Kant’s Formula of Humanity can be analyzed into two parts. One is an injunction to treat humanity always as an end. The other is a prohibition on using humanity as a mere means. The second is often referred to as the FH prohibition or the mere means prohibition. It has become popular to interpret this prohibition in terms of consent. The idea is that, if X uses Y's humanity as a means and Y does not consent to it, (...) then X uses Y's humanity as a mere means. There is then debate about the kind of consent that is relevant: possible, actual, or rational. In this paper, I argue against this interpretation. Section one sets up the consent account. Section two attacks possible and actual consent accounts on doctrinal grounds. Section three extends this doctrinal attack to rational consent accounts. Section four circles back to the original motivation for the consent interpretation. I argue that the consent account rests on a misinterpretation, and I conclude with a quick sketch of an alternative interpretation of the FH prohibition. (shrink)

This paper explores how transformative experience generates decision-making problems of particular seriousness in medical settings. Potentially transformative experiences are especially likely to be encountered in medicine, and the associated decisions are confronted jointly by patients and clinicians in the context of an imbalance of power and expertise. However in such scenarios the principle of informed consent, which plays a central role in guiding clinicians, is unequal to the task. We detail how the principle’s assumptions about autonomy, rationality and information (...) handle transformative experiences poorly, appealing to several difficult cases for medical decision-making to illustrate the resulting problem, and we consider how the existing literature on complications with consent fails to offer a resolution. We argue that recognition of the problem has a role to play in achieving a more effective response to transformative decisions. In Sect. 1 we introduce several representative cases of challenging patient decision-making that clinicians might face. In Sect. 2 we detail how transformative experience has been analysed in the recent literature, before outlining in Sect. 3 the theoretical basis of the principle of informed consent, which plays a central role in how clinicians are expected to support decision-making. In Sect. 4, having laid the groundwork for a clear description, we return to the cases given in Sect. 1 to confirm how their transformative nature presents a problem: either clinicians treat the decisions faced by these patients as ‘normal’, encouraging them to focus on information provision that patients may be unable to act on, or they treat them as transformative, in which case they lack the resources to recognise whether they are helping patients make (subjectively) good decisions. In Sect. 5 we argue that the existing literature does not offer any escape from this problem. We close in Sect. 6 by noting the significant impact that appreciating the problem of transformative experience could have on supporting transformative decisions in medicine and briefly suggesting how we might aim to develop new approaches to dealing with these. (shrink)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against (...) their own best interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

In his article “Nudging and Informed Consent,” Shlomo Cohen (2013) argues, among other things, that 1) “to the extent that the nudge-influenced decision making is rational—in whatever sense,” there...

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now (...) the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

The starting point regarding consent has to be that it is both extremely important, and that it is often suspicious. In this article, the author tries to make sense of both of these claims, from a largely liberal perspective, tying consent, predictably, to the value of autonomy and distinguishing between autonomy as sovereignty and autonomy as nonalienation. The author then discusses adaptive preferences, claiming that they suffer from a rationality flaw but that it's not clear that this flaw (...) matters morally or politically. What matters is whether they suffer from an autonomy flaw. To answer this question, the author develops an account of autonomy failure, according to which a preference is nonautonomous if an injustice played an appropriate role in its causal history. The author then discusses the moral implications—and in an initial way, the political ones as well—of proclaiming a preference, or consent based on it, nonautonomous in this way. (shrink)

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By (...) appealing to these powers, my version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

In this paper, I will explain and motivate the common consent argument for theism. According to the common consent argument it is rational for you to believe that God exists because you know so many other people believe that God exists. Having motivated the argument, I will explain and motivate several pressing objections to the argument and evaluate their probative force. The paper will serve as both an accessible introduction to this argument as well as a resource (...) for continued research on the topic. (shrink)

