Any ethical inquiry into addiction research is faced with the preliminary challenge that the term “addiction” is itself a matter of scientific and ethical controversy. Accordingly, the chapter begins with a brief history of the term “addiction.” The chapter then turns to ethical issues surrounding consent and decision-making capacity viewed from the perspective of the current opioid epidemic. One concern is the neglect of the cyclical nature of addiction and the implications of this for the validity (...) of current psychometric instruments used to evaluate decision-making capacity in addiction. Another is the apparent discrepancy—possibly an ethical double standard—in the manner in which society and addiction researchers view the mental capacity and vulnerability of individuals who suffer from severe addiction. On the whole, the main ethical concern of the chapter is the puzzling lack of clinical research on decision-making capacity in research on addiction. (shrink)

Charland's article suggests that we need to think more about whether decision-making capacity is impaired in severe addiction, working from the idea that drug dealers rely on this understanding of addiction to draw in their clients. Charland argues that it is possible to make a choice without being in control (to make decisions without having decision-making capacity). I argue in support of Charland's ideas by examining the reasons supporting a medical model of addiction and its importance. (...) (For Charland's article and the full set of commentaries, please see the Research Gate link). (shrink)

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation of (...) situational vulnerability and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (shrink)

The exposure of doctors, nurses and other medical professionals to risks in the context of epidemics is significant. While traditional medical ethics offers the thought that these dangers may limit the extent to which a duty to care is applicable in such situations, it has less to say about what we might owe to medical professionals who are disadvantaged in these contexts. Luck egalitarianism, a responsibility-sensitive theory of distributive justice, appears to fare particularly badly in that regard. If we want (...) to maintain that medical professionals are responsible for their decisions to help, cure and care for the vulnerable, luck egalitarianism seems to imply that their claim of justice to medical attention in case of infection is weak or non-existent. The article demonstrates how a recent interpretation of luck egalitarianism offers a solution to this problem. Redefining luck egalitarianism as concerned with responsibility for creating disadvantages, rather than for incurring disadvantage as such, makes it possible to maintain that medical professionals are responsible for their choices and that those infected because of their choice to help fight epidemics have a full claim of justice to medical attention. (shrink)

A crucial question in relation to support designed to enable the legal capacity of people with mental disabilities concerns when support constitutes undue influence. This article addresses this question in order to facilitate the development of law and policy in England and Wales, by providing a normative analysis of the different approaches to undue influence across decisions about property, contracts, health, finances, and accommodation. These are all potential contexts for supporting legal capacity, and, in doing so, the article compares approaches (...) to undue influence that are rarely considered together. -/- Drawing on the UN Convention on the Rights of Persons with Disabilities, third sector and public body documents, and law in England and Wales, the analysis identifies six models that conceptualise undue influence in terms of: modes of influence; an overborne will; an inference from the situation; an overborne will understood as a mental incapacity; an overborne will in connection with vulnerability; and impaired discursive control. This final approach is a novel proposal for understanding undue influence. The analysis highlights key policy-relevant issues that distinguish the models, and generates a deliberative framework for navigating them, with the ‘overborne will’, ‘inference-based’, and ‘discursive control’ models identified as potentially fitting for the support context. (shrink)

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; (...) and concern for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct (...) verdicts about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

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

There is wide consensus among bioethicists about the importance of autonomy when determining whether or not a patient has the right to refuse life-saving treatment (LST). In this context, autonomy has typically been understood in terms of the patient’s ability to make an informed decision. According to the traditional view, decision-making capacity (DMC) is seen as both necessary and sufficient for the right to refuse LST. Recently, this view has been challenged by those who think that considerations (...) of authenticity and putative counterexamples should lead us to revise the traditional account. In this paper, we respond to these revisionist arguments, and we defend the traditional view according to which we have autonomy-based reasons to respect a patient’s decision to refuse LST if and only if she has DMC. (shrink)

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

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is (...) often incorrectly advertised as being value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called ‘serious prudential mistakes’ avoids these rational and practical problems. (shrink)

Jennifer Hawkins (2024) offers two cases that challenge traditional accounts of decision-making capacity, according to which respect for a medical decision turns on an individual’s cognitive capacities at the time the decision is made (Hawkins 2024; Appelbaum and Grisso 1988). In each of her described cases (involving anorexia nervosa and grief, respectively), a patient makes a decision that—although instrumentally rational at the time—does not reflect the patient’s longer-term values due to being in a particular psychological (...) state. Importantly, this state does not impair the patient’s cognition, but rather predisposes them to make a decision that conflicts with their own broader values, beliefs, or desires. (shrink)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in (...) conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts (...) appear to count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the (...) ability to track one’s own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates the spirit of widely accepted ethical constraints on decision-making assessment. (shrink)

