One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to (...) reduce the indeterminacy surrounding medical decisions. In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

While the substantiation of “best interests” has received much attention, the question of how “the child” is conceptualised to ensure any action taken or decision made is in the particular child’s best interests has been largely neglected. In this paper, I argue that the lack of robust understanding of who “the child” is means that we continue to make many generalisations and category-based assumptions in determining the child’s best interests. In addressing the challenge of (...) doing right by the individual child, I propose a three-step approach based on a theoretical model of the child that avoids presumptions about child-typical needs and insists on an assessment of the child’s individual characteristics, needs, qualities, and circumstances, making it the only conceptualisation fully meeting the child centrism criterion required by children’s rights as determined by the United Nations Convention on the Rights of the Child. (shrink)

I consider the current best interests of patients who were once thought to be either completely unaware (to be in PVS) or only minimally aware (MCS), but who, because of advanced fMRI studies, we now suspect have much more “going on” inside their minds, despite no ability to communicate with the world. My goal in this chapter is twofold: (1) to set out and defend a framework that I think should always guide thinking about the best (...) class='Hi'>interests of highly cognitively compromised patients, and then (2) to defend a particular conclusion that applies to this specific patient population. The framework requires us to ask two questions: Is the individual suffering? Is the individual gaining any benefit from life? There must be benefit of some sort for life to be worth preserving, and the benefit must outweigh any suffering (if there is suffering present). I then argue it would be best overall to allow these patients to die. Either these patients are not really very aware at all, in which case they are most likely not suffering, but not benefiting from life either, or they are mentally intact enough to make benefit a theoretical possibility, but in fact they are not benefiting because they cannot communicate with anyone. Such patients would most likely suffer. As there is no way currently to address their suffering, we should allow them to die. No matter the truth about their cognitive lives, death would either be a neutral event, or a blessing. (shrink)

It is unclear that United States schools are doing sufficient work to identify and protect the interests of their LGB students this analysis, we rely on certain public-health research in social epidemiology to show that discrimination against LGB adolescents imposes morally significant harms to both adolescents and community. We apply "trust” and “social capital” to educational standards and practices as foundations for educational practices that work toward full equality of LGB students in regard to opportunity and other primary social (...) goods. (shrink)

The cumulative impact of enhancement technologies may alter the human species in the very long-term future. In this article, I will start showing how radical genetic enhancements may accelerate the conversion into a novel species. I will also clarify the concepts of ‘biological species’, ‘transhuman’ and ‘posthuman’. Then, I will summarize some ethical arguments for creating a transhuman or posthuman species with a substantially higher level of well-being than the human one. In particular, I will present what I shall call (...) the Principle of the Best Interests of Posthumanity, which states that the enhancement of the human and transhuman species must be directed towards the creation of a posthuman existence that is substantially more valuable than its predecessors. I suggest that human extinction may be considered, within that principle, as one of the best interests of posthumanity. Finally, I will develop three objections that make that principle unattractive and that show that pursuing a full-blown programme of posthuman evolution is ethically flawed. (shrink)

This paper examines a variety of social scientific studies purporting to demonstrate that transracial adoption is in the best interests of children. Finding flaws in these studies and the ethical and political arguments based upon such scientific findings, we argue for adoption practices and policies that respect the racial and ethnic identities of children of color and their communities of origin.

There is a broad philosophical consensus that both children’s and prospective parents’ interests are relevant to the justification of a right to parent. Against this view, I argue that it is impermissible to sacrifice children’s interests for the sake of advancing adults’ interest in childrearing. Therefore, the allocation of the moral right to parent should track the child’s, and not the potential parent’s, interest. This revisionary thesis is moderated by two additional qualifications. First, parents lack the moral right (...) to exclude others from associating with the child. Second, children usually come into the world as part of a relationship with their gestational mother; often, this relationship deserves protection. (shrink)

The future of health research will be characterised by three continuing trends: rising demand for health data; increasing impracticability of obtaining specific consent for secondary research; and decreasing capacity to effectively anonymise data. In this context, governments, clinicians and the research community must demonstrate that they can be responsible stewards of health data. IRBs and RECs sit at heart of this process because in many jurisdictions they have the capacity to grant consent waivers when research is judged to be of (...) particular value. However, several different terms are used to refer to this value, indicating a lack of conceptual clarity regarding the appropriate test for access to health data for research without consent. In this paper we do three things. First we describe the current confusion and instability in terminology relating to public interest in the context of consent waivers. Second we argue for harmonisation of terminology on the grounds of clarity, transparency and consistency. Third we argue that the term ‘public interest’ best reflects the normative work required to justify consent waivers because it is the broadest of the competing terms. ‘Public interest’ contains within its scope positive and negative implications of a study, as well as welfare, justice and rights considerations. In making this argument, we explain the normative basis for consent waivers, and provide a starting place for further discussion about the precise conditions in which a given study can be said to advance the public interest. Ipsos MORI study found that: … the public would be broadly happy with administrative data linking for research projects provided Those projects have social value, broadly defined. Data are de-identified. Data are kept secure. Businesses are not able to access the data for profit. (shrink)

