate criminal offenders. But the term ‘criminal rehabilitation’ is often used without being explicitly defined, and in ways that are consistent with widely divergent conceptions. In this paper, we present a taxonomy that distinguishes, and explains the relationships between, different conceptions of criminal rehabilitation. Our taxonomy distinguishes conceptions of criminal rehabilitation on the basis of (i) the aims or ends of the putatively rehabilitative measure, (...) and (ii) the means that may be used to achieve the intended end. We also explore some of the implications of each conception, some of the payoffs of a taxonomy of the kind we offer, and some areas for future work. (shrink)

In some jurisdictions, the institutions of criminal justice may subject individuals who have committed crimes to preventive detention. By this, I mean detention of criminal offenders (i) who have already been punished to (or beyond) the point that no further punishment can be justified on general deterrent, retributive, restitutory, communicative or other backwardlooking grounds, (ii) for preventive purposes—that is, for the purposes of preventing the detained individual from engaging in further criminal or otherwise socially costly conduct. Preventive detention, thus understood, (...) shares many features with the quarantine measures sometimes employed in the context of infectious disease control. Both interventions involve imposing (usually severe) constraints on freedom of movement and association. Both interventions are standardly undeserved: in quarantine, the detained individual deserves no detention (or so I will, for the moment, assume), and in preventive detention, the individual has already endured any detention that can be justified by reference to desert. Both interventions are, in contrast to civil commitment under mental health legislation, normally imposed on more-or-less fully autonomous individuals. And both interventions are intended to reduce the risk that the constrained individual poses to the public. Yet despite these similarities, preventive detention and quarantine have received rather different moral report cards. (shrink)

I suggest that the social justice issues raised by Internet regulation can be exposed and examined by using a methodology adapted from that described by John Rawls in 'A Theory of Justice'. Rawls' theory uses the hypothetical scenario of people deliberating about the justice of social institutions from the 'original position' as a method of removing bias in decision-making about justice. The original position imposes a 'veil of ignorance' that hides the particular circumstances of individuals from them so that they (...) will not be influenced by self-interest. I adapt Rawls' methodology by introducing an abstract description of information technology to those deliberating about justice from within the original position. This abstract description focuses on computing devices that users can use to access information and information networks that information devices use to communicate. The abstractness of this description prevents the particular characteristics of the Internet and the computing devices in use from influencing the decisions about the just use and regulation of information technology and networks. From this abstract position, the principles of justice that the participants accept for the rest of society will also apply to the computing devices people use to communicate, and to Internet regulation. (shrink)

A central question in the current neurolegal and neuroethical literature is how brain-reading technologies could contribute to criminal justice. Some of these technologies have already been deployed within different criminal justice systems in Europe, including Slovenia, Italy, England and Wales, and the Netherlands, typically to determine guilt, legal responsibility, or recidivism risk. In this regard, the question arises whether brain-reading could permissibly be used against the person's will. To provide adequate legal protection from such non-consensual brain-reading in the European legal (...) context, ethicists have called for the recognition of a novel fundamental legal right to mental privacy. In this paper, we explore whether these ethical calls for recognising a novel legal right to mental privacy are necessary in the European context. We argue that a right to mental privacy could be derived from, or at least developed within in the jurisprudence of the European Court of Human Rights, and that introducing an additional fundamental right to protect against brain-reading is not necessary. What is required, however, is a specification of the implications of existing rights for particular neurotechnologies and purposes. (shrink)

It is often assumed that perceptual experience provides evidence about the external world. But much perception can occur unconsciously, as in cases of masked priming or blindsight. Does unconscious perception provide evidence as well? Many theorists maintain that it cannot, holding that perceptual experience provides evidence in virtue of its conscious character. Against such views, I challenge here both the necessity and, perhaps more controversially, the sufficiency of consciousness for perception to provide evidence about the external world. In addition to (...) motivating and defending the idea that unconscious perception can and does often provide evidence, I observe that whether or not perceptual phenomenology is relevant to the evidentiary status of perception depends on the nature of consciousness. And I argue that a well-supported theory of consciousness—higher-order thought theory—invites a striking conclusion: that perceptual phenomenology is not on its own sufficient to provide for evidence of the external world. (shrink)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.