This collection of articles was written over the last 10 years and edited to bring them up to date (2017). The copyright page has the date of the edition and new editions will be noted there as I edit old articles or add new ones. All the articles are about human behavior (as are all articles by anyone about anything), and so about the limitations of having a recent monkey ancestry (8 million years or much less depending on viewpoint) and (...) manifest words and deeds within the framework of our innate psychology as presented in the table of intentionality. As famous evolutionist Richard Leakey says, it is critical to keep in mind not that we evolved from apes, but that in every important way, we are apes. If everyone was given a real understanding of this (i.e., of human ecology and psychology to actually give them some control over themselves), maybe civilization would have a chance. As things are however the leaders of society have no more grasp of things than their constituents and so collapse into anarchy is inevitable. The first group of articles attempts to give some insight into how we behave that is reasonably free of the theoretical delusions that are universal. In the next group, I show how these insights apply by reviewing some books in philosophy and psychology. Next I review books on science and religion and finally provide reviews and articles showing how understanding of both science and philosophy gives insight into the tragic delusions destroying the world. People believe that society can be saved by science, religion and politics, so I provide some suggestions as to why this is unlikely via short articles and reviews of recent books by well-known writers. It is critical to understand why we behave as we do and so the first section presents articles that try to describe (not explain as Wittgenstein insisted) behavior. I start with a brief review of the logical structure of rationality, which provides some heuristics for the description of language (mind, rationality, personality) and gives some suggestions as to how this relates to the evolution of social behavior. This centers around the two writers I have found the most important in this regard, Ludwig Wittgenstein and John Searle, whose ideas I combine and extend within the dual system (two ii systems of thought) framework that has proven so useful in recent thinking and reasoning research. As I note, there is in my view essentially complete overlap between philosophy, in the strict sense of the enduring questions that concern the academic discipline, and the descriptive psychology of higher order thought (behavior). Once one has grasped Wittgenstein’s insight that there is only the issue of how the language game is to be played, one determines the Conditions of Satisfaction (what makes a statement true or satisfied etc.) and that is the end of the discussion. Since philosophical problems are the result of our innate psychology, or as Wittgenstein put it, due to the lack of perspicuity of language, they run throughout human discourse and behavior, so there is endless need for philosophical analysis, not only in the ‘human sciences’ of philosophy, sociology, anthropology, political science, psychology, history, literature, religion, etc., but in the ‘hard sciences’ of physics, mathematics, and biology. It is universal to mix the language game questions with the real scientific ones as to what the empirical facts are. Scientism is ever present and the master has laid it before us long ago, i.e., Wittgenstein (hereafter W) beginning with the Blue and Brown Books in the early 1930’s. "Philosophers constantly see the method of science before their eyes and are irresistibly tempted to ask and answer questions in the way science does. This tendency is the real source of metaphysics and leads the philosopher into complete darkness." (BBB p18) The key to everything about us is biology, and it is obliviousness to it that leads millions of smart educated people like Obama, Chomsky, Clinton and the Pope to espouse suicidal utopian ideals that inexorably lead straight to Hell on Earth. As W noted, it is what is always before our eyes that is the hardest to see. We live in the world of conscious deliberative linguistic System 2, but it is unconscious, automatic reflexive System 1 that rules. This is the source of the universal blindness described by Searle’s The Phenomenological Illusion (TPI), Pinker’s Blank Slate and Tooby and Cosmides’ Standard Social Science Model. The astute may wonder why we cannot see System 1 at work, but it is clearly counterproductive for an animal to be thinking about or second guessing every action, and in any case, there is no time for the slow, massively integrated System 2 to be involved in the constant stream of split second ‘decisions’ we must make. As W noted, our ‘thoughts’ (T1 or the ‘thoughts’ of System 1) must lead directly to actions. iii It is my contention that the table of intentionality (rationality, mind, thought, language, personality etc.) that features prominently here describes more or less accurately, or at least serves as an heuristic for, how we think and behave, and so it encompasses not merely philosophy and psychology, but everything else (history, literature, mathematics, politics etc.). Note especially that intentionality and rationality as I (along with Searle, Wittgenstein and others) view it, includes both conscious deliberative System 2 and unconscious automated System 1 actions or reflexes. Thus, all the articles, like all behavior, are intimately connected if one knows how to look at them. As I note, The Phenomenological Illusion (oblivion to our automated System 1) is universal and extends not merely throughout philosophy but throughout life. I am sure that Chomsky, Obama, Zuckerberg and the Pope would be incredulous if told that they suffer from the same problem as Hegel, Husserl and Heidegger, (or that that they differ only in degree from drug and sex addicts in being motivated by stimulation of their frontal cortices by the delivery of dopamine (and over 100 other chemicals) via the ventral tegmentum and the nucleus accumbens), but it’s clearly true. While the phenomenologists only wasted a lot of people’s time, they are wasting the earth and their descendant’s futures. Many of the articles describe the ‘digital delusions’, which confuse the language games of System 2 with the automatisms of System 1, and so cannot distinguish biological machines (i.e., people) from other kinds of machines (i.e., computers). The ‘reductionist’ claim is that one can ‘explain’ behavior at a ‘lower’ level, but what actually happens is that one does not explain human behavior but a ‘stand in’ for it. Hence the title of Searle’s classic review of Dennett’s book (“Consciousness Explained”)— “Consciousness Explained Away”. In most contexts ‘reduction’ of higher level emergent behavior to brain functions, biochemistry, or physics is incoherent. Also for ‘reduction’ of chemistry or physics, the path is blocked by chaos and uncertainty. Anything can be ‘represented’ by equations, but when they ‘represent’ higher order behavior, it is not clear (and cannot be made clear) what the ‘results’ mean. Reductionist metaphysics is a joke, but most scientists and philosophers lack the appropriate sense of humor. Other digital delusions are that we will be saved from the pure evil (selfishness) of System 1 by computers/AI/robotics/ nanotech/genetic engineering created by System 2. The No Free Lunch principal tells us there will be serious and possibly fatal consequences. The adventurous may regard this principle as a higher order emergent expression of the Second Law of Thermodynamics. Hi-tech enthusiasts hugely underestimate the problems iv resulting from unrestrained motherhood, and of course it is neither profitable nor politically correct (and now with third world supremacism dominant, not even possible) to