In this article we explore the underpinnings of what we view as a recent "backlash" in English law, a judicial reaction against considering children's and young people's expressions of their own feelings about treatment as their "true" wishes. We use this case law as a springboard to conceptual discussion, rooted in (a) empirical psychological work on child development and (b) three key philosophical ideas: rationality, autonomy and identity. Using these three concepts, we explore different understandings of our central theme, true (...) wishes. These different conceptual interpretations, we argue, help to elucidate important clinical questions in the area of children's informed consent to treatment. For example, how much should a child's own wishes count in making medical decisions? Does it make a difference if the child or young person is undergoing psychiatric treatment?—if in some sense her wishes are abnormal, not "true" expressions of what she really wants? If the child's wishes do not count, why not? If they do matter but count for less, how much less? We conclude by advocating functional tests of a young person's true wishes, applicable on a case-by-case basis, rather than a black-and-white distinction between "incompetent" children and "competent" adults. (shrink)

The article focuses on the justification provided by classical contract theory for the right of states to enact laws and the corresponding obligation of political allegiance. First the distinction between political authority and parental authority developed by John Locke in his seminal work “Two Treatises of Government” is explored. Thereafter it is discussed why the interests the individuals have in the creation of a state fail to vindicate the exercise of governmental power. As regards David Hume’s influential objections to contract (...) theory it is argued that the consent criterion of political legitimacy withstands his criticism. Hume cannot establish that the core idea of Locke’s justificatory approach is mistaken; he merely demonstrates that hardly any existing state meets the consent requirement. Finally the question is discussed which conditions a state must fulfil in order to be entitled to claim that its citizens tacitly approve of its authority. (shrink)

To fully rationally answer Socrates’s question, ‘How should one live?’, we need to answer the epistemic question: ‘How can one know how one should live?’. This paper attempts to answer both. ` The issue of rationality is crucial here. ‘Rationality’ here only concerns knowledge, e.g., ways to acquire scientific knowledge, and meta-knowledge concerning values. No values as such are rational or knowledge. However:- Many factors are required for human rationality to exist and develop, e.g., life, mental health and evidence-based (...) education. Human rationality’s need for those factors, hence their value to rationality, is rationally-unquestionable – and that applies to the practised values prescribing the prescribable factors. Those prescribable factors require certain interrelated epistemic, moral, social, political, legal, educational and other values to be practised. This implies a pro-rationality values-theory with one obligatory, general end – a uniquely rationally-unquestionable end. This end provides the basis for answering Socrates’s question as rationally (correctly) as is possible for values. That end is fundamentally epistemic, namely ‘Be pro-rationality’, yet the theory has deeply-humanly-meaningful, universal applications. It has implications for current and all possible moral, social, political, legal, educational, environmental etc issues. E.g., the theory shows that human rationality crucially requires certain emotions, health-care, education and upbringing. With this, the paper discusses affection, free speech, journalism, psychotherapy, political and sexual consent, rights, responsibilities, freedom and government. The theory’s sub-values prescribe much prescribed by some other theories, e.g., broad and deep knowledge-acquisition (in certain areas), rationally-critical thinking, non-sexism, non-racism, general types of liberalism, holistic flourishing, happiness, unselfishness and fairness. However, all other values-theories lack pro-rationality theory’s maximum possible rational-unquestionability, internal coherence and coherence with rationality. The theory encourages total freedom in a-rationality areas, areas irrelevant to its obligatory end. The theory inherently requires its advocates to be (self )critical, rationally viewing the theory’s necessarily human-suggested specifics as often fallible or unavoidably approximate. So the theory is a work-in-progress. (shrink)

This article examines the operation of “reasonable steps” as a statutory standard for analysis of the availability of the defence of belief in consent in sexual assault cases and concludes that application of section 273.2(b) of the Criminal Code, as presently worded, often undermines the legal validity and correctness of decisions about whether the accused acted with mens rea, a guilty, blameworthy state of mind. When the conduct of an accused who is alleged to have made a mistake about (...) whether a complainant communicated consent is assessed by the hybrid subjective-objective reasonableness standard prescribed by s. 273.2, many decision-makers rely on extra-legal criteria and assumptions grounded on their personal experience and opinion about what is reasonable. In the midst of debate over what the accused knew and what steps were “reasonable” given what the accused knew, the legal definition of consent in section 273.1 is easily over-looked and decision-makers focus on facts that are legally irrelevant and prejudice rational deliberation. -/- That is precisely what we see here; the result is often failure to enforce the law. The author proposes: -/- (a) that section 273.2 be amended to reflect the significant developments achieved in sexual consent jurisprudence since enactment of the provision in 1992; and -/- (b) that, in the interim, the judiciary act with resolve to make full and proper use of the statutory and common law tools that are presently available to determine whether the accused acted with mens rea in relation to the absence of sexual consent. (shrink)