According to Rosenthal's higher-order thought (HOT) theory of consciousness, one is in a conscious mental state if and only if one is aware of oneself as being in that state via a suitable HOT. Several critics have argued that the possibility of so-called targetless HOTs?that is, HOTs that represent one as being in a state that does not exist?undermines the theory. Recently, Wilberg (2010) has argued that HOT theory can offer a straightforward account of such cases: since consciousness is a (...) property of mental state tokens, and since there are no states to exhibit consciousness, one is not in conscious states in virtue of targetless HOTs. In this paper, I argue that Wilberg's account is problematic and that Rosenthal's version of HOT theory, according to which a suitable HOT is both necessary and sufficient for consciousness, is to be preferred to Wilberg's account. I then argue that Rosenthal's account can comfortably accommodate targetless HOTs because consciousness is best understood as a property of individuals, not a property of states. (shrink)

Would compulsory treatment or vaccination for COVID-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic in this jurisdiction. We argue that, if the permissive English approach to external constraints for COVID-19 has been justified, then there is a case for a (...) similarly permissive approach to compulsory medical interventions. (shrink)

The current debate on closed-loop brain devices (CBDs) focuses on their use in a medical context; possible criminal justice applications have not received scholarly attention. Unlike in medicine, in criminal justice, CBDs might be offered on behalf of the State and for the purpose of protecting security, rather than realising healthcare aims. It would be possible to deploy CBDs in the rehabilitation of convicted offenders, similarly to the much-debated possibility of employing other brain interventions in this context. Although such use (...) of CBDs could in principle be consensual, there are significant differences between the choice faced by a criminal offender offered a CBD in the context of criminal justice, and that faced by a patient offered a CBD in an ordinary healthcare context. Employment of CBDs in criminal justice thus raises ethical and legal intricacies not raised by healthcare applications. This paper examines some of these issues under three heads: autonomy, human rights, and accountability. (shrink)

Recent advances in stem cell research suggest that in the future it may be possible to create eggs and sperm from human stem cells through a process that we term in vitro gametogenesis (IVG). IVG would allow treatment of some currently untreatable forms of infertility. It may also allow same-sex couples to have genetically-related children. For example, cells taken from one man could potentially be used to create an egg, which could then be fertilised using naturally produced sperm from another (...) man to create a genetically-related child with half of its DNA from each of the men. In this chapter, we consider whether this technology could justifiably be denied to same-sex couples if it were made available as a fertility treatment to different-sex couples. We argue that it could not. (shrink)

Relationalism holds that perceptual experiences are relations between subjects and perceived objects. But much evidence suggests that perceptual states can be unconscious. We argue here that unconscious perception raises difficulties for relationalism. Relationalists would seem to have three options. First, they may deny that there is unconscious perception or question whether we have sufficient evidence to posit it. Second, they may allow for unconscious perception but deny that the relationalist analysis applies to it. Third, they may offer a relationalist explanation (...) of unconscious perception. We argue that each of these strategies is questionable. (shrink)

Open Peer Commentary, referring to "Neuroethics at 15: The Current and Future Environment for Neuroethics".