be honest about it. The last section describes various versions of the ‘altruism delusion’ that we are selected for cooperation, and that the euphonious ideals of Democracy, Diversity and Equality will lead us into utopia, if we just manage things correctly (the possibility of politics). Again, the No Free Lunch Principle ought to warn us it cannot be true, and we see throughout history and all over the contemporary world, that without strict controls, selfishness and stupidity gain the upper hand and soon destroy any nation that embraces it. In addition, the monkey mind steeply discounts the future, and so we cooperate in selling our descendant’s heritage for temporary comforts, greatly exacerbating the problems. I describe versions of this delusion (i.e., that we are basically ‘friendly’ if just given a chance) as it appears in some recent books on sociology/biology/economics. I end with an essay on the great tragedy playing out in America and the world, which can be seen as a direct result of our evolved psychology manifested as the inexorable machinations of System 1. Our psychology, eminently adaptive and eugenic on the plains of Africa from ca. 6 million years ago, when we split from chimpanzees, to ca. 50,000 years ago, when many of our ancestors left Africa (i.e., in the EEA or Environment of Evolutionary Adaptation), is now maladaptive and dysgenic and the source of our Suicidal Utopian Delusions. So, like all discussions of behavior (philosophy, psychology, sociology, biology, anthropology, politics, law, literature, history, economics, soccer strategies, business meetings, etc.), this book is about evolutionary strategies, selfish genes and inclusive fitness (kin selection). Many accept the delusion that we are selected for cooperation with people generally (group selection or altruism) and not just our immediate relatives (kin selection or inclusive fitness), so I spend some time in the essays of the last section demolishing this fantasy. One thing rarely mentioned by the group selectionists is the fact that, even were ‘group selection’ possible, selfishness is at least as likely (probably far more likely in most contexts) to be group selected for as altruism. Just try to find examples of true altruism in nature –the fact that we can’t (which we know is not possible if we understand evolution) tells us that its apparent presence in humans is an artefact of modern life concealing the facts, and that it can no more be selected for than the tendency to suicide (which in fact it is). One does not really need science or mathematics to grasp this – it is crushingly obvious that an v organism cannot be selected for behavior that decreases the frequency of its own genes in the next generation. One might also benefit from considering a phenomenon never (in my experience) mentioned by group selectionists -- cancer. No group has as much in common as the (originally) genetically identical cells in our own bodies-a 100 trillion cell clone-- but we are all born with thousands and perhaps millions of cells that have already taken the first step on the path to cancer and generate millions to billions of cancer cells in our life. If we did not die of other things first, we (and perhaps all multicellular organisms) would all die of cancer. Only a massive and hugely complex mechanism built into our genome that represses or derepresses trillions of genes in trillions of cells, and kills and creates billions of cells a second, keeps the majority of us alive long enough to reproduce. One might take this to imply that a just, democratic and enduring society for any kind of entity on any planet in any universe is only a dream, and that no being or power could make it otherwise. It is not only ‘the laws’ of physics that are universal and inescapable, or perhaps we should say that inclusive fitness is a law of physics. The great mystic Osho said that the separation of God and Heaven from Earth and Humankind was the most evil idea that ever entered the Human mind. In the 20th century an even more evil notion arose—that humans are born with rights, rather than having to earn privileges. Thus, every day the population increases by 200,000, who must be provided with resources to grow and space to live, and who soon produce another 200,000 etc. And one almost never hears it noted that what they receive must be taken from those already alive. Their lives diminish those already here in both major obvious and countless subtle ways. Every new baby destroys the earth from the moment of conception. There cannot be human rights without human wrongs. It cannot be more obvious, but one will never see the streets full of protesters against motherhood. America and the world are in the process of collapse from excessive population growth, most of it for the last century and now all of it due to 3rd world people. Consumption of resources and the addition of 4 billion more ca. 2100 will collapse industrial civilization and bring about starvation, disease, violence and war on a staggering scale. The earth loses about 2% of it’s topsoil every year, so as it nears 2100, most of it’s food growing capacity will be gone. Billions will die and nuclear war is all but certain. In America, this is being hugely accelerated by massive immigration and immigrant reproduction, combined with abuses made possible by democracy. Depraved human nature inexorably turns the dream of democracy and diversity into a vi nightmare of crime and poverty. China will continue to overwhelm America and the world, as long as it maintains the dictatorship which limits selfishness. The root cause of collapse is the inability of our innate psychology to adapt to the modern world, which leads people to treat unrelated persons as though they had common interests. This, plus ignorance of basic biology and psychology, leads to the social engineering delusions of the partially educated who control democratic societies. Few understand that if you help one person you harm someone else—there is no free lunch and every single item anyone consumes destroys the earth beyond repair. Consequently, social policies everywhere are unsustainable and one by one all societies without stringent controls on selfishness will collapse into anarchy or dictatorship. Without dramatic and immediate changes, there is no hope for preventing the collapse of America, or any country that follows a democratic system. The popular notions supported by the Democratic Party and Third World Supremacists are that Democracy, Diversity, Equality and Social Justice will produce a Utopia in America and the world, but it is clear as crystal that they unavoidably foster selfishness and divisiveness and are producing collapse. Hence my concluding essay “Suicide by Democracy”. The most basic facts, almost never mentioned, are that there are not enough resources in America or the world to lift a significant percentage of the poor out of poverty and keep them there. Even the attempt to do this is already bankrupting America and destroying the world. The earth’s capacity to produce food decreases daily, as does our genetic quality. And now, as always, by far the greatest enemy of the poor is other poor and not the rich. -/- My writings are available as paperbacks and Kindles on Amazon. -/- Talking Monkeys: Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet - Articles and Reviews 2006-2017 (2017) ASIN B071HVC7YP. -/- The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle--Articles and Reviews 2006-2016 (2017) ASIN B071P1RP1B. -/- Suicidal Utopian Delusions in the 21st century: Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2017 (2017) 2nd printing with corrections (Feb 2018) ASIN B0711R5LGX -/- Suicide by Democracy: an Obituary for America and the World (2018) ASIN B07CQVWV9C -/- . (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, (...) and Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