Pragmatic encroachment theories have a problem with evidence. On the one hand, the arguments that knowledge is interest-relative look like they will generalise to show that evidence too is interest-relative. On the other hand, our best story of how interests affect knowledge presupposes an interest-invariant notion of evidence. -/- The aim of this paper is to sketch a theory of evidence that is interest-relative, but which allows that ‘best story’ to go through with minimal changes. The core (...) idea is that the evidence someone has is just what evidence a radical interpreter says they have. And a radical interpreter is playing a kind of game with the person they are interpreting. The cases that pose problems for pragmatic encroachment theorists generate fascinating games between the interpreter and the interpretee. They are games with multiple equilibria. To resolve them we need to detour into the theory of equilibrium selection. I’ll argue that the theory we need is the theory of risk-dominant equilibria. That theory will tell us how the interpreter will play the game, which in turn will tell us what evidence the person has. The evidence will be interest-relative, because what the equilibrium of the game is will be interest-relative. But it will not undermine the story we tell about how interests usually affect knowledge. (shrink)

Arguing for mathematical realism on the basis of Field’s explanationist version of the Quine–Putnam Indispensability argument, Alan Baker has recently claimed to have found an instance of a genuine mathematical explanation of a physical phenomenon. While I agree that Baker presents a very interesting example in which mathematics plays an essential explanatory role, I show that this example, and the argument built upon it, begs the question against the mathematical nominalist.

In Western political philosophy, democracy is generally the dominant view regarding what the best form of government is, and this holds even in respect to promoting minority rights. However, I argue that there is a better theory for satisfying minority interests and rights. I amass numerous studies from the social sciences demonstrating how democracy does poorly in accounting for minority interests. I then contend that a particular hybrid view that fuses a meritocracy with democracy can do a (...) better job than democracy in accounting for minority interests and in having more equal rights and fair policies coming from the legislative and executive branches. Finally, I defend this thesis from numerous counters. (shrink)

In “The Best of All Possible Worlds” William E. Mann argues that some possible worlds are morally incommensurable with some others, because some choices are between incompatible alternatives that are themselves incommensurable. The best possible world must be better than, and hence commensurable with, every other world. So if anyone in the actual world ever faces a choice between incompatible alternatives that are morally incommensurable, this is not the best possible world. But it seems that some of (...) us do, on occasion, face such choices. So this is not the best possible world. (shrink)

L.A. Paul argues that interesting issues for rational choice theory are raised by epistemically transformative experiences: experiences which provide access to knowledge that could not be known without the experience. Consideration of the epistemic effects of pregnancy has important implications for our understanding of epistemically transformative experiences and for debate about the ethics of abortion and applied ethics more generally. Pregnancy is epistemically transformative both in Paul’s narrow sense and in a wider sense: those who have not been pregnant face (...) significant barriers to acquiring the knowledge made accessible through pregnancy. This knowledge is crucial for engaging with the ethics of abortion. The epistemically transformativeWIDE nature of pregnancy may require us to use new methods to try to partially grasp what pregnancy is like such as for example, significant engagement with narrative literature. Because pregnancy is also epistemically transformative in a narrow sense, we need to work out how to engage in ethical reasoning when relevant knowledge is not fully accessible to all. This argument has implications beyond the debate about abortion. Philosophers in many areas of applied ethics will need to work out how to respond appropriately to epistemically transformative experiences. (shrink)

I argue that law is not best considered an essentially contested concept. After first explaining the notion of essential contestability and disaggregating the concept of law into several related concepts, I show that the most basic and general concept of law does not fit within the criteria generally offered for essential contestation. I then buttress this claim with the additional explanation that essential contestation is itself a framework for understanding complex concepts and therefore should only be applied when it (...) is useful to gain a greater understanding of uses of the concept to which it is applied (adducing criteria for making such judgments of usefulness). With that in mind, I then show that applying the appellation of essential contestation to the concept of law does not helpfully illuminate the most general concept of law (usually of most interest to legal philosophers) and therefore it should not be used, while allowing that it might be more useful for the related concept of the rule of law. (shrink)

Uncertainty plays an important role in The General Theory, particularly in the theory of interest rates. Keynes did not provide a theory of uncertainty, but he did make some enlightening remarks about the direction he thought such a theory should take. I argue that some modern innovations in the theory of probability allow us to build a theory which captures these Keynesian insights. If this is the right theory, however, uncertainty cannot carry its weight in Keynes’s arguments. This does not (...) mean that the conclusions of these arguments are necessarily mistaken; in their best formulation they may succeed with merely an appeal to risk. (shrink)

