This paper argues that the moral value of unconditional forgiveness is more complicated and constrained than it is often taken to be. When we unconditionally forgive, we engage with someone in a way that doesn’t take seriously their perspective about the meanings and values at stake in our relations with them. Other things being equal, this is problematic; it is normatively condescending, belittling the place of the other person’s moral agency in our relations with them. This doesn’t mean that (...) unconditional forgiveness is always bad or impermissible. It does, though, complicate how we should think about its moral value. (shrink)

In my paper “Moral Grounds for Forgiveness,” I argued that forgiveness is morally appropriate only when a sincere apology is received, thus ruling out the three grounds for unconditional forgiveness suggested by John Kleinig in his paper “Forgiveness and Unconditionality.” In response to his reply “Defending Unconditional Forgiveness,” I argue here that my terminology, once clarified, does not undermine my construal of resentment; that conditional forgiveness is just as discretionary as unconditional forgiveness; and that what we choose (...) to take into account when we forgive must be a morally appropriate grounding for that particular end, but that only a sincere apology could satisfy this condition. I end by conceding that the three grounds suggested by Kleinig nevertheless play an essential role in the process of (conditional) forgiveness insofar as they facilitate a willingness to forgive and an openness toward accepting an apology. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

The concept of respect for persons is often rejected as a basis for understanding forgiveness. As many have argued, to hold your offender responsible for her actions is to respect her as a person; but this kind of respect is more likely to sustain, rather than dissolve, your resentment toward her (Garrard & McNaughton 2003; 2011; Allais 2008). I seek to defend an alternative view in this paper. To forgive, on my account, involves ceasing to identify your offender with her (...) wrongdoing, and this requires a corresponding affective change on your behalf. While there are different ways this may happen, I argue that respect for your offender as a person can play a significant role in the process. (shrink)

Forgiveness as a positive response to wrongdoing is a widespread phenomenon that plays a role in the moral lives of most persons. Surprisingly, Kant has very little to say on the matter. Although Kant dedicates considerable space to discussing punishment, wrongdoing and grace, he addresses the issues of human forgiveness directly only in some short passages in the Lectures on Ethics and in one passage of the Metaphysics of Morals. As noted by Sussman, the TL passage, however, betrays some ambivalence. (...) Kant establishes a duty of virtue to be forgiving (TL, 6:460), yet he immediately warns against its excess: meek toleration of recurrent wrongs could manifest a lack of self-respect and a violation of a duty to oneself (TL, 6:461). Sussman claims that this ambivalence ultimately arises from the fact that forgiveness sits uncomfortably in Kant’s moral thought. First, forgiveness has an ‘ineluctably elective aspect’ that makes it, to a certain extent, arbitrary and dependent on particular features of the forgiver’s psychology and, as such, in tension with Kant’s central claims that human beings are autonomous agents capable of determining their own moral status. Second, according to Sussman, Kant’s moral retributivism, i.e. ‘the particular moral position that every moral wrong against another deserves punishment of the wrongdoer’ seems to be in tension with the possibility of a ‘truly redemptive forgiveness’. Moreover, forgiveness also seems to be in tension with a passage of the Religion in which Kant argues that the moral guilt from our original evil disposition cannot be understood as a debt or liability that can be compensated, erased, transferred or otherwise wiped out by others (Rel, 6:72). Thus, to the extent that forgiveness might be thought to involve the forgoing of moral guilt, it seems incompatible with Kant’s views on culpability and punishment. This chapter seeks to clarify Kant’s views on forgiveness in order to show that, although not often appreciated, personal forgiveness plays an important role in the lives of ordinary human agents as understood by Kant. In particular, I aim to show there is a conception of forgiveness available to Kant that is not incompatible with Kant’s views of punishment and culpability. In Section 1, I argue that, for Kant, far from being merely ‘elective,’ forgiveness is, under certain conditions, morally required. I provide a brief summary of an interpretation of Kant’s theory of forgiveness that I have defended in recently published work , in order to argue that Kant’s duty to be forgiving should be understood as an imperfect duty of virtue which is conditional on repentance. Kant is not ambivalent about this duty because he maintains that when the relevant conditions are not met, we have a perfect duty to ourselves not to forgive unrepentant wrongdoers. The TL passage thus identifies two different duties. In Section 2, I show that forgiveness, as conceptualised by Kant, does not require the forgoing of punishment or the overcoming of moral guilt and that this could, in fact, be seen as an attractive feature of Kant’s position. I end by offering a very brief assessment of Kant’s views. (shrink)

Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely (...) on such appeals. I argue that in cases where an agent will undergo a significant alteration in their evaluative outlook – ‘evaluative shift’ – three central, persuasive objections to paternalism lose their force, and offer a prima facie case for paternalism in some of these cases. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism may be justified. (shrink)