According to Marshall et al. (2024), some of the patients who refuse to stay in observation after being resuscitated following an opioid overdose are likely not making an autonomous choice. While I do not intend to dispute this claim, it merits discussion what is the concept of autonomy at play in making this assessment. I contend that the concept at work is more substantive than Marshall et al. acknowledge—and more substantive, too, than the form of autonomy usually (...) thought to underpin the moral justification of the requirement of informed consent . (shrink)

Over the past decade, scholars, institutions, and activists have voiced strong concerns about the potential of automated decision systems to indirectly discriminate against vulnerable groups. This article analyses the ethics of algorithmic indirect discrimination, and argues that we can explain what is morally bad about such discrimination by reference to the fact that it causes harm. The article first sketches certain elements of the technical and conceptual background, including definitions of direct and indirect algorithmic differential treatment. It next (...) introduces three prominent accounts of fairness as potential explanations if the badness of algorithmic indirect discrimination, but argues that all three are vulnerable to powerful levelling-down-style objections. Instead, the article demonstrates how proper attention to the way differences in decision-scenarios affect the distribution of harms can help us account for intuitions in prominent cases. Finally, the article considers a potential objection based on the fact that certain forms of algorithmic indirect discrimination appear to distribute rather than cause harm, and notes that we can explain how such distributions cause harm by attending to differences in individual and group vulnerability. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...) to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

Since 2016, when the Facebook/Cambridge Analytica scandal began to emerge, public concern has grown around the threat of “online manipulation”. While these worries are familiar to privacy researchers, this paper aims to make them more salient to policymakers — first, by defining “online manipulation”, thus enabling identification of manipulative practices; and second, by drawing attention to the specific harms online manipulation threatens. We argue that online manipulation is the use of information technology to covertly influence another person’s decision-making, (...) by targeting and exploiting their decision-making vulnerabilities. Engaging in such practices can harm individuals by diminishing their economic interests, but its deeper, more insidious harm is its challenge to individual autonomy. We explore this autonomy harm, emphasising its implications for both individuals and society, and we briefly outline some strategies for combating online manipulation and strengthening autonomy in an increasingly digital world. (shrink)