Over the years I’ve written many papers defending an idiosyncratic version of interest-relative epistemology. This book collects and updates the views I’ve expressed over those papers. -/- Interest-relative epistemologies all start in roughly the same way. A big part of what makes knowledge important is that it rationalises action. But for almost anything we purportedly know, there is some action that it wouldn’t rationalise. I know what I had for breakfast, but I wouldn’t take a bet at billion to one (...) odds about it. Knowledge has practical limits. The first idiosyncratic feature of my version of interest-relative epistemology is how those limits are identified. Other interest-relative philosophers typically say that the limits have to do with stakes; in high stakes situations knowledge goes away. That’s no part of my view. I think knowledge goes away in long odds situations. High stakes situations are almost always are long odds situations, for reasons to do with the declining marginal utility of money. But the converse isn’t true. On my view, knowledge often goes away in cases where it is trivial to check before action. This idea, that interests matter in long odds cases, and not just in high stakes cases, is the main constant in what I’ve written on interest-relativity over the years. -/- But there are three other respects in which the view I’m going to set out and defend in this book is very different from the view I set out in older papers. -/- I used to identify the practical limits on knowledge with cases where relying on the purported knowledge would get the wrong answer. I focused, that is, on the outputs of inquiry. Knowledge goes away if relying on it would lead one to make a mistake. I now think I was looking at the wrong end of inquiry. Knowledge goes away if the thinker starts conducting an inquiry where the purported knowledge is an inappropriate starting point, and inappropriate for the special reason that it might be false. Now one way we can tell that something is a bad starting point is that starting there will mean we end up at the wrong place. But it’s not the only way. Sometimes a bad starting point will lead to the right conclusion for the wrong reasons. As the Nyāya philosophers argued, rational inquiry starts with knowledge. If it would be irrational to start this inquiry with a particular belief, that belief isn’t knowledge. -/- Not all inquiries are practical inquiries, but many are. And practical inquiries are usually going to be at the center of attention in this book. But what is someone trying to figure out when they conduct a practical inquiry? I used to think that they were trying to figure out which option maximised expected utility, and to a first approximation identified knowledge with those things one could conditionalise on without changing the option that maximised expected utility. As noted in the previous paragraph, I no longer think that we can identify knowledge with what doesn’t change our verdicts. But more importantly, I no longer think that expected utility maximisation is as central to practical inquiry as I once did. There are some theoretical reasons from game theory that raise some doubts about expected utility maximisation. Weak dominance reasoning is part of our theory of rational choice, and can’t be modelled as expected utility maximisation. Perhaps some kinds of equilibrium seeking are parts of practical inquiry, and can’t be modelled as expected utility maximisation. But there are also very practical reasons to think that practical inquiry doesn’t aim at expected utility maximisation. When there are a lot of very similar options - think about selecting a can from a supermarket shelf - and it’s more trouble than it’s worth to figure out which of them maximises expected utility, it’s best to ignore the differences between them and just pick. As I’ll argue in Chapter 6, this makes a big difference to how interests and knowledge interact. -/- In the version of interest-relativity that I’m defending here, everything in epistemology is interest-relative. Knowledge, rational belief, and evidence are all interest-relative. But they are all interest-relative in slightly different ways. The main aim here is to defend the interest-relativity of knowledge. A common objection to interest-relative theories of knowledge is that they can’t be extended into theories of all the things we care about in epistemology. Here I try to meet that challenge. The way I do so is a little messy. It would be nice if there was some part of epistemology that’s interest-invariant, as I used to think, or if all the interest-relative notions were interest-relative in the same way, as other interest-relative epistemologists argue. For better or worse, that’s not the view I’m defending. Interests matter throughout epistemology, and we just have to go case by case to figure out how and why they matter. (shrink)

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all of us. (...) The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests. (shrink)

This paper is about a problem that can arise when we try to harness the “wisdom of the crowd” from groups comprised of individuals who exhibit a certain kind of epistemic humility in the way they respond to testimonial evidence. I begin by setting out the problem and then make some initial steps toward solving it. The solution I develop is tentative and may not apply in all circumstances, but it promises to alleviate what seems to me to be a (...) problem of both theoretical interest and practical importance. (shrink)

Attempting to compare scientific theories requires a philosophical model of meaning. Yet different scientific theories have at times—particularly in early chemistry—pre-supposed disparate theories of meaning. When two theories of meaning are incommensurable, we must say that the scientific theories that rely upon them are meta-incommensurable. Meta- incommensurability is a more profound sceptical threat to science since, unlike first-order incommensurability, it implies complete incomparability.

This seminal paper, which marks a turning point of the chemical revolution, is presented for the first time in a complete English translation. In this first half Lavoisier undermines phlogiston chemistry by arguing that his French contemporaries had replaced Stahl’s original theory with radically different systems that conceptualised the phlogiston principle in completely incompatible ways. He refutes their claims by showing that these later models were riddled with inconsistencies as to phlogiston’s weight, its ability to penetrate glass and its role (...) as a source of colour and odour in chemical compounds. (shrink)

Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one (...) is the view that prudential value is, at least partly, concerned with the shape of a life as a whole. (shrink)

Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy depends on (...) epistemic intimacy: the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity. (shrink)

Self destruction, inapprehensible an option as it might be, has been a challenging issue for philosophers and scholars since the dawn of time, forcing meditation into a vigorous and everlasting debate. The core question is: could suicide ever be deemed rational a choice? And if so, could it count as a moral alternative, if the circumstances call for it? The Stoics from Zeno up to Epictetus and Seneca regarded suicide as the ultimate resort, as the utmost opportunity for a rational (...) being to maintain his virtue, when all other bridges are burnt. For an act to be moral, it has to be deliberate, as well as the manifestation of an established evaluative hierarchy, however spontaneous and instantaneous might the latter be. In other words, a moral act is one that agents rationally opt for over other possible alternatives, on the subjective basis of their alleged best interests. Modern philosophers as Tom Beauchamp, Margaret Battin and Jacques Choron stress the criterion of rationality as a key issue regarding the ethics of suicide. Utilizing Rorty’s second definition of rationality, the article examines whether self destruction can be the outcome of proper evaluative assessment and deliberation, given that, as T. N. Pelegrinis suggests, such an evaluation seems to rest on a symmetry case, which might hardly be based on sound foundation. (shrink)