Respect for autonomy and beneficence are frequently regarded as the two essential principles of medical ethics, and the potential for these two principles to come into conflict is often emphasised as a fundamental problem. On the one hand, we have the value of beneficence, the driving force of medicine, which demands that medical professionals act to protect or promote the wellbeing of patients or research subjects. On the other, we have a principle of respect for autonomy, which demands that we (...) respect the self-regarding decisions of individuals. As well as routinely coming into opposition with the demands of beneficence in medicine, the principle of respect for autonomy in medical ethics is often seen as providing protection against beneficial coercion (i.e. paternalism) in medicine. However, these two values are not as straightforwardly opposed as they may appear on the surface. In fact, the way that we understand autonomy can lead us to implicitly sanction a great deal of paternalistic action, or can smuggle in paternalistic elements under the guise of respect for autonomy. -/- This paper is dedicated to outlining three ways in which the principle of respect for autonomy, depending on how we understand the concept of autonomy, can sanction or smuggle in paternalistic elements. As the specific relationship between respect for autonomy and beneficence will depend on how we conceive of autonomy, I begin by outlining two dominant conceptions of autonomy, both of which have great influence in medical ethics. I then turn to the three ways in which how we understand or employ autonomy can increase or support paternalism: firstly, when we equate respect for autonomy with respect for persons; secondly, when our judgements about what qualifies as an autonomous action contain intersubjective elements; and thirdly, when we expect autonomy to play an instrumental role, that is, when we expect people, when they are acting autonomously, to act in a way that promotes or protects their own wellbeing. I then provide a proposal for how we might work to avoid this. I will suggest that it may be impossible to fully separate paternalistic elements out from judgements about autonomy. Instead, we are better off looking at why we are motivated to use judgements about autonomy as a means of restricting the actions of patients or research subjects. I will argue that this is a result of discomfort about speaking directly about our beneficent motivations in medical ethics. Perhaps we can reduce the incentive to smuggle in these beneficent motivations under the guise of autonomy by talking directly about beneficent motivations in medicine. This will also force us to recognise paternalistic motivations in medicine when they appear, and to justify paternalism where it occurs. (shrink)

In this paper, I argue that forgiveness is a morally appropriate response only when it is grounded in the wrongdoer’s demonstration of genuine remorse, their offer of a sincere apology, and, where appropriate, acts of recompense and behavioral change. I then respond to John Kleinig’s suggestion (in his paper “Forgiveness and Unconditionality”) that when an apology is not forthcoming, there are at least three additional grounds that, when motivated by virtues such as love and compassion, could nevertheless render “unconditional (...) forgiveness” a morally laudable option. I argue that such grounds could indeed constitute or result in laudable responses to wrongdoing, but only if they are not conceived of or described in terms of forgiveness. (shrink)

During the Standing Rock protests in North Dakota, USA/Turtle Island, a group of military veterans knelt in front of Oceti Sakowin Elders asking forgiveness for centuries of settler colonial military ventures in Oceti Sakowin Territory. Leonard Crow Dog forgave them and immediately demanded respect for Native Nations throughout the U.S. Lacking such respect, he said, Native people will cease paying taxes. Crow Dog’s post-forgiveness remarks speak to the political context of the military veterans’ request: They seek collective forgiveness amidst ongoing (...) occupation and harms committed by the collective they represent. In this chapter, I examine this case study and argue that ongoing harm undermines requests for forgiveness on behalf of collectives. I look to the work of Glen Coultard, Waziyatawin, and Leanne Simpson to consider what a responsible request for collective forgiveness would entail. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

Thaler and Sunstein advocate 'libertarian paternalism'. A libertarian paternalist changes the conditions under which people act so that their cognitive biases lead them to choose what is best for themselves. Although libertarian paternalism manipulates people, Thaler and Sunstein say that it respects their autonomy by preserving the possibility of choice. Conly argues that libertarian paternalism does not go far enough, since there is no compelling reason why we should allow people the opportunity to choose to bring disaster (...) upon themselves if sometimes they will make the wrong decision. She defends 'coercive paternalism'. The present paper argues that errors in reasoning are not due only to cognitive biases. People also make errors because they have an insufficient level of general intelligence. Intelligence is distributed on a continuum. Those who fall on higher levels of the continuum have greater abilities, in certain contexts, to reason about both their own and others' interests. Coercive paternalism may sometimes be appropriate to prevent less intelligent people from engaging in self-destructive behavior due to errors of reasoning. (shrink)

The categorical denial of third-party forgiveness represents an overly individualistic approach to moral repair. Such an approach fails to acknowledge the important roles played by witnesses, bystanders, beneficiaries, and others who stand in solidarity to the primary victim and perpetrator. In this paper, I argue that the prerogative to forgive or withhold forgiveness is not universal, but neither is it restricted to victims alone. Not only can we make moral sense of some third-party acts and utterances of the form, “I (...) can or cannot forgive…” but also, we ought to recognize them as legitimate instances of third party forgiveness. Concern for the primary victim’s autonomy tends to exaggerate a need for moral deference, while ignoring how others are called upon to support and mediate for victims of violence and oppression. I advocate a cautious extension of the victim’s prerogative to forgive, one that grounds forgiveness in a double relation of sympathetic identification and attentive care. Following Jean Harvey’s recent work, I call this relationship moral solidarity. Furthermore, I argue, there are important moral and political reasons to acknowledge third party forgiveness; these reasons are particularly evident in contexts of oppression. In fact, third party refusals to forgive may have particular moral significance. In situations of abuse, oppression and damaged self-respect, third party refusals may protect the agency of victims who too easily forgive. (shrink)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in (...) her Natural Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes for which (...) a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that (...) uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously. (shrink)