This paper expands on another which focussed on Socrates’s question: ‘How should one live?’. The present paper also focusses on the ‘meaning of life’ and ‘meaning in life’ issues, and more on rights. To fully rationally answer Socrates’s question, we need to answer the epistemic question: ‘How can one know how one should live?’. This paper attempts to answer both. And knowing how one should live fundamentally involves knowing what values one should live by. This includes which rights one should (...) have and which rights others should have. So one’s values include how one should treat all persons (and (other) animals, the environment and so on.) All this relates to what one finds meaningful in life and the meaning or point of one’s life. In sum, all the notions in this paper’s title are interrelated. The issue of rationality is crucial here. Just one example here (qualified later) is that our rationality gives us cognitively meaningful notions. ‘Rationality’ here only concerns knowledge, e.g., ways to acquire scientific knowledge, and meta-knowledge concerning values. No values or rights as such are rational or knowledge. However:- Many factors are required for human rationality to exist and develop, e.g., life, mental health and evidence-based education. Human rationality’s need for those factors, hence their value to rationality, is rationally-unquestionable – and that applies to the practised values prescribing the prescribable factors. With this, there are rationally-unquestionable rights to those factors. Those prescribable factors require certain interrelated epistemic, moral, social, political, legal, educational and other values/rights to be practised. This implies a pro-rationality values-theory with one obligatory, general end – a uniquely rationally-unquestionable end. This end provides the basis for answering Socrates’s question as rationally (correctly) as is possible for values/rights. That end is fundamentally epistemic, namely ‘Be pro-rationality’, yet the theory has deeply-humanly-meaningful, universal applications. It has implications for current and all possible moral, social, political, legal, educational, environmental etc issues. E.g., the theory shows that human rationality crucially requires love and certain other emotions, health-care, education and upbringing. These require certain right to be respected and practised. With this, the paper discusses affection, free speech, journalism, psychotherapy, political and sexual consent, responsibilities, freedom and government. The theory’s general sub-values prescribe much prescribed by some other theories, e.g., broad and deep knowledge-acquisition (in certain areas), rationally-critical thinking, non-sexism, non-racism, general types of liberalism, holistic flourishing, happiness, unselfishness and fairness. However, all other values-theories lack pro-rationality theory’s maximum possible rational-unquestionability, internal coherence and coherence with rationality. The theory encourages (the right to) total freedom in a-rationality areas, areas irrelevant to its obligatory end. The theory inherently requires its advocates to be (self )critical, rationally viewing the theory’s necessarily human-suggested specifics as often fallible or unavoidably approximate. So the theory is a work-in-progress. (shrink)

The prohibition against using others ‘merely as means’ is one of Kant’s most famous ideas, but it has proven difficult to spell out with precision what it requires of us in practice. In ‘How to Use Someone “Merely as a Means”’ (2020), I proposed a new interpretation of the necessary and sufficient conditions for using someone ‘merely as a means’. I argued that my agent-focused actual consent inter- pretation has strong textual support and significant advantages over other readings of (...) the prohibition. In the present essay, I respond to comments by Claudia Blöser, Irina Schumski, and Oliver Sensen. I first address the role of maxims in relation to the Formula of Humanity, and I spell out in more detail the relation between the agent’s belief and the actual facts pertaining to the consent of the person who is used as means to the agent’s end. I then discuss the importance of the requirement that agents make their use of others conditional on the others’ consent as a matter of moral principle. I next show that the proposed reading of the prohibition, despite its focus on the agent’s maxims and practical reasoning, yields important conclusions about the moral status of external actions, and I address several cases that are pur- ported to spell trouble for my reading of Kant’s prohibition. I end by outlining two challenges for possible (rational) consent readings of the prohibition against using others merely as means. (shrink)