This article proposes a sensory studies methodology for the interpretation of museum objects. The proposed method unfolds in two phases: virtual encounter via an on-line catalog and actual exposure in the context of a handling workshop. In addition to exploring the écart between image and object, the “Sensing Art and Artifacts” exercise articulates a framework for arriving at a multisensory, cross-cultural, interactive understanding of aesthetic value. The case studies presented here involve four objects from the collection of the Hunterian Museum (...) as sensed and interpreted by scholars of psychology, philosophy, sociology, and anthropology. It is proposed that aesthetic judgment in the expanded (cross-cultural) sense contemplated here involves apprehending the museum object through multiple sensory modalities in place of the conventional Western fixation on visible form. (shrink)

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

Children are routinely treated paternalistically. There are good reasons for this. Children are quite vulnerable. They are ill-equipped to meet their most basic needs, due, in part, to deficiencies in practical and theoretical reasoning and in executing their wishes. Children’s motivations and perceptions are often not congruent with their best interests. Consequently, raising children involves facilitating their best interests synchronically and diachronically. In practice, this requires caregivers to (in some sense) manage a child’s daily life. If (...) apposite, this management will focus partly on a child’s well-being. To be ably executed, an account of children’s well-being will need to be articulated. This chapter focuses on the nature of children’s well-being. It has five sections. The first section clarifies the focus. The second section examines some hurdles to articulating a view of children’s well-being. The third section evaluates some accounts of children’s well-being. The fourth section addresses the view that children possess features essential to them that make their lives on balance prudentially bad for them. The fifth section sums things up. (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 (...) class='Hi'>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)

We explain libertarian thought about family and children, including controversial issues in need of serious attention. To begin our discussion of marriage, we distinguish between procedural and substantive contractarian approaches to marriage, each endorsed by various libertarians. Advocates of both approaches agree that it is a contract that makes a marriage, not a license, but disagree about whether there are moral limits to the substance of the contract with only advocates of the substantive approach accepting such. Either approach, though, offers (...) advantages over the current licensing system, so we discuss paths from that to a contractarian system. We also discuss the concept of marriage itself, the ages of consent for marriage, sexual activity, and reproduction, as well as how marriages can be dissolved, and coercion that sometimes occurs in marriage. We then turn to children. We first discuss reproductive freedom and then discuss the moral relationship between children and parents, especially considering stewardship, propertarian, and best interests approaches (we also touch on anti-natalism). One of the biggest issues facing parents is how to properly raise and educate children; we discuss this in depth and consider the sort of schooling that should be offered in a free society. Since children lack the requisite ability to consent, they cannot choose their education; how to respond to this is of the utmost importance for libertarians. As we note, the same issue of consent looms large for many forms medical treatment of children. (shrink)

In this paper we carefully study the problem of liberty as it applies to school choice, and whether there ought to be restricted liberty in the case of homeschooling. We examine three prominent concerns that might be brought against homeschooling, viz., that it aggravates social inequality, worsens societal conflict and works against the best interests of children. To examine the tensions that occur between parental liberty, children's interests, and state oversight, we consider the case of homeschooling in (...) the Dutch context. (shrink)

Parenthood is one of the best gifts nature and god has given to humans. Being a parent is a feeling that can be compared to none other but as a baby caretaker a nanny can do this. As a parent, we always strive to provide the best of everything to our children. This however often comes at a price. Mostly it means that both the parents have to be working in order to provide the best facilities and (...) at the same time secure the future of their children and Newborn Baby. Even if one of the parent chooses to sacrifice the career and stay at home, raising a child in a nuclear family set up is still a challenge. -/- This is when an experienced and gentle baby caretaker can be of utmost help. However such caretaker who can be entrusted with the care and security of your child is often hard to find. Especially in cities like NOIDA baby caretaker are available for your service. Well no more. -/- No more is the need to sacrifice your career or professional aspirations. You can peacefully leave to work, entrusting your lovely children in the hands of the baby caretaker. Majority of the time that your child will be spending is with the caretaker and it is therefore absolutely necessary that a baby caretaker possess all the qualities of a good parent. Benevolence, patience, care and attention, all these qualities can be found in the baby caretaker provided by us. Our caretaker ensures the welfare of the child, creating the environment for sound mental, emotional and health development of the children. -/- We need to guarantee that the caretaker has the child's best interest at heart and looks at the security of our child with the same eye as we do. We select the baby caretakers that view this profession as means of contentment and satisfaction in their lives and not just another menial job to earn their livelihood. Children have the inherent need to have somebody always around them in oder to feel secure and wanted, avoiding loneliness and boredom. A Caretaker for baby in Noida not only provides this companion but also ensures that the natural curiosity of a child is kept alive even in the absence of their parents. -/- Big cities with the diverse kind of population, mostly coming to work from various parts of the country, have had some history of violent cases. And that’s why precaution should be taken while hiring Best caretaker in Noida . With thorough background check and verified references, all such apprehensions can be laid to rest.+ . (shrink)

Patient autonomy has a critical role in making decisions in medical practice and it is accepted by international conventions on health care and various national medical codes. However, pertaining to terminally ill patients, this right becomes very problematic in regards to end of life decisions. Utilitarian ethicists motivated by materialistic worldview and individualism have made patient autonomy based arguments for the permissibility of active euthanasia. An appraisal of pro-euthanasia arguments that include the best interest, golden rule, and autonomy is (...) made in this paper. The best interest and golden rule arguments are based on subjective moral judgment thus failing the universalization test. The argument from autonomy is unconvincing because of the confounded autonomy of the terminally ill patients. (shrink)