Like the ‘thoughts and prayers’ so commonly offered by politicians in the aftermath of disaster, it is incredibly common to hear ‘autonomy and dignity’ invoked together in response to some threat to human wellbeing. As such, it seems natural to assume they must bear some kind of relation to one another. But are they merely two core human interests, that happen to be vulnerable to the same kinds of threat? Or are they interrelated in a deeper way? What I aim (...) to do in this chapter is draw on the philosophical literature on both concepts to consider how they might be connected, and explore whether certain ways of connecting them are more fruitful than others. I argue that the two most prominent connections drawn in the philosophical literature – that dignity is grounded in autonomy, and that respect for dignity is synonymous with respect for autonomy – are both highly problematic. Instead, I suggest we see autonomy and dignity as mutually supportive. Doing so has both practical and theoretical benefits: it can help us identify threats to both autonomy and dignity; and it exposes theoretical lacunae, especially within the autonomy literature. (shrink)

According to the High Court in England and Wales, the primary purpose of legal interventions into the lives of vulnerable adults with mental capacity should be to allow the individuals concerned to regain their autonomy of decision making. However, recent cases of clinical decision making involving capacitous vulnerable adults have shown that, when it comes to medical law, medical ethics and clinical practice, vulnerability is typically conceived as opposed to autonomy. The first aim of this paper is to detail the (...) problems that arise when the courts and health care practitioners respond to the vulnerability of capacitous adults on the basis of such an opposition. It will be shown that not only does the common law approach to vulnerability fail to adequately capture the autonomy of capacitous vulnerable adults, the conception of vulnerability and autonomy in oppositional terms leads to objectionably paternalistic health care responses that undermine the autonomy of vulnerable patients as well as clinical and legal interventions that violate their autonomy. In response, the second aim of this paper is to show that the concepts of autonomy and vulnerability are necessarily entwined and, on that basis, the focus should be on promoting the autonomy of capacitous vulnerable adults where possible. In order to make this case, the paper explains the limitations of standard approaches to the autonomy of vulnerable adults and, in their place, offers a conception of legitimate, self-authorised autonomy that is fundamentally dependent on intersubjective practices of recognition. (shrink)

Introduction -- What is personal responsibility? -- Ordinary language -- Common conceptions -- What do philosophers mean by responsibility? -- Personally responsible for what? -- What do philosophers think? part I -- Causes -- Capacity -- Control -- Choice versus brute luck -- Second-order attitudes -- Equality of opportunity -- Deservingness -- Reasonableness -- Reciprocity -- Equal shares -- Combining criteria -- What do philosophers think? part II -- Utility -- Self-respect -- Autonomy -- Human flourishing -- Natural duties and (...) special obligations -- A matter of perspectives -- Combining values -- What do politicians think? -- A brief typology -- International comparisons -- Welfare reform -- Healthcare reform -- Rights and responsibilities -- On the responsibilities of politicians -- What do ordinary people think? -- Why ask? -- Attitudes to welfare claimants -- When push comes to shove -- Perceptions and reality -- Further international comparisons -- The trouble with opinion surveys -- Four contemporary issues in focus -- Unemployment -- Health -- Drug abuse -- Personal debt and financial rewards -- So how do we decide? -- Getting the public involved -- Citizens juries -- Answering some potential criticisms. (shrink)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting (...) patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

Forgiveness is mostly seen as a virtuous human response to wrongful conduct. But what happens when there is no acknowledgement of wrongdoing on the part of the wrongdoer? Does the forgiveness of the unrepentant still count as forgiveness? The Fourteenth Dalai Lama, for instance, is a figure who highly promotes the value of forgiveness. His homeland has been occupied by China since 1950, yet he maintains that he forgives and feels no enmity towards the Chinese government. The Chinese authorities, for (...) their part, have never admitted to wrongful invasion of the ‘roof of the world’, hence there has been no acceptance of the Dalai Lama’s forgiveness. Can the Dalai Lama’s forgiving under these circumstances, however, still be seen as forgiveness? In the present contribution, I shed light on the Buddhist view on forgiveness in the hope of inspiring ideas that might contribute to the pursuit of peace. Firstly, I explore certain matters surrounding the general idea of forgiveness and subsequently introduce Buddhist perspectives. Secondly, I respond to the key question of this paper by highlighting the Dalai Lama’s views as a means to elaborate on the Buddhist stance. I conclude by comparing Buddhist points of view with some contemporary philosophical perspectives and illustrating some distinguishing features of the Buddhist notion of forgiveness. From the above, I endeavour to establish that the Buddhist take on forgiveness is ultimately unconditional. (shrink)