I defend a deontological social contract justification of punishment for free will deniers. Even if nobody has free will, a criminal justice system is fair to the people it targets if we would consent to it in a version of original position deliberation (OPD) where we assumed that we would be targeted by the justice system when the veil is raised. Even if we assumed we would be convicted of a crime, we would consent to the imprisonment of (...) violent criminals if prison conditions were better than the state of nature but deterring enough to prevent the state of nature. And even if we assumed we would be accused of a crime, we would consent to an evidentiary standard low enough to allow a conviction rate sufficient to prevent the state of nature. After explaining this justification, I contrast it with the public health quarantine justification defended by Derk Pereboom and Gregg Caruso, and argue that it provides a stronger response to the using criminals as mere means objection. (shrink)

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

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational (...) choice in alignment with one's values and goals). (shrink)

Is Rousseau an advocate of natural law or not? The purpose of Rehm’s paper is to suggest a positive answer to this controversially discussed question. On the one hand, Rousseau presents a critical history of traditional natural law theory which in his view is based on flawed suppositions: not upon natural, but on artificial qualities of man, and even rationality and sociability are counted among the latter. On the other hand he presents the self-confident manifesto for a fresh start in (...) natural law theory, founded on what to Rousseau’s mind is the true idea of human nature. The paper intends to show that the only natural qualities which can be seen as anthropological constants are those that keep man flexible, namely perfectibility and freedom of will. It is argued that these are exactly the qualities which according to Rousseau serve as the standard of natural law for the system of politics and its laws: Only a state based upon the free consent of individuals can do justice to man’s perfectibility and freedom of will. Rehm stresses that because of perfectibility and freedom of will, this self-commitment has to be revisable, which is why the republic of the “Social Contract” should not have a constitution, or any law that the citizens cannot alter. It is demonstrated that in Rousseau’s view, this republic is the enabling condition of natural liberty. -/- . (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall (...) into the broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

In this paper, I examine the ethics of e - trust and e - trustworthiness in the context of health care, looking at direct computer-patient interfaces (DCPIs), information systems that provide medical information, diagnosis, advice, consenting and/or treatment directly to patients without clinicians as intermediaries. Designers, manufacturers and deployers of such systems have an ethical obligation to provide evidence of their trustworthiness to users. My argument for this claim is based on evidentialism about trust and trustworthiness: the idea that trust (...) should be based on sound evidence of trustworthiness. Evidence of trustworthiness is a broader notion than one might suppose, including not just information about the risks and performance of the system, but also interactional and context-based information. I suggest some sources of evidence in this broader sense that make it plausible that designers, manufacturers and deployers of DCPIs can provide evidence to users that is cognitively simple, easy to communicate, yet rationally connected with actual trustworthiness. (shrink)

Defends Kantian paternalism: Interference with an individual’s liberty for her own sake is justified absent her actual consent only to the extent that such interference stands a reasonable chance of preventing her from exercising her liberty irrationally in light of the rationally chosen ends that constitute her conception of the good. More specifically, interference with an individual’s liberty is permissible only if, by interfering, we stand a reasonable chance of preventing that agent from performing actions she chose due to (...) distorted reasoning and which would result in that agent’s rationally chosen ends not being as fully realized as they would have been had she so acted. -/- Applied to suicide intervention Kantian paternalism implies that such intervention is justified to the extent that it prevents a person from ending her life when, due to distorted reasoning, she engages in suicidal behavior that is at odds with her rationally chosen ends. (shrink)

According to The Consensus Gentium Argument from the premise: “Everyone believes that God exists” one can conclude that God does exist. In my paper I analyze two ways of defending the claim that somebody’s belief in God is a prima facie reason to believe. Kelly takes the fact of the commonness of the belief in God as a datum to explain and argues that the best explanation has to indicate the truthfulness of the theistic belief. Trinkaus Zagzebski grounds her defence (...) on rationality of epistemic trust in others. In the paper I argue that the second line of reasoning is more promising and I propose its improved version. (shrink)