Medical ethics would be better if people were taught to think more clearly about well-being or the concept of what is good for a person. Yet for a variety of reasons, bioethicists have generally paid little attention to this concept. Here, I argue, first, that focusing on general theories of welfare is not useful for practical medical ethics. I argue, second, for what I call the “theory-without-theories approach” to welfare in practical contexts. The first element of this approach is a (...) focus on examining important and relatively uncontroversial constituents of welfare as opposed to general theories. The second key element is a framework for thinking about choice in relation to welfare, a framework I refer to as “the mild objectivity framework.” I conclude with illustrations of the way in which the “theory without theories approach” can improve thinking in medicine. (shrink)

The central thesis of this book is that we need to reform philosophy and join it to science to recreate a modern version of natural philosophy; we need to do this in the interests of rigour, intellectual honesty, and so that science may serve the best interests of humanity. Modern science began as natural philosophy. In the time of Newton, what we call science and philosophy today – the disparate endeavours – formed one mutually interacting, integrated endeavour (...) of natural philosophy: to improve our knowledge and understanding of the universe, and to improve our understanding of ourselves as a part of it. Profound discoveries were made, indeed one should say unprecedented discoveries. It was a time of quite astonishing intellectual excitement and achievement. And then natural philosophy died. It split into science on the one hand, and philosophy on the other. This happened during the 18th and 19th centuries, and the split is now built into our intellectual landscape. But the two fragments, science and philosophy, are defective shadows of the glorious unified endeavour of natural philosophy. Rigour, sheer intellectual good sense and decisive argument demand that we put the two together again, and rediscover the immense merits of the integrated enterprise of natural philosophy. This requires an intellectual revolution, with dramatic implications for how we understand our world, how we understand and do science, and how we understand and do philosophy. There are dramatic implications, too, for education. And it does not stop there. For, as I show in the final chapter, resurrected natural philosophy has dramatic, indeed revolutionary methodological implications for social science and the humanities, indeed for the whole academic enterprise. It means academic inquiry needs to be reorganized so that it comes to take, as its basic task, to seek and promote wisdom by rational means, wisdom being the capacity to realize what is of value in life, for oneself and others, thus including knowledge, technological know-how and understanding, but much else besides. The outcome is institutions of learning rationally designed and devoted to helping us tackle our immense global problems in increasingly cooperatively rational ways, thus helping us make progress towards a good world – or at least as good a world as possible. (shrink)