In her paper “Democracy, Public Policy, and Lay Assessments of Scientific Testimony” Elizabeth Anderson (2011) identifies a tension between the requirements of responsible public policy making and democratic legitimacy. The tension, put briefly, is that responsible public policy making should be based on the best available scientific research, but for it to be democratically legitimate there must also be broad public acceptance of whatever policies are put in place. In this chapter I discuss this tension, with a strong focus on (...) the issue of climate change. My aims are twofold. First, I argue that the tension is harder to resolve than Anderson supposes because some ways of securing acceptance for science-based policies will themselves be democratically illegitimate. Second, I take a closer look at the role intellectual autonomy plays in the tension. Many think that what I call “science marketing” methods for securing broad(er) acceptance of scientific claims are illegitimate because they infringe on our intellectual autonomy. I argue that it is less clear that this is true than many suppose. This is because, put roughly, judicious use of targeted science marketing methods need not stop us from developing the ability to think about scientific issues for ourselves. In fact, they may even aide us in developing this ability. While this doesn’t quite resolve the tension identified by Anderson, it does some of the necessary groundwork for resolving it. (shrink)

What is it about a person's becoming an adult that makes it generally inappropriate to treat that person paternalistically any longer? The Standard View holds that a mere difference in age or stage of life cannot in itself be morally relevant, but only matters insofar as it is correlated with the development of capacities for mature practical reasoning. This paper defends the contrary view: two people can have all the same general psychological attributes and yet the mere fact that one (...) person is at the beginning of a life and another in the middle of one can justify treating the younger person more paternalistically than the older one. Recognising the moral relevance of age, moreover, is crucial if one is to accommodate both the liberal moral ideal of respect for autonomy and our demanding educational aims, given that these otherwise come into conflict with one another. (shrink)

ABSTRACTThe responsibility of the food and beverage industry for noncommunicable diseases is a controversial topic. Public health scholars identify the food and beverage industry as one of the main contributors to the rise of these diseases. We argue that aside from moral duties like not doing harm and respecting consumer autonomy, the food industry also has a responsibility for addressing the structural injustices involved in food-related health problems. Drawing on the work of Iris Marion Young, this article first shows how (...) food-related public health problems can be understood as structural injustices. Second, it makes clear how the industry is sustaining these health injustices, and that due to this connection, corporate actors share responsibility for addressing food-related health problems. Finally, three criteria are discussed as grounds for attributing responsibility, allowing for further specification on what taking responsibility for food-related health problems can entail in corporate practice. (shrink)

This chapter analyses the behavioural economist Matthew Rabin's work on biases in decision-making. Rabin argues that these biases cause self-harm and that we should tax individuals to ensure that they do not give in to these biases. The chapter's core question is whether there is a soft-paternalistic justification for these taxes. The answer is nuanced. It argues that Rabin’s description of these biases as “irrational” is not always appropriate—sometimes, for example, they are merely a form of preference change. When they (...) are due to the latter, the behaviour is fully voluntary, and there exists no soft-paternalistic justification for coercive intervention. It also argues that even when these biases do lead to substantially non-voluntary choices, we should prefer policies that improve self-knowledge and self-control to taxes. However, the paper notes that Rabin’s analysis reveals circumstances under which these autonomy-enhancing strategies will not be effective. In such cases, and only in such cases, Rabin’s taxes have a soft paternalistic justification. (shrink)

Our understanding of folk and scientific psychology often informs the law’s conclusions regarding questions about the voluntariness of a defendant’s action. The field of psychology plays a direct role in the law’s conclusions about a defendant’s guilt, innocence, and term of incarceration. However, physical sciences such as neuroscience increasingly deny the intuitions behind psychology. This paper examines contemporary biases against the autonomy of psychology and responds with considerations that cast doubt upon the legitimacy of those biases. The upshot is that (...) if reasonable doubt is established regarding whether psychology’s role in the law should be displaced, then there is room for future work to be done with respect to the truth of psychology’s conclusions about criminal responsibility. (shrink)