Agents have powers to bring about change. Do agents have normative powers to bring about normative change directly? This chapter distinguishes between direct normative change and descriptive and institutional changes, which may indirectly be normatively significant. This article argues that agents do indeed have the powers to bring about normative change directly. It responds to a challenge claiming that all normativity is institutional and another claiming that exercises of normative powers would violate considerations of supervenience. The article also responds to (...) a challenge - generalizing Kent Hurtig’s recent challenge about consent - which states that exercises of normative powers are valid only in cases that do not matter - they never bring about a “normative transformation” of what the agent overall ought to do. It turns out that consent is normatively transformative in some cases, but the main contribution of exercises of normative powers is at the contributory level not that of overall oughts. Invalid exercises of normative powers are void of any normative effects. Rational agents as possessors of normative powers are not merely responsive to pre-existing normative reasons, but they can also create normative reasons. A “responsive” view of rational agency sees us as being able to track existing normative reasons and make descriptive changes (on which normative changes supervene). The “creative” view of rational agency sees us as being able not only to construct institutions but also to create normative reasons directly. The chapter concludes that agents are both responsive and creative. (shrink)

Much of the work in moral philosophy and the political debate on abortion has focused on when in human development personhood begins. In this article, using a variant of Derek Parfit’s view on personal identity, I instead frame the question as one of victimhood. I argue for what I call the Victim Requirement for the wrongness of killing–killing is wrong only if there is an identifiable victim. An identifiable victim is, temporally speaking, in the midst of a chain of psychological (...) connections in the sense of “Relation R.” I go on to argue for a version of psychological identity which makes consciousness a necessary condition of rational self-interest and numerical identity across time. The implications for the abortion debate, based upon the best neurological evidence, are that abortion cannot be wrong before at least 22 weeks of pregnancy and perhaps significantly later. I then respond to alternatives to my Victim Requirement and argue that they either fail on their own merits or are deeply problematic. Finally, I discuss the role of autonomy and consent in a world where fetal consciousness develops much earlier. (shrink)

I argue that embryonic stem cell research is fair to the embryo, even on the assumption that the embryo has attained full personhood and an attendant right to life at conception. This is because the only feasible alternatives open to the embryo are to exist briefly in an unconscious state and be killed or to not exist at all. Hence, one is neither depriving the embryo of an enduring life it would otherwise have had nor is one causing the embryo (...) pain. I also argue that a rational agent in a situation relevantly similar to that of the embryo would consent to such research, and I use this insight to ground two justice-based arguments in favor of this research. (shrink)

Some experts have argued that patients facing certain types of choices should not be told whether their risk is above or below average, because this information may trigger a bias (Fagerlin et al. 2007). But careful consideration shows that the comparative risk heuristic can usefully guide decisions and improve their quality or rationality. Building on an earlier paper of mine (Schwartz 2009), I will argue here that doctors and decision aids should provide comparative risk information to patients, even while further (...) research is conducted. (shrink)

This article tries to show that commonplace economic, ethico-religious, anti-racist,and logical-consistency objections to public funding of abortions and abortion counseling for poor women are quite weak. By contrast, arguments appealing to basic human rights to freedom of speech, informed consent, protection from great harm, justice and equal protection under the law, strongly support public funding. Thus, refusing to provide abortions at public expense for women who cannot afford them is morally unacceptable and rationally unjustifiable, despite the opinions of former (...) Presidents Reagan and Bush, the more conservative members of the Supreme Court of the United States, the current Congress, and the majority of the American people. (shrink)

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and gender (...) issues; rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

Epistemic paternalism is the practice of interfering with someone’s inquiry, without their consent, for their own epistemic good. In this chapter, I explore the relationship between epistemic paternalism and two other epistemological theses: epistemic permissivism and standpoint epistemology. I argue that examining this relationship is fruitful because it sheds light on a series of cases in which epistemic paternalism is unjustified and brings out notable similarities between epistemic permissivism and standpoint epistemology.