In this book I show that science suffers from a damaging but rarely noticed methodological disease, which I call rationalistic neurosis. It is not just the natural sciences which suffer from this condition. The contagion has spread to the social sciences, to philosophy, to the humanities more generally, and to education. The whole academic enterprise, indeed, suffers from versions of the disease. It has extraordinarily damaging long-term consequences. For it has the effect of preventing us from developing traditions and institutions (...) of learning rationally devoted to helping us learn how to make progress towards a wiser, more civilized world. On our fragile earth, overcrowded, fraught with injustice, inequality and conflict, menaced by unprecedented and terrifying technological and industrial means for change and destruction, we urgently need to acquire a little more wisdom and civilization if we are to avoid repeating horrors of the kind suffered by so many during the 20th century (and already suffered by many in the first few years of the 21st century). We can ill afford to have in our hands instruments of learning botched and bungled from the standpoint of helping us learn how to live more wisely. It may seem scarcely credible that something as important as our institutions of learning can suffer from wholesale, structural defects. Why has this not been noticed before? Why have not armies of scientists and scholars appreciated the point and, long ago, put the matter right? The answer will emerge as my argument unfolds. I will show that one of the most damaging features of rationalistic neurosis is that it has built-in methodological and institutional mechanisms which effectively conceal that anything is wrong. But there is also an immediately obvious reason: specialization, and the resulting fragmentation of academia, has resulted in a situation in which hardly anyone takes responsibility for the overall ideals, the overall aims and methods, of academic inquiry. Academics, these days, are specialists, furiously trying to keep abreast of developments in their own specialist fields. They have no time, and no inducement, to lift their eyes from their particular disciplines, and look at the whole endeavour. Science has long been under attack, at least since the Romantic movement. Blake objected to “Single vision & Newton’s sleep” and declared that “Art is the Tree of Life... Science is the Tree of Death”. Keats lamented that science will “clip an Angel’s wings” and “unweave a rainbow”. Whereas the Enlightenment had valued science and reason as tools for the liberation of humanity, Romanticism found science and reason oppressive and destructive, and instead valued art, imagination, inspiration, individual genius, emotional and motivational honesty rather than careful attention to objective fact. Much subsequent opposition to science stems from, or echoes, the Romantic opposition of Blake, Wordsworth, Keats and many others. There is the movement Isaiah Berlin has described as the “Counter-Enlightenment” (Berlin, 1979, ch. 1). There is existentialism, with its denunciation of the tyranny of reason, its passionate affirmation of the value and centrality of irrationality in human life, from Dostoevsky, Kierkegaard and Nietzsche to Heidegger and Sartre (see, for example, Barrett, 1962). There is the attack on Enlightenment ideals concerning science and reason undertaken by the Frankfurt school, by postmodernists and others, from Horkheimer and Adorno to Lyotard, Foucault, Habermas, Derrida, MacIntyre and Rorty (see Gascardi, 1999). The soul-destroying consequences of valuing science and reason too highly is a persistent theme in literature: it is to be found in the works of writers such as D.H. Lawrence, Doris Lessing, Max Frisch, Y. Zamyatin. There is persistent opposition to modern science and technology, and to scientific rationality, often associated with the Romantic wing of the green movement, and given expression in such popular books as Marcuse’s One Dimensional Man, Roszak’s Where the Wasteland Ends, Berman’s The Reenchantment of the World and Appleyard’s Understanding the Present. There is the feminist critique of science and conceptions of science: see, for example, Fox Keller (1984) and Harding (1986). And there are the corrosive implications of the so-called “strong programme” in the sociology of knowledge, and of the work of social constructivist historians of science, which depict scientific knowledge as a belief system alongside many other such conflicting systems, having no more right to claim to constitute knowledge of the truth than these rivals, the scientific view of the world being no more than an elaborate myth, a social construct (see Barnes and Bloor, 1981; Bloor, 1991; Barnes, Bloor and Henry, 1996; Shapin and Schaffer, 1985; Shapin, 1994; Pickering, 1984; Latour, 1987). This latter literature has provoked a counter-attack by scientists, historians and philosophers of science seeking to defend science and traditional conceptions of scientific rationality: see Gross and Levitt (1994), Gross, Levitt and Lewis (1996), and Koertge (1998). This debate between critics and defenders of science came abruptly to public attention with the publication of Alan Sokal’s brilliant hoax article ‘Transgressing the boundaries’ in a special issue of the cultural studies journal Social Text in 1996 entitled Science Wars: see Sokal and Bricmont (1998). What does this book have to contribute, given the above avalanche of criticism of science? The criticisms of science developed in this book are diametrically opposed to the above, in so far as the above criticisms oppose scientific rationality, seek to diminish or restrict its influence, or hold that it is unattainable. My central point is that we suffer, not from too much scientific rationality, but from not enough. What is generally taken to constitute scientific rationality is actually nothing of the kind. It is rationalistic neurosis, a characteristic, influential and damaging kind of irrationality masquerading as rationality. Science is damaged by being trapped within a widely upheld but severely defective philosophy of science; free science from this defective philosophy, provide it with a more intellectually rigorous philosophy, and it will flourish in both intellectual and humanitarian terms. And more generally, as we shall see, academic inquiry as a whole is damaged by being trapped within an intellectually defective philosophy of inquiry; free it from this defective philosophy, from its rationalistic neurosis, and it will flourish in intellectual and human terms. It is not reason that is damaging, but defective pretensions to reason — rationalistic neurosis —masquerading as reason. Thus what I seek to do here is the exact opposite of what all those who oppose science and scientific rationality do. I shall argue that Reason, the authentic article, arrived at by generalizing the progress-achieving methods of science, can have profoundly liberating and enriching consequences for all worthwhile, problematic aspects of life, and thus deserves to enter into every aspect of life. The bare bones of the argument of this book can be stated quite simply like this. Science cannot proceed without making the substantial metaphysical assumption that the universe is physically comprehensible (to some extent at least). But this conflicts with the orthodox view that in science everything is assessed impartially with respect to evidence, nothing being permanently assumed independently of evidence. So the metaphysical assumption of comprehensibility is repressed. Science pretends that no such assumption is made. But this damages science. For the assumption is substantial, influential and highly problematic. It needs to be made explicit within science so that it can be critically scrutinized, so that alternatives can be developed and considered. Pretending the assumption is not being made undermines the intellectual rigour of science, its intellectual value and success. And it does not stop there. For science also makes value assumptions. Quite properly, science is concerned to discover that which is of value. New factual knowledge devoid of all value (whether intellectual or practical) does not contribute to science. But the orthodox view of science holds that values have no place within science. As in the case of metaphysics, here too, science pretends that values have no role to play within the intellectual domain of science. And this damages science. For values are, if anything, even more influential and problematic than metaphysics (in influencing the direction of research). Here