A number of concerns have been raised about the possible future use of pharmaceuticals designed to enhance cognitive, affective, and motivational processes, particularly where the aim is to produce morally better decisions or behavior. In this article, we draw attention to what is arguably a more worrying possibility: that pharmaceuticals currently in widespread therapeutic use are already having unintended effects on these processes, and thus on moral decision making and morally significant behavior. We review current evidence on the moral effects (...) of three widely used drugs or drug types: propranolol, selective serotonin reuptake inhibitors, and drugs that effect oxytocin physiology. This evidence suggests that the alterations to moral decision making and behavior caused by these agents may have important and difficult-to-evaluate consequences, at least at the population level. We argue that the moral effects of these and other widely used pharmaceuticals warrant further empirical research and ethical analysis. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

After raising some minor philosophical points about Kevin Elliott’s A Tapestry of Values (2017), I argue that we should expand on the themes raised in the book and that philosophers of science need to pay as much attention to the loom of science (i.e., the institutional structures which guide the pursuit of science) as the tapestry of science. The loom of science includes such institutional aspects as patents, funding sources, and evaluation regimes that shape how science gets pursued, and that (...) attending to these aspects will enable us to provide more robust guidance on the values that infuse the tapestry of science. (shrink)

Many have claimed that epistemic rationality sometimes requires us to have imprecise credal states (i.e. credal states representable only by sets of credence functions) rather than precise ones (i.e. credal states representable by single credence functions). Some writers have recently argued that this claim conflicts with accuracy-centered epistemology, i.e., the project of justifying epistemic norms by appealing solely to the overall accuracy of the doxastic states they recommend. But these arguments are far from decisive. In this essay, we prove some (...) new results, which show that there is little hope for reconciling the rationality of credal imprecision with accuracy-centered epistemology. (shrink)

Synthetic biologists aim to generate biological organisms according to rational design principles. Their work may have many beneficial applications, but it also raises potentially serious ethical concerns. In this article, we consider what attention the discipline demands from bioethicists. We argue that the most important issue for ethicists to examine is the risk that knowledge from synthetic biology will be misused, for example, in biological terrorism or warfare. To adequately address this concern, bioethics will need to broaden its scope, contemplating (...) not just the means by which scientific knowledge is produced, but also what kinds of knowledge should be sought and disseminated. (shrink)

Reproductive genetic technologies allow parents to decide whether their future children will have or lack certain genetic predispositions. A popular model that has been proposed for regulating access to RGTs is the ‘genetic supermarket’. In the genetic supermarket, parents are free to make decisions about which genes to select for their children with little state interference. One possible consequence of the genetic supermarket is that collective action problems will arise: if rational individuals use the genetic supermarket in isolation from one (...) another, this may have a negative effect on society as a whole, including future generations. In this article we argue that RGTs targeting height, innate immunity, and certain cognitive traits could lead to collective action problems. We then discuss whether this risk could in principle justify state intervention in the genetic supermarket. We argue that there is a plausible prima facie case for the view that such state intervention would be justified and respond to a number of arguments that might be adduced against that view. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

While there seems to be much evidence that perceptual states can occur without being conscious, some theorists recently express scepticism about unconscious perception. We explore here two kinds of such scepticism: Megan Peters and Hakwan Lau's experimental work regarding the well-known problem of the criterion -- which seems to show that many purported instances of unconscious perception go unreported but are weakly conscious -- and Ian Phillips' theoretical consideration, which he calls the 'problem of attribution' -- the worry that many (...) purported examples of unconscious perception are not perceptual, but rather merely informational and subpersonal. We argue that these concerns do not undermine the evidence for unconscious perception and that this sceptical approach results in a dilemma for the sceptic, who must either deny that there is unconscious mentality generally or explain why perceptual states are unique in the mind such that they cannot occur unconsciously. Both options, we argue, are problematic. (shrink)

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we discuss (...) the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

While many public health threats are now widely appreciated by the public, the risks from asbestos exposure remain poorly understood, even in high-risk groups. This article makes the case that asbestos exposure is an important, ongoing global health threat, and argues for greater policy efforts to raise awareness of this threat. It also proposes the extension of asbestos bans to developing countries and increased public subsidies for asbestos testing and abatement.