According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, (...) this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy. (shrink)

Privacy and surveillance scholars increasingly worry that data collectors can use the information they gather about our behaviors, preferences, interests, incomes, and so on to manipulate us. Yet what it means, exactly, to manipulate someone, and how we might systematically distinguish cases of manipulation from other forms of influence—such as persuasion and coercion—has not been thoroughly enough explored in light of the unprecedented capacities that information technologies and digital media enable. In this paper, we develop a definition of manipulation that (...) addresses these enhanced capacities, investigate how information technologies facilitate manipulative practices, and describe the harms—to individuals and to social institutions—that flow from such practices. -/- We use the term “online manipulation” to highlight the particular class of manipulative practices enabled by a broad range of information technologies. We argue that at its core, manipulation is hidden influence—the covert subversion of another person’s decision-making power. We argue that information technology, for a number of reasons, makes engaging in manipulative practices significantly easier, and it makes the effects of such practices potentially more deeply debilitating. And we argue that by subverting another person’s decision-making power, manipulation undermines his or her autonomy. Given that respect for individual autonomy is a bedrock principle of liberal democracy, the threat of online manipulation is a cause for grave concern. (shrink)

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

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

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as (...) friends and lovers. There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Data-driven predictive algorithms are widely used to automate and guide high-stake decision making such as bail and parole recommendation, medical resource distribution, and mortgage allocation. Nevertheless, harmful outcomes biased against vulnerable groups have been reported. The growing research field known as 'algorithmic fairness' aims to mitigate these harmful biases. Its primary methodology consists in proposing mathematical metrics to address the social harms resulting from an algorithm's biased outputs. The metrics are typically motivated by -- or substantively rooted in (...) -- ideals of distributive justice, as formulated by political and legal philosophers. The perspectives of feminist political philosophers on social justice, by contrast, have been largely neglected. Some feminist philosophers have criticized the local scope of the paradigm of distributive justice and have proposed corrective amendments to surmount its limitations. The present paper brings some key insights of feminist political philosophy to algorithmic fairness. The paper has three goals. First, I show that algorithmic fairness does not accommodate structural injustices in its current scope. Second, I defend the relevance of structural injustices -- as pioneered in the contemporary philosophical literature by Iris Marion Young -- to algorithmic fairness. Third, I take some steps in developing the paradigm of 'responsible algorithmic fairness' to correct for errors in the current scope and implementation of algorithmic fairness. I close by some reflections of directions for future research. (shrink)

Children continue to be overlooked as a topic of concern in discussions around the ethical use of people’s data and information. Where children are the subject of such discussions, the focus is often primarily on privacy concerns and consent relating to the use of their data. This paper highlights the unique challenges children face when it comes to online interferences with their decision-making, primarily due to their vulnerability, impressionability, the increased likelihood of disclosing personal information online, and their (...) developmental capacities. These traits allow for practices such as hypernudging to be executed on them more accurately and with more serious consequences, specifically by potentially undermining their autonomy. We argue that children are autonomous agents in the making and thus require additional special protections to ensure that the development of their autonomy is safeguarded. This means that measures should be taken to prohibit most forms of hypernudging children and thus ensure that they are protected from this powerful technique of digital manipulation. (shrink)

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision in R.v Bournewood Community and Mental Health NHS Trust, ex parte L.

With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients “comparative risk information,” such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the “personal risk”), the risk reduction the treatment (...) provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine. (shrink)

In medical settings, machines are in close proximity with human beings: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. Machines in these contexts are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. -/- As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What (...) theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness? -/- The essays in this collection by researchers from both humanities and science describe various theoretical and experimental approaches to adding medical ethics to a machine, what design features are necessary in order to achieve this, philosophical and practical questions concerning justice, rights, decision-making and responsibility, and accurately modeling essential physician-machine-patient relationships. -/- This collection is the first book to address these 21st-century concerns. (shrink)

Responsive governance during the COVID-19 pandemic became a severe challenge for countries worldwide. With a relatively poor healthcare structure, Bangladesh performed moderately well in managing the first wave of the pandemic (March-December 2020). With substantive policy and decision-making support from the Centre, local governments collaborated with various relevant actors to enhance their pandemic-related services. In this background, this research used an integrative framework to study a case of local-level collaborative governance-the Saturia Model. Based on the authors' experience, reflections (...) and review, this analysis explores various socioeconomic and environmental factors behind the effectiveness of this collaboration in containment policies and providing support services to vulnerable groups. Findings indicate that coordination between state and non-state actors, resource mobilization, access and communication, community engagement and the adaptative capacity of the government are vital for making such collaborations work in a crisis. The lessons are valuable for prospective understanding and policy interventions. (shrink)