too, values need to be made explicit within science so that they can be scrutinized, so that alternatives can be developed and assessed. Pretending that values play no role within the intellectual domain damages science; both the intellectual and the practical aspects of science are adversely affected. Science fails to pursue those avenues of research that lie in the best interests of humanity. And it goes further. Science is pursued in a social, cultural, economic and political context. It is a part of various social, economic and political projects which seek to achieve diverse human objectives. But the idea that science is an integral part of humanitarian or political enterprises with political ends clashes, once again, with the official view of science that the aim of science is to improve factual knowledge. The political objectives of science are repressed. And, once again, this damages science. For, of course, the political objectives of science, like all our political objectives, are profoundly problematic. These need to be made explicit so that they can be scrutinized, so that alternatives can be developed and considered. The pretence that science does not have this political dimension once again undermines the intellectual rigour of science, and its human value. It lays science open to becoming a part of economic, corporate and political enterprises that are not in the best interests of humanity. The upshot of the line of argument just indicated is that we need to bring about a revolution in the aims and methods of science, and of academic inquiry more generally. Natural science needs to change; its relationship with the rest of academic inquiry, with social inquiry and the humanities, needs to change; and most importantly and dramatically, academic inquiry as a whole needs to change. The basic task of the academic enterprise needs to become to help humanity learn how to tackle its problems of living in more cooperatively rational ways than at present. We need to put the intellectual tasks of articulating our problems of living, and proposing and critically assessing possible solutions, possible and actual actions, at the heart of academic inquiry. The basic task needs to be to help humanity learn a bit more wisdom – wisdom being the capacity to realize what is of value in life, for oneself and others, wisdom including knowledge and technological know-how, but much else besides. Natural science, despite its flaws, has massively increased our knowledge and technological know-how. This in turn has led to a massive and sometimes terrifying increase in our power to act. Often this unprecedented power to act is used for human good, as in medicine or agriculture. But it is also used to cause harm, whether unintentionally (initially at least) as when industrialization and modern agriculture lead to global warming, destruction of natural habitats and rapid extinction of species, or intentionally, as when the technology of war is used by governments and terrorists to maim and kill. Before the advent of modern science, when we lacked the means to do too much damage to ourselves and the planet, lack of wisdom did not matter too much. Now, with our unprecedented powers to act, bequeathed to us by science, lack of wisdom has become a menace. This is the crisis behind all the other current global crises: science without wisdom. In these circumstances, to continue to pursue knowledge and technological know-how dissociated from a more fundamental quest for wisdom can only deepen the crisis. As a matter of urgency, we need to free science and academia of their neuroses; we need to bring about a revolution in the academic enterprise so that the basic aim becomes to promote wisdom by intellectual and educational means. At present science and the humanities betray both reason and humanity. The argument of this book, which I have just summarized, begins with a discussion of the philosophical and methodological problems that beset theoretical physics. At once, many of those who are concerned about moral, political and environmental issues that plague our world today, will feel impatient. What have the methodological problems of theoretical physics to do with third world poverty, war and the threat of war, pollution, extinction of species, the menace of conventional, chemical, biological and nuclear armaments? I can only plead with such a reader: patience. The root cause of the sickness of our times does indeed lie, I claim, with a methodological sickness of natural science or, even more specifically, of physical science. What makes the modern world so utterly different from all previous ages is our possession of modern science and technology. This is the instrument that has changed the conditions of human life almost beyond all recognition, and put unprecedented, and sometimes terrifying, powers into our hands. One should not dismiss out of hand the suggestion that a part of our problem may lie with this instrument, this engine, of rapid change. We see, here, too, the way in which intellectual specialization, referred to above, has effectively concealed from view the nature and extent of the problem that confronts us. The argument that I shall develop in what follows begins with physics, with problems concerning the aims and methods of physics. But it then leaps to social science, to philosophy, to the humanities, to education, to psychotherapy, and to politics: in the end there is scarcely an aspect of modern life that is not touched and, potentially, affected by the argument. How many academic experts are prepared to follow, to take seriously, an argument that ranges so recklessly across such a wide range of academic disciplines? How many non-academic non-experts? But just this is what the argument and message of this book requires. I hope that the reader will endure with patience the somewhat esoteric discussion concerning the aims and methods of physics pursued in chapter one. This may not seem to have anything much to do with the urgent problems of our times, but it does. This is in part how the intellectual disaster I seek to expose in this book conceals itself from view: it buries itself in the obscure, recondite field of the philosophy of physics. Those who devote their lives to the philosophy of physics are, by and large, too myopic to see how their specialized field of study has anything to do with the great and dreadful humanitarian problems and disasters of our age; and those who are above all concerned with these humanitarian disasters have no time at all for abstruse issues concerning the aims and methods of physics. And so the connection is never made. As it happens, the methodological neurosis of physics, with which we begin in chapter one, is actually a quite simple matter to grasp. It does not require any real knowledge of physics to understand. Indeed, physicists and philosophers of physics are much more likely to find the argument difficult to follow than are non-experts. We non-scientists can stand back and see the whole wood; scientists, trained to think in terms of the current orthodox conception of science, trapped in the thickets of research, will find this much harder to do. In an attempt to take this peculiar circumstance into account, I have arranged the exposition as follows. In chapter one I give a simple exposition of the case for declaring natural science to suffer from what I call "rationalistic neurosis"; this avoids all technicalities, and goes straight to the heart of the matter. In the appendix I tackle a host of more technical objections that may be made to the elementary argument of chapter one. So, those experts in the fields of the philosophy of physics and philosophy of science who find the argument of chapter one naïve and unconvincing, should consult the appendix before tossing the book away in disgust. I write in the hope that there will be a few who will not dismiss out of hand the suggestion that the question of how we are to go about learning how to live in wiser and more civilized ways might have something to learn from scientific learning, and will take the trouble to pursue the line of argument traced out in this book. I write in the hope that these few will grasp just how desperate our situation is, how urgent the need to change the status quo, and will do everything in their power to alert others to the need to heal the methodological sickness from which our institutions and traditions of learning at present suffer. To begin with, we need a campaigning organization, modelled perhaps on "Friends of the Earth", which might be called something like "Friends of Wisdom". (shrink)