On a Parfit-inspired account of culpability, as the psychological connections between a person’s younger self and older self weaken, the older self’s culpability for a wrong committed by the younger self diminishes. Suppose we accept this account and also accept a culpability-based upper limit on punishment severity. On this combination of views, we seem forced to conclude that perpetrators of distant past wrongs should either receive discounted punishments or be exempted from punishment entirely. This article develops a strategy for resisting (...) this conclusion. I propose that, even if the perpetrators of distant past wrongs cannot permissibly be punished for the original wrongs, in typical cases they can permissibly be punished for their ongoing and iterated failures to rectify earlier wrongs. Having set out this proposal, I defend it against three objections, before exploring how much punishment it can justify. (shrink)

I offer here a new hypothesis about the nature of implicit attitudes. Psy- chologists and philosophers alike often distinguish implicit from explicit attitudes by maintaining that we are aware of the latter, but not aware of the former. Recent experimental evidence, however, seems to challenge this account. It would seem, for example, that participants are frequently quite adept at predicting their own perfor- mances on measures of implicit attitudes. I propose here that most theorists in this area have nonetheless overlooked (...) a commonsense distinction regarding how we can be aware of attitudes, a difference that fundamentally distinguishes implicit and explicit attitudes. Along the way, I discuss the implications that this distinction may hold for future debates about and experimental investigations into the nature of implicit attitudes. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

Much disease and disability is the result of lifestyle behaviours. For example, the contribution of imprudence in the form of smoking, poor diet, sedentary lifestyle, and drug and alcohol abuse to ill-health is now well established. More importantly, some of the greatest challenges facing humanity as a whole – climate change, terrorism, global poverty, depletion of resources, abuse of children, overpopulation – are the result of human behaviour. In this chapter, we will explore the possibility of using advances in the (...) cognitive sciences to develop strategies to intentionally manipulate human motivation and behaviour. While our arguments apply also to improving prudential motivation and behaviour in relation to health, we will focus on the more controversial instance: the deliberate targeted use of biomedicine to improve moral motivation and behaviour. We do this because the challenge of improving human morality is arguably the most important issue facing humankind (Persson and Savulescu, forthcoming). We will ask whether using the knowledge from the biological and cognitive sciences to influence motivation and behaviour erodes autonomy and, if so, whether this makes it wrong. (shrink)

Selection against embryos that are predisposed to develop disabilities is one of the less controversial uses of embryo selection technologies. Many bio-conservatives argue that while the use of ESTs to select for non-disease-related traits, such as height and eye-colour, should be banned, their use to avoid disease and disability should be permitted. Nevertheless, there remains significant opposition, particularly from the disability rights movement, to the use of ESTs to select against disability. In this article we examine whether and why the (...) state could be justified in restricting the use of ESTs to select against disability. We first outline the challenge posed by proponents of ‘liberal eugenics’. Liberal eugenicists challenge those who defend restrictions on the use of ESTs to show why the use of these technologies would create a harm of the type and magnitude required to justify coercive measures. We argue that this challenge could be met by adverting to the risk of harms to future persons that would result from a loss of certain forms of cognitive diversity. We suggest that this risk establishes a pro tanto case for restricting selection against some disabilities, including dyslexia and Asperger's syndrome. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...) the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

In this issue, Elizabeth Shaw and Gulzaar Barn offer a number of replies to my arguments in ‘Criminal Rehabilitation Through Medical Intervention: Moral Liability and the Right to Bodily Integrity’, Journal of Ethics. In this article I respond to some of their criticisms.

Working memory, an important posit in cognitive science, allows one to temporarily store and manipulate information in the service of ongoing tasks. Working memory has been traditionally classified as an explicit memory system – that is, as operating on and maintaining only consciously perceived information. Recently, however, several studies have questioned this assumption, purporting to provide evidence for unconscious working memory. In this paper, we focus on visual working memory and critically examine these studies as well as studies of unconscious (...) perception that seem to provide indirect evidence for unconscious working memory. Our analysis indicates that current evidence does not support an unconscious working memory store, though we offer independent reasons to think that working memory may operate on unconsciously perceived information. (shrink)

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this (...) paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.