A common critique of nudges is that they reduce someone's of choices or elicit behavior through means other than rational persuasion. In this paper, I argue against this form of critique. I argue that, if there is anything distinctively worrisome about nudges from the standpoint of morality, it is their tendency to hide the amount of social control that they embody, undermining democratic governance by making it more difficult for members of a political community to detect the social architect’s (...) pulling of the strings. This concern is particularly salient as to choices where it is important for people to directly engage with a certain set of values, “big personal decisions” (to use a simplifying phrase). Many healthcare decisions are exactly these kinds of choices. (shrink)

This paper identifies strands of reasoning underlying several theories of democratic authority. It shows why each of them fails to adequately explain or justify it. Yet, it does not claim (per philosophical anarchism) that democratic authority cannot be justified. Furthermore, it sketches an argument for a perspective on the justification of democratic authority that would effectively respond to three problems not resolved by alternative theories—the problem of the expert, the problem of specificity, and the problem of deference. Successfully resolving these (...) problems is at least evidence for the viability of a justification of democratic authority. This perspective integrates procedural concerns with those about the quality of democratic outcomes. It shows that democratic authority, if there is such a thing, requires reliable democratic procedures as the only sort citizens could rationally accept. (shrink)

Moral Understanding of Al-Ghazali In order to evaluate the moral understanding of Ghazali correctly, we should pay attention to how he handles the basic concepts and how he views the life of the hereafter. Ghazali sees moral descriptions such as good, bad and absurd as “knowledge pre-existing in the mind” and believes that it is inherent to do good and avoid evil. Reason naturally encourages people to avoid harm. Reason has the universal knowledge of good and evil. The concepts of (...) moral good and bad are necessary in the mind, and it cannot be known with the mind that individual verbs are good and bad (particular). Particulars, for example, if lying is bad, it is known by 'experience'. In this respect, he has been influenced by philosophers in his statements pointing to the rational aspect of morality. The second important factor that determines Ghazali's view of morality is Sufism. He adopts a morality that advises to stay away from the world in accordance with the mystical understanding of life, and is shaped by compassion and consent. In Ghazali, morality has assumed an individual character with this aspect and the social ethics understanding has been pushed to the second plan. In such an individual understanding of morality, activities and activities aimed at achieving the hereafter and the hereafter are considered important. For this purpose, worship takes on a moral character and points out our responsibilities towards Allah. Those who worship are moral and deserve salvation. Thus, worship becomes a "goal", not a "tool" in the acquisition of morality. Those who fulfill their responsibilities to God behave morally. As a result, the two main pillars that make up the Ghazali understanding of morality are philosophical reason and mystical world view. Since reason is an innate feature of human beings, man knows the good and the bad as a fundamental and can behave morally with this knowledge. Again, knowing that this world is a temporary place, people will work with the focus on the hereafter and live morally by worshiping Allah. (shrink)

A large part of Richard Rorty’s works focus on criticizing the received view about philosophy. He argues, in his historical reconstruction of philosophical activity, that there has always been a misconception about philosophy in the history of philosophy. This misconception assumes that philosophy aims to grasp the ultimate knowledge, so it desperately engages in an attempt to achieve “truth”. In this view, which he calls representationalism and points to it by the metaphor of the mirror of nature, knowledge aims to (...) represent something out of mind, and the duty of philosophy is to put forward a theory about the representation. According to Rorty, based on this popular view philosophy is a foundational discipline that aims to evaluate epistemological claims of other disciplines. Rorty attempts to criticize and reject this Cartesian epistemological agenda for philosophy. Rorty’s approach to philosophy is therapeutic; that is, he tries to resolve philosophical problems rather than solve them. By adopting a historical method, Rorty seeks to show that “philosophy as epistemology” is a result of the dominance of what he calls the metaphor of the mirror of nature. From a critical rationalist perspective, the present article intends to critique Rorty’s views on epistemology. In this paper, Rorty’s historiographical approach is criticized in several ways. First, Rorty offers a one-sided and biased reconstruction of the history of philosophy to fit the abovementioned metaphor. Secondly, he treats history as rigid data from which it is possible to draw doctrinal conclusions. Whereas, as critical rationalists have said time and again, history by itself has no meaning. Moreover, Rorty’s justificationism is criticized. Rorty maintains that knowledge needs to be justified, and since it cannot be justified through representation, it must be justified by the consent of society. In other words, agreement in a group of people can provide an epistemic authority. Thus, both Rorty’s view and foundationalism, despite their differences, share justificationism in epistemology. That is, they both believe that knowledge needs to be justified. On the other hand, as critical rationalists have shown, justification in any shape and form, whether internal or external, is neither possible nor necessary. We also attempt to illustrate how Rorty’s epistemological approach results in confusion between epistemology and psychology; moreover, his epistemological behaviorism still suffers from some sort of justifications. In conclusion, Rorty expresses his criticism of epistemology with the metaphor of the mirror of nature. According to him, foundationalism is the result of the conflation of the Platonic conception of knowledge as something unchangeable, with the Cartesian mind that seeks certainty. However, his ignorance of the main crux of the matter in epistemology causes his own suggestion of epistemological behaviorism to suffer from the same problem, that is justificationism, which now appears in another form, i.e., social consensus. While, as critical rationalists repeated time and again, justification is neither possible nor necessary and not even desirable. They have shown that a non-justificationist approach to knowledge aimed at truth as a regulative idea could be a better approach. (shrink)