In the face of disobedience, and in the name of the short-term goal of a smooth-functioning and/or happy household, parents often feel caught between two diametrically opposed parenting strategies; make it happen or let it go. However, either strategy of dictator or friend can seriously jeopardize a child’s long-term best interests. If children, adolescents, young adults, full adults or oldsters are even to hear, let alone reasonably answer, the prudential and ethical “whys” that their intended actions scream, they (...) will need to attend to health of their unique human capacity to reason. They will need to understand deeply that reason is not a capacity to be used solely in academic endeavors and/or for making a living, but rather that reason’s prime function is to assist in making the best of all possible lives. If parents want their children to understand this, then they need to walk the talk and invite reason into their homes. The result will be that authoritarian parents will need to let go, while “parents as friends” will need to belly up to the bar, in order to entrench the first rule of a reasonable household and that is that the best reason always wins. (shrink)

This paper argues that philosophers of science have before them an important new task that they urgently need to take up. It is to convince the scientific community to adopt and implement a new philosophy of science that does better justice to the deeply problematic basic intellectual aims of science than that which we have at present. Problematic aims evolve with evolving knowledge, that part of philosophy of science concerned with aims and methods thus becoming an integral part of science (...) itself. The outcome of putting this new philosophy into scientific practice would be a new kind of science, both more intellectually rigorous and one that does better justice to the best interests of humanity. (shrink)

We philosophers of science have before us an important new task that we need urgently to take up. It is to convince the scientific community to adopt and implement a new philosophy of science that does better justice to the deeply problematic basic intellectual aims of science than that which we have at present. Problematic aims evolve with evolving knowledge, that part of philosophy of science concerned with aims and methods thus becoming an integral part of science itself. The outcome (...) of putting this new philosophy into scientific practice would be a new kind of science, both more intellectually rigorous, and one that does better justice to the best interests of humanity. (shrink)

The game theoretic notion of best-response reasoning is sometimes criticized when its application produces multiple solutions of games, some of which seem less compelling than others. The recent development of the theory of team reasoning addresses this by suggesting that interacting players in games may sometimes reason as members of a team – a group of individuals who act together in the attainment of some common goal. A number of properties have been suggested for team-reasoning decision-makers’ goals to satisfy, (...) but a few formal representations have been discussed. In this paper we suggest a possible representation of these goals based on the notion of mutual advantage. We propose a method for measuring extents of individual and mutual advantage to the interacting decision-makers, and define team interests as the attainment of outcomes associated with maximum mutual advantage in the games they play. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

This paper defends a new norm of assertion: Assert that p only if you are in a position to know that p. We test the norm by judging its performance in explaining three phenomena that appear jointly inexplicable at first: Moorean paradoxes, lottery propositions, and selfless assertions. The norm succeeds by tethering unassertability to unknowability while untethering belief from assertion. The PtK‐norm foregrounds the public nature of assertion as a practice that can be other‐regarding, allowing asserters to act in the (...) best interests of their audience when psychological pressures would otherwise prevent them from communicating the knowable truth. (shrink)

Distrust in scientific experts can be surprisingly stubborn, persisting despite evidence supporting the experts’ views, demonstrations of their competence, or displays of good will. This stubborn distrust is often viewed as a manifestation of irrationality. By contrast, this article proposes a logic of “status distrust”: low-status individuals are objectively vulnerable to collective decision-making, and can justifiably distrust high-status scientific experts if they are not confident that the experts do not have their best interests at heart. In phenomena of (...) status distrust, social status is thus an indicator of distrust, and this has wider implications for the literatures on trust in science and on expert communication. (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by (...) appealing to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, (...) however, relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way. (shrink)

This paper argues that Epictetus’ ethics involves three features which are also present in Aristotle’s discussion of akrasia in the Nicomachean Ethics: 1) A major problem for agents is when they fail to render a universal premise effective at motivating a particular action in accordance with that premise. 2) There are two reasons this occurs: Precipitancy and Weakness. 3) Precipitancy and Weakness can be prevented by gaining a fuller understanding of our beliefs and commitments. This comparison should make clear that (...) akrasia is certainly not absent from Epictetus. Rather a very Aristotelian understanding of why we fail to act in accordance with what we take to be in our own best interests remains at the center of his ethics. (shrink)

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, (...) however, relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way. (shrink)

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s autonomy is not (...) respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient’s previous values must be in that patient’s best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. (shrink)

In our dealings with young children, we often get them to do or think things by arranging their environments in certain ways; by dissembling, simplifying, or ambiguating the facts in answer to their queries; by carefully selecting the states of affairs, behavior of others, and utterances to which they shall be privy. We rightly justify these practices by pointing out a child's malleability, and the necessity of paying close attention to formative influences during its years of growth. This filtering of (...) influences is necessary, we point out, if children are ever to reach a degree of maturity and inner stability that will enable them to understand and cope adequately with the complexities, contradictions, and difficulties of the world from which we now seek to shield them. Thus a child's eventual state of competence, maturity, and autonomy adequately justifies our current practices of manipulation and selection of his environment: such practices are rightly held to be ultimately in the child's best interests as an adult. There is no future state of things with reference to which the Utilitarian night justify his policy of secrecy and manipulation, and in light of which this policy night eventually be dispensed with and commonly validated, in retrospect, as a means to the worthwhile goal of moral maturity. That is, there is no point at which the attitude of the Utilitarian to the rest of the community can develop past the analogous attitude of the parent towards the child; no point at which the Utilitarian might eventually bear to others a relationship of mutual acknowledgement and respect as mature, autonomous, moral adults. The consistent Utilitarian, then, largely regards himself as if he were the only adult in a community of children. (shrink)

This paper argues that the concept of paternalism is currently overextended to include a variety of actions that, while resembling paternalistic actions, are importantly different. I use the example of Japanese physicians’ non-disclosures of cancer diagnoses directly to patients, arguing that the concept of maternalism better captures these actions. To act paternalistically is to substitute one's own judgement for that of another person and decide in place of that person for his/her best interest. By contrast, to act maternalistically is (...) to decide for another person based on a reasonable understanding of that person's own preferences. The concept of maternalism allows for a more thorough assessment of the moral justification of these types of actions. I conclude that it is possible, at least in principle, to justify Japanese physicians’ non-disclosures, and that this justification must be based on an understanding of these actions as maternalistic. (shrink)