In this paper I consider some issues concerning cognitive enhancements and the ethics of enhancing in reproduction and parenting. I argue that there are moral reasons to enhance the cognitive capacities of the children one has, or of the children one is going to have, and that these enhancements should not be seen as an alternative to pursuing important changes in society that might also improve one’s own and one’s children’s life. It has been argued that an emphasis on enhancing (...) cognitive capacities might encourage the commodification of children. But this objection seems misplaced. The reasons why one decides to reproduce can be subject to moral approbation or condemnation, as such rea-sons might be indicators of the quality of one’s parenting and the happiness of the future persons one is committed to bringing to life. However, once the decision to reproduce is made, no further harm comes from taking as few risks as possible on behalf of the persons to whom one is giving life with their health, character and cognitive capacities. (shrink)

The Substituted Judgment Standard for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, (...) I offer an alternative standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy. (shrink)

The scientific understanding of cognition and consciousness is currently hampered by the lack of rigorous and universally accepted definitions that permit comparative studies. This article proposes new functional and unambiguous definitions for cognition and consciousness in order to provide clearly defined boundaries within which general theories of cognition and consciousness may be developed. The proposed definitions are built upon the construction and manipulation of reality representation, decision making, and learning and are scoped in terms of an underlyinglogical structure. (...) It is argued that the presentation of reality also necessitates the concept of absence and the capacity to perform transitive inference. Explicit predictions relating to these new definitions, along with possible ways to test them, are also described and discussed. (shrink)

The human factor in information systems is a large vulnerability when implementing cybersecurity, and many approaches, including technical and policy driven solutions, seek to mitigate this vulnerability. Decisions to apply technical or policy solutions must consider how an individual’s values and moral stance influence their responses to these implementations. Our research aims to evaluate how individuals prioritise different ethical principles when making cybersecurity sensitive decisions and how much perceived choice they have when doing so. Further, we sought to use (...) participants’ responses to cybersecurity scenarios to create profiles that describe their values and individual factors including personality. Participants (n = 193) in our study responded to five different ethically sensitive cybersecurity scenarios in random order, selecting their action in that scenario and rating and ranking of the ethical principles (i.e., Beneficence, Non-Maleficence, Justice, Autonomy, Explicability) behind that action. Using participants’ demographics, personality, values, and cyber hygiene practices, we created profiles using machine learning to predict participants’ choices and the principle of most importance to them across scenarios. Further, we found that, generalising, for our participants Autonomy was the most important ethical principle in our scenarios, followed by Justice. Our study also suggests that participants felt they had some agency in their decision making and they were able to weigh up different ethical principles. (shrink)

When comparing alternative courses of action, modern military decision makers often must consider both the military effectiveness and the ethical consequences of the available alternatives. The basis, design, calibration, and performance of a principles-based computational model of ethical considerations in military decision making are reported in this article. The relative ethical violation (REV) model comparatively evaluates alternative military actions based upon the degree to which they violate contextually relevant ethical principles. It is based on a set of (...) specific ethical principles deemed by philosophers and ethicists to be relevant to military courses of action. A survey of expert and non-expert human decision makers regarding the relative ethical violation of alternative actions for a set of specially designed calibration scenarios was conducted to collect data that was used to calibrate the REV model. Perhaps unsurprisingly, the survey showed that people, even experts, disagreed greatly amongst themselves regarding the scenarios’ ethical considerations. Despite this disagreement, two significant results emerged. First, after calibration the REV model performed very well in terms of replicating the ethical assessments of human experts for the calibration scenarios. The REV model outperformed an earlier model that was based on tangible consequences rather than ethical principles, that earlier model performed comparably to human experts, the experts outperformed human non-experts, and the non-experts outperformed random selection of actions. All of these performance comparisons were measured quantitatively and confirmed with suitable statistical tests. Second, although humans tended to value some principles over others, none of the ethical principles involved—even the principle of not harming civilians—completely overshadowed all of the other principles. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these (...) principles help to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

In the recent literature on episodic memory, there has been increasing recognition of the need to provide an account of its adaptive function. In this context, it is sometimes argued that episodic memory is critical for certain forms of decision making about the future. We criticize existing accounts that try to give episodic memory a role in decision making, before giving a novel such account of our own. This turns on the thought of a link between (...) episodic memory and the emotion of regret. We discuss how both experienced and anticipated regret can have a distinctive influence on decision making, and argue that the ability to recollect past events in episodic memory underpins the capacity to engage in the sophisticated types of mental time travel recruited in experiencing and anticipating regret. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments (...) and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