My starting point is what I call the Normative Authority Conception of justification, where S is justified in their belief that p at t (to some degree n) if and only if their believing that p at t is not ruled out by epistemic norms that have normative authority over S at t. With this in mind, this paper develops an account of doxastic justification by first developing an account of the normative authority of epistemic norms. Drawing from work in (...) political philosophy, I argue that (a) the cognitive and evaluative commitments and concerns behind our actual practices of holding each other and ourselves accountable for our beliefs reveal which epistemic norms we have consented to be under, and that (b) it is because we have consented to be under the authority of these norms – by actually holding ourselves and others accountable to them – that they in turn have normative authority over us. By connecting the authority of epistemic norms to the authority we have over ourselves in this way, the resulting account of doxastic justification (i) explains why it can be appropriate to criticize, resent, or sanction someone for having unjustified beliefs, (ii) avoids the phenomena of normative alienation and normative parochialism, and (iii) respects the social and collective nature of epistemic justification. (shrink)

It is clear that beliefs can be assessed both as to their justification and their rationality. What is not as clear, however, is how the rationality and justification of belief relate to one another. Stewart Cohen has stumped for the popular proposal that rationality and justification come to the same thing, that rational beliefs just are justified beliefs, supporting his view by arguing that ‘justified belief’ and ‘rational belief’ are synonymous. In this paper, I will give reason to (...) think that Cohen’s argument is spurious. I will show that ‘rational’ and ‘justified’ occupy two distinct semantic categories – ‘rational’ is an absolute gradable adjective and ‘justified’ is a relative gradable adjective – telling against the thought that ‘rational belief’ and ‘justified belief’ are synonymous. I will then argue that the burden of proof is on those who would equate rationality and justification, making the case that those who hold this prominent position face the difficulty of explaining how rationality and justification come to the same thing even though ‘rational’ and ‘justified’ are not synonymous. (shrink)

Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of (...) consent because valid consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

A response to review essays by Chrisoula Andreou, John Brunero, Matthias Haase, Erasmus Mayr, and Sarah Paul on Sergio Tenenbaum's _Rational Powers in Action_.

A variety of interpreters have argued that Kant construes the animality of human beings as ‘transformed’, in some sense, through the possession of rationality. I argue that this interpretation admits of multiple readings and that it is either wrong, or doesn't result in the conclusion for which its proponents argue. I also explain the sense in which rationality nevertheless significantly differentiates human beings from other animals.

Philosophy and Phenomenological Research, EarlyView. Despite the acknowledgement of the moral significance of consent there is still much work to be done in determining which specific sexual encounters count as unproblematically consensual. This paper focuses on the impact of deception. It takes up the specific case of deception about one's self. It may seem obvious that one ought not to lie to a sexual partner about who one is, but determining which features of oneself are most relevant, as well (...) as the lies which it follows would be impermissible to tell, is complicated. It is argued here that deception about one's morally valenced character traits, those we think of as virtues and vices, are particularly problematic. This is true regardless of whether knowing the truth about those traits would have made a difference to one's partner's consent. Attention is then drawn to a range of types of lies that one ought not to tell. (shrink)

Why is consent revocable? In other words, why must we respect someone's present dissent at the expense of her past consent? This essay argues against act-based explanations and in favor of a rule-based explanation. A rule prioritizing present consent will serve our interests the best, in light of our interests in having flexibility over our consent and in minimizing the possibility of error in people's judgments about whether we consent.