In a series of reflections published in the wake of the Covid-19 crisis, Giorgio Agamben expresses a number of concerns related to the way the pandemic has altered the very fabric of our societies, potentially changing it forever. While maintaining a certain scepticism towards the threat represented by the virus itself, Agamben claims that the response to the contagion shows how easy it is for authorities to limit individual freedoms in the name of public health, and how readily they are (...) willing to put such limitations in place. At the same time, the pandemic shows how easy it is for individuals to accept this situation as the new normal, and how readily they are willing to give up their freedoms and relationships. In this paper I offer a brief overview of Agamben’s worries, focussing on two issues in particular: the loss of individual freedom of movement and association, and the moral and political implications of social distancing. I then approach these issues from a different angle, making use of relational theory to propose an alternative framework which relies on the notion of vulnerability. While agreeing with Agamben that there is reason to worry about the state seizing the opportunity to exercise unchecked power over its citizens, I argue that we should pay attention to the ways in which social distancing measures can be grounded in solidarity and respect for the autonomy of vulnerable individuals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Iddo Landau responds:I believe that there is much to learn from Gilead's arguments, and that his paper adds to the understanding of the themes presented in the original discussion. However, in the end I do not think that the claims I made are rebuffed.Gilead should be commended for expanding the discussion of the Mandarin thought experiment (henceforth: Mandarin) from the existentialist context, to which it was limited in my (...) original article, to the Kantian one. This is a fruitful move. However, we should keep in mind that in Kantianism—unlike existentialism—to be autonomous is to be moral. Thus, some of my claims may be understood differently in existentialist and Kantian contexts. I wrote, "I would like to argue, however, that it [the Mandarin thought experiment] also casts doubt on an important and central existentialist notion: the value of being an authentic, autonomous individual, who behaves as he or she does not because of fear of what others would say, but because he or she genuinely chooses this or that course of action" ("To Kill a Mandarin," p. 95). But to claim, in a Kantian context, that the Mandarin casts doubt on the value of being autonomous is to suggest that the Mandarin casts doubt on the value of being moral, which it certainly does not. Similarly, in a Kantian context it cannot be the case that "if we were true, autonomous individuals... we would have killed an unknown person," since a Kantian autonomous individual is moral and would not kill an innocent person. In the existentialist context, however, things are different; there, autonomy is not tantamount to morality, and the suggestion that we should be autonomous creates many risks. When reading Gilead, I at times felt that he was examining certain expressions that had originally been set in an existentialist context, where autonomy does not equal morality, as though they had been presented in a Kantian one.Gilead also seems to overstate my position on the ability to behave morally when social supervision is revoked. He suggests that, in my [End Page 158] view, "in order to behave morally, respecting the moral law or value is certainly less than enough" and that I regard as "self-deception or simply wishful thinking... any attempt at thinking... that other motives (such as the respect for the moral law) are sufficient to behave morally." However, I do not make such strong claims. I do not think that respecting the moral law is insufficient for behaving morally, only that many (even if not all) will not choose to mind the moral law. Nor do I think that, when there is no external social supervision, it is impossible to remain moral, or that no one can successfully withstand the temptation that the Mandarin presents, or that any view that people are able to withstand the temptation and act morally without social supervision is self-deception. However, I do believe that the number of people who can withstand the temptation, and act morally when there is no social supervision, is significantly smaller than we like to think. Unfortunately, if complete secrecy is guaranteed and the return value for wrongdoing is sufficiently high, many, including "nice" people like you and me, who condemn immoral behavior and are considered by others and themselves as perfectly decent, will either kill an innocent person or have significant difficulties in refraining from doing so.But I should point out, first, that this is an empirical, objective question, and thus not in line with the subjectivist, personal character of much of the original paper. Second, I should note that while I cannot present a satisfactory empirical proof for my assessment, there is nevertheless some basis for it: too many people, upstanding people like you and me, told me time and again that they would accept the Mandarin deal, or at least find it difficult to resist it. Gilead thinks that only very few would so respond, but does not present any empirical evidence for this claim, not even as limited and unscientific as mine, stating that he simply believes "the opposite to be the case." He also feels the suggestion to be annoying. I agree that it is... (shrink)

Contrary to what we might initially think, domestic violence is not simply a violation of respect. This characterization of domestic violence misses two key points. First, the issue of respect in connection with domestic violence is not as straightforward as it appears. Second, domestic violence is also a violation of care. These key points explain how domestic violence negatively affects a victim’s autonomy and agency—the ability to choose and pursue her own goals and life plan.We have a moral responsibility to (...) respond to the problem of domestic violence as individuals. But the state also has a responsibility to respond. According to Kant in the Doctrine of Right, one of the purposes of the state is to secure just treatment for everyone. I argue that this includes an obligation to put in place policies and services that will promote the autonomy and agency of victims of domestic violence. (shrink)

Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. (...) However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine. (shrink)

In a recent discussion, Walter Glannon discusses a number of ways we might try to minimize harm to patients who experience intraoperative awareness. In this response I direct attention to a possibility that deserves further attention. It might be that a kind of psychological intervention – namely, informing patients of the possibility of intraoperative awareness and of what to expect in such a case – would constitute a unique way to respect patient autonomy, as well as minimize the harm that (...) typically follows intraoperative awareness events. (shrink)

Focusing on current efforts to persuade the public to comply with Covid-19 best practices, this essay examines what role appeals to religious reasons should (or should not) play in leaders’ attempts to secure followers’ acceptance of group policies in contexts of religious and moral pluralism. While appeals to followers’ religious commitments can be helpful in promoting desirable public health outcomes, they also raise moral concerns when made in the contexts of secular institutions with religiously diverse participants. In these contexts, leaders (...) who appeal to religious reasons as bases of justification for imposing Covid policies may seem to fail to show respect for the autonomy of those who lack the relevant religious commitments, and—especially when a leader herself rejects the religious commitments she makes reference to to persuade others—her appeals to religious reasons may seem to constitute ethically problematic exercises of manipulation. This essay draws on the resources of contemporary political philosophy to analyze and respond to these concerns and concludes that they are not sufficiently well-founded. To the contrary, it contends that there are good moral grounds for leaders to appeal to religious reasons as (partial) bases of justification for why followers should accept Covid policies. In the course of the argument, this essay also highlights how contemporary political theory can enrich discussions about the distinctions between coercion, manipulation, and leadership, and thereby give insight not only into the ethics of leadership but also—at least by the lights of central theories of leadership like that of James MacGregor Burns (1978)—into whether and how appeals to religious reasons can figure into genuine exercises of leadership, in contrast with mere instances of the wielding of social power. (shrink)