In a context of imperfect risk protection, households may protect against the impact of a health shock by employing various financial and non-financial coping mechanisms, such as foregoing or reducing needed medical care, labor substitution, consumption reduction, borrowing money, dissaving, and selling assets. However, leveraging certain coping mechanisms may reduce future productivity, potentially trapping households in chronic or persistent poverty. Resources and risk are not necessarily shared equitably within a household; the ability and willingness of the household to leverage coping (...) mechanisms, or the choice of coping mechanism may depend on the social protection policy context, household socioeconomic status, and type of intrahousehold risk sharing. Vietnam has been making policy changes aimed towards achieving Universal Health Coverage for the past several decades, culminating in a 2015 change mandating universal insurance coverage. This can potentially influence both providers in making decisions around service delivery and households around financing care. This research aims to contribute to the literature exploring the relationships among direct and indirect health care costs, potentially maladaptive coping mechanisms, and household living standards, within the particular health financing and social protection environment in Vietnam. (shrink)

Current technology and surveillance practices make behaviors traceable to persons in unprecedented ways. This causes a loss of anonymity and of many privacy measures relied on in the past. These de facto privacy losses are by many seen as problematic for individual psychology, intimate relations and democratic practices such as free speech and free assembly. I share most of these concerns but propose that an even more fundamental problem might be that our very ability to act as autonomous and purposive (...) agents relies on some degree of privacy, perhaps particularly as we act in public and semi-public spaces. I suggest that basic issues concerning action choices have been left largely unexplored, due to a series of problematic theoretical assumptions at the heart of privacy debates. One such assumption has to do with the influential conceptualization of privacy as pertaining to personal intimate facts belonging to a private sphere as opposed to a public sphere of public facts. As Helen Nissenbaum has pointed out, the notion of privacy in public sounds almost like an oxymoron given this traditional private-public dichotomy. I discuss her important attempt to defend privacy in public through her concept of ‘contextual integrity.’ Context is crucial, but Nissenbaum’s descriptive notion of existing norms seems to fall short of a solution. I here agree with Joel Reidenberg’s recent worries regarding any approach that relies on ‘reasonable expectations’ . The problem is that in many current contexts we have no such expectations. Our contexts have already lost their integrity, so to speak. By way of a functional and more biologically inspired account, I analyze the relational and contextual dynamics of both privacy needs and harms. Through an understanding of action choice as situated and options and capabilities as relational, a more consequence-oriented notion of privacy begins to appear. I suggest that privacy needs, harms and protections are relational. Privacy might have less to do with seclusion and absolute transactional control than hitherto thought. It might instead hinge on capacities to limit the social consequences of our actions through knowing and shaping our perceptible agency and social contexts of action. To act with intent we generally need the ability to conceal during exposure. If this analysis is correct then relational privacy is an important condition for autonomic purposive and responsible agency—particularly in public space. Overall, this chapter offers a first stab at a reconceptualization of our privacy needs as relational to contexts of action. In terms of ‘rights to privacy’ this means that we should expand our view from the regulation and protection of the information of individuals to questions of the kind of contexts we are creating. I am here particularly interested in what I call ‘unbounded contexts’, i.e. cases of context collapses, hidden audiences and even unknowable future agents. (shrink)

Local participation is always beneficial for sustainable action and environmental problems resulting from urban implementation due to the failure of social and institutional change necessary for a successful transformation of rural life to urban life ahead of the rapid movement of the population. Despite good legal practice and comprehensive guidelines, evidence suggests that Environmental Impact Assessment (EIA) or more broadly Environmental, Social and Health Impact Assessment (ESHIA) have not yet been found satisfactory in Nigeria, as the current system amounts to (...) duplication of efforts and cost. However, ESHIA has been developed and integrated to help manage project activities, facilities, and operations sustainably, so that both economic and ecological profits are accrued (sustainable development) or ensure that any development project does not result in excessive deterioration of and/or the irreversible adverse effect on any component of the environment – a recite for sustainable development. A literature review was done by using a variety of search engines including Research Gate, Google Scholar, Academia, Mendeley, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports. The thrust of this study is to evaluate the potential benefits of ESHIA as a tool for sustainable environmental development. The evaluation and implementation of EIA are one of the strengths of these tools. Indeed, EIA is the first and foremost management tool employed to help mitigate adverse, potential, and associated impacts of proposed major developments in our environment. EIA is a regulatory requirement that is efficiently used to improve performance, project design, enhancing decision-making, and facilitating policy programs in a sustainable environment. An evaluation of the EIA systems reveals several weaknesses of the EIA system. These include the inadequate capacity of EIA approval authorities, deficiencies in screening and scoping, poor EIA quality, insufficient public participation, and weak monitoring, and erratic government policies. Overall, most EIA study rarely meets the objectives of being a project planning tool to contribute to achieving sustainable development and mitigate the impact of the development project. The study recommends some directions for the future to ensure that entire content of the EIA are religiously implemented, review the existing EIA act, increase the expertise of EIA consultants, create a liaison office with an international organisation and with sister agency, ESHIA must enjoy Improved budgetary provision, time latitude, spatial contexts and methodological improvements for outcome measures to achieve results that are relevant to sustainable development by improving project design, enhancing decision making and facilitating policy programs. (shrink)