The traditional view according to which we adults tacitly consent to a state’s lawful actions just by living within its borders—the residence theory—is now widely rejected by political philosophers. According to the critics, this theory fails because consent must be (i) intentional, (ii) informed, and (iii) voluntary, whereas one’s continued residence within a state is typically none of these things. Few people intend to remain within the state in which they find themselves, and few realize that by remaining (...) they are consenting to the state’s lawful actions. In addition, the various obstacles standing in the way of us leaving the state render our remaining involuntary. Thus, the critics conclude, few if any people can be considered to have consented through their residence. I argue that these objections fail and that the residence theory remains a viable option, at least for those who are not committed incompatibilists. (shrink)

The predominant view is that a study using health data is observational research and should require individual consent unless it can be shown that gaining consent is impractical. But recent arguments have been made that citizens have an ethical obligation to share their health information for research purposes. In our view, this obligation is sufficient ground to expand the circumstances where secondary use research with identifiable health information is permitted without explicit subject consent. As such, for some (...) studies the Institutional Review Board/Research Ethics Committee review process should not assess the practicality of gaining consent for data use. Instead the review process should focus on assessing the public good of the research, public engagement and transparency. (shrink)

Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; (...) and third, participants’ understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies. (shrink)

Deception sometimes results in nonconsensual sex. A recent body of literature diagnoses such violations as invalidating consent: the agreement is not morally transformative, which is why the sexual contact is a rights violation. We pursue a different explanation for the wrongs in question: there is valid consent, but it is not consent to the sex act that happened. Semantic conventions play a key role in distinguishing deceptions that result in nonconsensual sex (like stealth condom removal) from those (...) that don’t (like white lies). Our framework is also applicable to more controversial cases, like those implicated in so-called “gender fraud” complaints. (shrink)

This collection of articles is a tribute to Nenad Smokrović, our friend and colleague from the Philosophy Department. He has been working on human rationality for over 25 years. Consequently, articles in this collection are either directly or indirectly related to this subject matter. In this volume, 19 authors from Croatia, Slovenia, Serbia, Italy, Israel, USA, and GB write about human rationality. What human rationality consists in? What is the relationship between its normative aspect (logic) and its descriptive aspect (psychology)? (...) Do people in fact reason according to the laws of logic? What is the nature and the function of reasoning, argumentation, and inference? ... We are publishing this volume in the hope that it will provide further contribution to the research in the field. (shrink)

Misconceived Consent: Miguel has stage IV lung cancer. He has nearly exhausted his treatment options when his oncologist, Dr. Llewellyn, tells him about an experimental vaccine trial that may boost his immune response to kill cancer cells. Dr. Llewellyn provides Miguel with a consent form that explains why the study is being conducted, what procedures he will undergo, what the various risks and benefits are, alternative sources of treatment, and so forth. She even sits down with him, carefully (...) talks through the most important points, and gives him time to ask questions. Though it is a Phase 1 study and the chance that he will benefit is very low, Miguel happily agrees to take part. A week later, after the first experimental injection, she asks him if he is worried about the risks. “Risks?” he asks. “I’m sure this is safe—you’re a doctor, after all!”. (shrink)

Tom Dougherty has recently defended the claim that all deception that is consequential for sex is seriously wrong. This discussion piece argues that deception does not have to seriously undermine consent and that when sexual deception is seriously wrong, that may not only be to do with its relation to consent. In doing so, it defends distinguishing between the seriousness of deceptions, whether these are sexual or in other areas of life, and so defends what Dougherty calls the (...) lenient view. (shrink)

I argue that the scope of rational framing effects may be broader than Bermúdez assumes. Even in many “canonical experiments,” the explanation of the judgment reversals or shifts may refer to reasons, including moral ones. Referring to the Asian disease paradigm (ADP), I describe how non-consequentialist reasons related to fairness and the distinction between doing and allowing may help explain and justify the typical pattern of choices in the cases like ADP.