Two problems are considered here. One relates to who has moral status, and the other relates to who has moral responsibility. The criteria for mattering morally have long been disputed, and many humans and nonhuman animals have been considered “marginal cases,” on the contested edges of moral considerability and concern. The marginalization of humans and other species is frequently the pretext for denying their rights, including the rights to health care, to reproductive freedom, and to bodily autonomy. There is broad (...) agreement across cultural and philosophical traditions about the capacities and responsibilities of moral agents. I propose an inclusive and expansive way of thinking about moral status, situating it not in the characteristics or capacities of individuals, but in the responsibilities and obligations of moral agents. Moral agents, under this view, are not privileged or entitled to special treatment but rather have responsibilities. I approach this by considering some African communitarian conceptions of moral status and moral agency. I propose that moral agency can also be more expansive and include not just individual moral agents but collective entities that have some of the traits of moral agents: power, freedom, and the capacity to recognize and act on the demands of morality and acknowledge and respect the rights of others. Expanding who and what is a moral agent correspondingly extends moral responsibility for respecting rights and fostering the conditions for the health and well-being of humans and animals onto the collective entities who uniquely have the capacity to attend to global-scale health threats such as pandemics and human-caused climate change. (shrink)

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem (...) from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

IN her work on the distinction between freedom and voluntariness, Serena Olsaretti suggests the following definition of voluntary action: an action is voluntary if it is not non-voluntary, and non-voluntary if it is performed because there are no acceptable alternatives, where ‘acceptable’ means conforming to some objective standard (which Olsaretti suggests might be well-being). Olsaretti suggests that ascriptions of responsibility are underwritten by judgments of voluntariness, rather than freedom. Also, Olsaretti notes that a concern for voluntary choice might be grounded (...) in respect for autonomy. So, two important questions in political philosophy – when an agent is responsible for her actions and what we must do if we want agents to live autonomous lives – hang upon whether Olsaretti's account of voluntariness is correct once it has been developed in detail. This article is a contribution to that development. I show that well-informedness about our options is crucial to whether we act voluntarily or not, and I argue that we should restrict the scope of what we consider relevantly unacceptable to include only things which involve serious prudential harm. Inevitably there are some questions left unanswered, but what follows indicates what I take to be the strongest form of Olsaretti's theory, and one which can play the role described for it above. (shrink)

Soda taxes are controversial. While proponents point to their potential health benefits and the public projects that could be funded with their revenue, critics argue that they are paternalistic and regressive. In this paper, we explore the prospects for designing a just soda tax, one that appropriately balances the often-competing ethical considerations of promoting social welfare, respecting people’s autonomy, and ensuring distributive fairness. We argue that policymakers have several paths forward for designing a just soda tax, but that the considerations (...) relevant to ethical policy design are more complicated than is sometimes acknowledged. (shrink)

Nudges are small changes in the presentation of options that make a predictable impact on people's decisions. Proponents of nudges often claim that they are justified as paternalistic interventions that respect autonomy: they lead people to make better choices, while still letting them choose for themselves. However, existing work on nudges ignores the possibility of “hard choices”: cases where a person prefers one option in some respects, and another in other respects, but has no all‐things‐considered preference between the two. In (...) this paper, I argue that many significant medical decisions are hard choices that provide patients with an opportunity to exercise a distinctive sort of “formative autonomy” by settling their preferences and committing themselves to weigh their values in a particular way. Since nudges risk infringing formative autonomy by depriving patients of this opportunity, their use in medical contexts should be sensitive to this risk. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and ethical conduct. Aside (...) from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)

Population obesity and associated morbidities pose significant public health and economic burdens in the United Kingdom, United States, and globally. As a response, public health initiatives often seek to change individuals’ unhealthy behavior, with the dual aims of improving their health and conserving health care resources. One such initiative—taxes on sugar‐sweetened beverages (SSB)—has sparked considerable ethical debate. Prominent in the debate are arguments seeking to demonstrate the supposed impermissibility of SSB taxes and similar policies on the grounds that they interfere (...) with individuals’ freedom and autonomy. Commentators have often assumed that a policy intended to restrict or change private individuals’ consumption behavior will necessarily curtail freedom and, as a corollary, will undermine individuals’ autonomy with respect to their consumption choices. Yet this assumption involves a conceptual mistake. To address the misunderstanding, it’s necessary to attend to the differences between negative liberty, freedom of options, and autonomy. Ultimately, concerns about negative liberty, freedom, and autonomy do not provide strong grounds for opposing SSB taxes. (shrink)