Opponents of biomedical enhancement frequently adopt what Allen Buchanan has called the “Personal Goods Assumption.” On this assumption, the benefits of biomedical enhancement will accrue primarily to those individuals who undergo enhancements, not to wider society. Buchanan has argued that biomedical enhancements might in fact have substantial social benefits by increasing productivity. We outline another way in which enhancements might benefit wider society: by augmenting civic virtue and thus improving the functioning of our political communities. We thus directly confront critics (...) of biomedical enhancement who argue that it will lead to a loss of social cohesion and a breakdown in political life. (shrink)

There is considerable disagreement about the epistemic value of novel predictive success, i.e. when a scientist predicts an unexpected phenomenon, experiments are conducted, and the prediction proves to be accurate. We survey the field on this question, noting both fully articulated views such as weak and strong predictivism, and more nascent views, such as pluralist reasons for the instrumental value of prediction. By examining the various reasons offered for the value of prediction across a range of inferential contexts , we (...) can see that neither weak nor strong predictivism captures all of the reasons for valuing prediction available. A third path is presented, Pluralist Instrumental Predictivism; PIP for short. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue how (...) at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

Prospective parents are sometimes partial towards their future children, engaging in what I call ‘pre-parental partiality’. Common sense morality is as permissive of pre-parental partiality as it is of ordinary parental partiality—partiality towards one’s existing children. But I argue that existing justifications for partiality typically establish weaker reasons in support of pre-parental partiality than in support of parental partiality. Thus, either these existing justifications do not fully account for our reasons of parental partiality, or our reasons to engage in pre-parental (...) partiality are indeed typically weaker than our reasons to engage in parental partiality. (shrink)

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical outcomes (...) or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients. (shrink)

It is sometimes claimed that those who succeed with the aid of enhancement technologies deserve the rewards associated with their success less, other things being equal, than those who succeed without the aid of such technologies. This claim captures some widely held intuitions, has been implicitly endorsed by participants in social-psychological research, and helps to undergird some otherwise puzzling philosophical objections to the use of enhancement technologies. I consider whether it can be provided with a rational basis. I examine three (...) arguments that might be offered in its favor and argue that each either shows only that enhancements undermine desert in special circumstances, or succeeds only under assumptions that deprive the appeal to desert of much of its dialectic interest. (shrink)

Sport is one of the first areas in which enhancement has become commonplace. It is also one of the first areas in which the use of enhancement technologies has been heavily regulated. Some have thus seen sport as a testing ground for arguments about whether to permit enhancement. However, I argue that there are fairness-based objections to enhancement in sport that do not apply as strongly in some other areas of human activity. Thus, I claim that there will often be (...) a stronger case for permitting enhancement outside of sport than for permitting enhancement in sport. I end by considering some methodological implications of this conclusion. (shrink)

Nicholas Agar argues, that enhancement technologies could be used to create post-persons—beings of higher moral status than ordinary persons—and that it would be wrong to create such beings.1 I am sympathetic to the first claim. However, I wish to take issue with the second.Agar's second claim is grounded on the prediction that the creation of post-persons would, with at least moderate probability, harm those who remain mere persons. The harm that Agar has in mind here is a kind of meta-harm: (...) the harm of being made more susceptible to being permissibly harmed—more liable to harm. Agar suggests that, if post-persons existed, mere persons could frequently be permissibly sacrificed in order to provide benefits to the post-persons. For instance, perhaps they could be permissibly used in lethal medical experiments designed to develop medical treatments for post-persons. By contrast, he suggests that mere persons typically cannot be permissibly sacrificed to provide benefits to other mere persons. He thus claims that mere persons would be more liable to sacrifice if post-persons existed than they are in the absence of post-persons. The creation of post-persons would make them worse off in at least this one respect.Agar then argues that, since this meta-harm imposed on mere persons would not be compensated, it would be wrong to create post-persons. It is here that I believe his argument begins to go awry. According to the concept of compensation that Agar deploys , a harm imposed on X is compensated just in …. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)