In “Harmful Choices, the Case of C, and Decision-Making Competence,” Pickering and colleagues advance an argument in favor of externalism, a view in which the competence of a decision maker is judged relative to factors external to their cognition. In advancing this argument, Pickering and colleagues focus on the external factor of harm: In their view, it is the harmfulness of a considered or chosen action that provides evidence against the competence of the decision maker. (...) However, the proper identification of harmful choices and outcomes remains a demanding task, largely because our understanding of what harm is remains deeply incomplete. Despite 50 years of tempestuous debate, the metaphysics of harm remains an unsettled question. The existence of such a debate does not, in and of itself, provide evidence against the externalist position; rather, it is the theories of harm themselves that pose meaningful challenges for the externalist. Our purpose, here, is to illuminate these challenges. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

In virtue of what are we responsible for our beliefs? I argue that doxastic responsibility has a crucial social component: part of being responsible for our beliefs is being responsible to others. I suggest that this responsibility is a form of answerability with two distinct dimensions: an individual and an interpersonal dimension. While most views hold that the individual dimension is grounded in some form of control that we can exercise over our beliefs, I contend that we are answerable for (...) our beliefs as long as they reflect our evaluative commitments and dispositions, or are products of our reasoning, where this does not amount to a form of control. I next argue that answerability has a second, largely neglected dimension: the interpersonal dimension, which is grounded in what I call our relations of doxastic dependence. As social creatures, we depend on one another in our capacity as believers. We depend on one another as believers not only in epistemic ways, but also in practical ways, because our beliefs inform and motivate our actions, and allow us to participate in shared practical goals. Depending on one another in these ways is an unavoidable part of cooperating in the shared project of pursuing epistemic and practical success, and it makes us vulnerable to both epistemic and moral harm. It is because of this, I argue, that answerability has interpersonal normative force upon us: we are subject to legitimate expectations associated with participating in relations of doxastic dependence. (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption (...) in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Most medical research and a substantial amount of non-medical research, especially that involving human participants, is governed by some kind of research ethics committee (REC) following the recommendations of the Declaration of Helsinki for the protection of human participants. The role of RECs is usually seen as twofold: firstly, to make some kind of calculation of the risks and benefits of the proposed research, and secondly, to ensure that participants give informed consent. The extent to which the role of the (...) REC includes the former is not uncontroversial. Indeed, the most prevalent debate on the role of RECs sees liberals and strong paternalists arguing over the importance of informed consent given by competent agents versus the significance of making benevolent decisions on behalf of others. On the one hand, liberals argue for the rights of competent adults to decide for themselves the kinds and extents of risks to which they wish to expose themselves. On the other hand, proponents of strong paternalism raise concerns about the likelihood of participants being able to truly understand the complex data involved in research. They support a role for RECs in which they exercise duties of benevolence towards patients and participants by limiting the extent to which they can be exposed to significant, permanent and irreversible harms. In this paper, we will argue that when it comes to decisions about risk it is neither possible nor desirable for RECs to adopt either role. (shrink)

Recent research has relied on trolley-type sacrificial moral dilemmas to study utilitarian versus nonutili- tarian modes of moral decision-making. This research has generated important insights into people’s attitudes toward instrumental harm—that is, the sacrifice of an individual to save a greater number. But this approach also has serious limitations. Most notably, it ignores the positive, altruistic core of utilitarianism, which is characterized by impartial concern for the well-being of everyone, whether near or far. Here, we develop, refine, (...) and validate a new scale—the Oxford Utilitarianism Scale—to dissociate individual differences in the ‘negative’ (permissive attitude toward instrumental harm) and ‘positive’ (impartial concern for the greater good) dimensions of utilitarian thinking as manifested in the general population. We show that these are two independent dimensions of proto-utilitarian tendencies in the lay population, each exhibiting a distinct psychological profile. Empathic concern, identification with the whole of humanity, and concern for future generations were positively associated with impartial beneficence but negatively associated with instrumental harm; and although instrumental harm was associated with subclinical psychopathy, impartial beneficence was associated with higher religiosity. Importantly, although these two dimensions were independent in the lay population, they were closely associated in a sample of moral philosophers. Acknowledging this dissociation between the instrumental harm and impartial beneficence components of utilitarian thinking in ordinary people can clarify existing debates about the nature of moral psychology and its relation to moral philosophy as well as generate fruitful avenues for further research. (shrink)