Artificial agents (AAs), particularly but not only those in Cyberspace, extend the class of entities that can be involved in moral situations. For they can be conceived of as moral patients (as entities that can be acted upon for good or evil) and also as moral agents (as entities that can perform actions, again for good or evil). In this paper, we clarify the concept of agent and go on to separate the concerns of morality and responsibility of agents (most (...) interestingly for us, of AAs). We conclude that there is substantial and important scope, particularly in Computer Ethics, for the concept of moral agent not necessarily exhibiting free will, mental states or responsibility. This complements the more traditional approach, common at least since Montaigne and Descartes, which considers whether or not (artificial) agents have mental states, feelings, emotions and so on. By focussing directly on mind-less morality we are able to avoid that question and also many of the concerns of Artificial Intelligence. A vital component in our approach is the Method of Abstraction for analysing the level of abstraction (LoA) at which an agent is considered to act. The LoA is determined by the way in which one chooses to describe, analyse and discuss a system and its context. The Method of Abstraction is explained in terms of an interface or set of features or observables at a given LoA. Agenthood, and in particular moral agenthood, depends on a LoA. Our guidelines for agenthood are: interactivity (response to stimulus by change of state), autonomy (ability to change state without stimulus) and adaptability (ability to change the transition rules by which state is changed) at a given LoA. Morality may be thought of as a threshold defined on the observables in the interface determining the LoA under consideration. An agent is morally good if its actions all respect that threshold; and it is morally evil if some action violates it. That view is particularly informative when the agent constitutes a software or digital system, and the observables are numerical. Finally we review the consequences for Computer Ethics of our approach. In conclusion, this approach facilitates the discussion of the morality of agents not only in Cyberspace but also in the biosphere, where animals can be considered moral agents without their having to display free will, emotions or mental states, and in social contexts, where systems like organizations can play the role of moral agents. The primary cost of this facility is the extension of the class of agents and moral agents to embrace AAs. (shrink)

This paper argues that potential cases of oppression, such as sex trafficking, can sometimes comprise autonomous choices by the trafficked individuals. This issue still divides radical from liberal feminists, with the former wanting to ‘rescue’ the ‘victims’ and the latter insisting that there might be good reasons for ‘hiding from the rescuers.’ This article presents new arguments for the liberal approach and raises two demands: first, help organizations should be run by affected women and be open-minded about whether or not (...) the trafficked individuals should remain in the sex industry. Second, the career choices of trafficked individuals should be expanded by the introduction of an opportunity-extending right to asylum. (shrink)

Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical (...) analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)

Nudging works through dispositions to decide with specific heuristics, and has three component parts. A nudge is a feature of an environment that enables such a disposition; a person is nudged when such a disposition is triggered; and a person performs a nudged action when such a disposition manifests in action. This analysis clarifies an autonomy-based worry about nudging as used in public policy or for private profit: that a person’s ability to reason well is undermined when she is nudged. (...) Reasoning well is a component of self-guidance, which is an aspect of autonomy and so something there is reason to promote, preserve, or respect. However, a person can reason well when she is nudged: Many of these heuristics are good rules to reason with, and she can be flexible with respect to them when she takes there to be a better way to reason. Along the way, this paper uncovers several design specifications for responsible nudging, and discusses open empirical questions. However, nudging’s being compatible with reasoning well crystallizes a distinct worry about manipulation: that nudge designers can rely on nudged people guiding themselves toward the designers’ own ends. Manipulation of this sort exploits one aspect of autonomy (namely, self-guidance) to undermine autonomy in other respects. (shrink)

AI designers endeavour to improve ‘autonomy’ in artificial intelligent devices, as recent developments show. This chapter firstly argues against attributing metaphysical attitudes to AI and, simultaneously, in favor of improving autonomous AI which has been enabled to respect autonomy in human agents. This seems to be the only responsible way of making further advances in the field of autonomous social AI. Let us examine what is meant by claims such as designing our artificial alter egos and sharing moral selves with (...) artificial humanoid devices. (shrink)

In general, we think that when it comes to the good of another, we respect that person’s will by acting in accordance with what he wills because he wills it. I argue that this is not necessarily true. When it comes to the good of another person, it is possible to disrespect that person’s will while acting in accordance with what he wills because he wills it. Seeing how this is so, I argue, enables us to clarify the distinct roles (...) that the wills of competent and incompetent people should play in third-party deliberations about their welfare. (shrink)

From the outset, critical social theory has sought to diagnose people’s participation in their own oppression, by revealing the roots of irrational and self-undermining choices in the complex interplay between human nature, social structures, and cultural beliefs. As part of this project, Ideologiekritik has aimed to expose faulty conceptions of this interplay, so that the objectively pathological character of what people are “freely” choosing could come more clearly into view. The challenge, however, has always been to find a way of (...) doing this without arrogantly assuming special access to what is good for people. And this danger of paternalism is one to which social theorists have all too often fallen prey. In this brief essay, I focus on contemporary instances of clearly self-defeating behavior in contexts of complex choices. I begin by discussing a recent attempt to diagnose and solve these failures of choices, namely the public policy recommendations of behavioral economist Richard Thaler and reform-minded legal theorist Cass Sunstein. Their influential “libertarian paternalist” approach is particularly interesting, both in what it includes (attention to the socially constructed nature of choice situations and the roots of the problems in human nature) and in what it leaves out (an understanding of the social construction of human nature and an adequate appreciation of the value of autonomy). After discussing it, I consider a broadly perfectionist alternative, to the effect that the problem lies in a failure to adequately appreciate the importance of developing autonomy. I then turn to sketching the outlines of a new approach, based on the concept of “autonomy gaps,” which approaches overly demanding policies in relational and action-theoretical terms. In the final section, I show how this provides the basis for an analysis both in terms of a critique of ideology and of social pathology. (shrink)

According to the results of 162 respondents survey, the affective and cognitive components of feelings of guilt in the space of Ukrainians’ collective consciousness were described. This space is complex, but poorly structured, capable of appearing and spreading little understood defensive assessments and attitudes. -/- The content of relevant processes recorded the following trends: undifferentiated feelings of guilt, general self-accusations, accusations of Ukrainians themselves for historical failures, shame for Ukrainians’ violence, readiness to recognize or not to recognize Ukrainians’ guilties, accusations (...) of Ukrainian powers of different periods, denunciation of Soviet power, Ukrainians’ feelings to be innocent victims of Russia, the avoidance of political guilt. -/- In defining of the perpetrators of Ukrainian historical miseries the agents of Russian-Soviet influences and the Ukrainian authorities of various times unconditionally dominate. Psychologically more problematic is the sphere of recognition / non-recognition by Ukrainians of their own faults. One can speak of the presence of a basic affective background – the experience of undifferentiated feelings of guilt. -/- The Ukrainians’ consciousness is characterized by two main emotional-value positions: denialdefensive (we are not guilty of anyone) and avoiding-defensive (we are only guilty of ourselves). The opposite self-accusatory position (we are guilty of others and should ask them for forgiveness) has a relatively small share. -/- The denial-defensive position essentially correlates with the narcissistic Ukrainian identity. The avoiding-defensive position reflects the conciliatory Ukrainian identity. Recognizing the historical blames of Ukrainians and a need to apologize concerns the representatives of humanistic Ukrainian identity. It means understanding the real state of affairs without illusory idealization, the ability to profoundly experience one’s involvement in the Ukrainian world, and the willingness to assume moral responsibility for the sins of the past. (shrink)

This chapter argues that adequately facing and responding to medical error requires making space for blame. In vindicating blame as a response to medical error, this essay does not advocate a return to a “bad apple” blame culture in which unlucky practitioners are unfairly scapegoated. It does, however, defend the targeted feeling and expression of angry, and even resentful, blaming attitudes toward health-care providers who make at least certain kinds of mistakes. The chapter makes the case that the angry and (...) resentful feelings associated with blame reflect a conception of oneself as a person worthy of consideration, and that expressing these feelings allows victims and families to fight for their dignity and self-respect. Along the way, it distinguishes between shaming and blaming, explaining that blaming, unlike shaming, characteristically aims to draw offenders into a moral dialogue. As a result, a good blaming practice can provide a logic within which providers who make costly errors may seek forgiveness, reconciliation, and healing. (shrink)

Food and beverage firms are frequently criticised for their impact on the spread of non-communicable diseases like obesity and diabetes type 2. In this article we explore under what conditions the sales and marketing of unhealthy food and beverage products is irresponsible. Starting from the notion of ordinary morality we argue that firms have a duty to respect people’s autonomy and adhere to the principle of non-maleficence in both market and non-market environments. We show how these considerations are relevant when (...) thinking about immoral behaviour in the food and beverage industry, and identify under what conditions sales and marketing of unhealthy foods and beverages to adults and children is wrong. Based on this analysis we argue that firms should take into account: whether consumers are able to identify manipulative marketing, the degree of manipulation, as well as the negative impact a product has on health. We hold that for the food industry to act responsible it should re-evaluate the marketing of unhealthy products to adults and refrain from marketing to children. We conclude this study by making several recommendations on how the food industry should interact with consumers and highlight what changes need to be made in corporate practice. (shrink)

It is common in the autonomy literature to claim that some more demanding theories of autonomy disrespect certain individuals by giving the result that those individuals lack autonomy. This claim is often made in the context of the debate between substantive and content-neutral theories of autonomy. Proponents of content-neutral theories often argue that, in deeming certain people non-autonomous—especially certain oppressed people who seem to have internalized their oppression in certain ways—the substantive theories disrespect those people. They take this as reason (...) to accept content-neutral views over substantive views. Despite its ubiquity, this concern about disrespect is hard to pin down precisely. In this paper, I articulate two questions that need to be answered before we can understand the disrespect objection. First: Who, exactly, is supposedly being disrespected by substantive views? Second: Why is it that excluding people with these features is disrespectful? I consider a number of possible answers to each of these questions, and I argue that none of them gives us a plausible explanation of why we should think substantive theories of autonomy are disrespectful to anyone. No matter how we fill in the details, I will argue, there is simply no reason to prefer content-neutral theories of autonomy over substantive ones on the grounds of respect. (shrink)

It has been argued by disability advocates that supported decision-making must replace surrogate, or substituted, decision-making for people with cognitive disabilities. From a moral perspective surrogate decision-making it is said to be an indefensible form of paternalism. At the heart of this argument against surrogate decision-making is the belief that such paternalistic action expresses something fundamentally disrespectful about those upon whom it is imposed: that they are inferior, deficient or child-like in some way. Contrary to this widespread belief, I (...) will argue that surrogate decision-making sometimes expresses more respect for people with life-long, ‘severe’ or ‘profound’ cognitive disabilities than does the adoption of supported decision-making.. Specifically, I argue that in some cases supported decision-making can arguably express that people with severe or profound cognitive disabilities lack equal moral value. I also argue that supported decision-making for people with profound cognitive disabilities can arguably express that they lack complex and rich inner lives. If our aim is to ensure our behaviour and practices express respect for people with life-long ‘severe’ or ‘profound’ cognitive disabilities, then sometimes surrogate rather than supportive decision-making will be a better option. (shrink)