There is increasing interest in using neuro-stimulation devices to achieve an ergogenic effect in elite athletes. Although the World Anti-Doping Authority does not currently prohibit neuro-stimulation techniques, a number of researchers have called on WADA to consider its position on this issue. Focusing on trans-cranial direct current stimulation as a case study of an imminent so-called ‘neuro-doping’ intervention, we argue that the emerging evidence suggests that tDCS may meet WADA’s own criteria for a method’s inclusion on its list of prohibited (...) substances and methods. We begin by surveying WADA’s general approach to doping, and highlight important limitations to the current evidence base regarding the performance-enhancing effect of pharmacological doping substances. We then review the current evidence base for the safety and efficacy of tDCS, and argue that despite significant shortcomings, there may be sufficient evidence for WADA to consider prohibiting tDCS, in light of the comparable flaws in the evidence base for pharmacological doping substances. In the second half of the paper, we argue that the question of whether WADA ought to ban tDCS turns significantly on the question of whether it is compatible with the ‘spirit of sport’ criterion. We critique some of the previously published positions on this, and advocate our own sport-specific and application-specific approach. Despite these arguments, we finally conclude by suggesting that tDCS ought to be monitored rather than prohibited due to compelling non-ideal considerations. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

In this article Cristoph Wulf examines the basic concepts of pedagogy and educational science in the German-speaking world, looking at education and socialization from the perspective of educational anthropology. He makes evident that the complex German concept of Bildung, in particular, can only be fully understood by means of a historical and philosophical analysis.

Do famous athletes have special obligations to act virtuously? A number of philosophers have investigated this question by examining whether famous athletes are subject to special role model obligations (Wellman 2003; Feezel 2005; Spurgin 2012). In this paper we will take a different approach and give a positive response to this question by arguing for the position that sport and gaming celebrities are ‘ambassadors of the game’: moral agents whose vocations as rule-followers have unique implications for their non-lusory lives. According (...) to this idea, the actions of a game’s players and other stakeholders—especially the actions of its stars—directly affect the value of the game itself, a fact which generates additional moral reasons to behave in a virtuous manner. We will begin by explaining the three main positions one may take with respect to the question: moral exceptionalism, moral generalism, and moral exemplarism. We will argue that no convincing case for moral exemplarism has thus far been made, which gives us reason to look for new ways to defend this position. We then provide our own ‘ambassadors of the game’ account and argue that it gives us good reason to think that sport and game celebrities are subject to special obligations to act virtuously. (shrink)

“Bioconservatives” in the human enhancement debate endorse the conservative claim that we should reject the use of biotechnologies that enhance natural human capacities. However, they often ground their objections to enhancement with contestable claims about human nature that are also in tension with other common tenets of conservatism. We argue that bioconservatives could raise a more plausible objection to enhancement by invoking a strain of conservative thought developed by G.A. Cohen. Although Cohen’s conservatism is not sufficient to fully revive the (...) bioconservative objection, we argue that it can be supplemented by an account of reasonable partiality for humanity in a way that provides further support to the bioconservative position in a manner congruous with broader conservatism. We propose that the idea of partiality to humanity can buttress the bioconservative objection into its strongest possible form. However, we conclude by arguing that, even in this form, the objection cannot do all the work that bioconservatives expect of it. (shrink)

This paper argues that we should replace the common classification of theories of welfare into the categories of hedonism, desire theories, and objective list theories. The tripartite classification is objectionable because it is unduly narrow and it is confusing: it excludes theories of welfare that are worthy of discussion, and it obscures important distinctions. In its place, the paper proposes two independent classifications corresponding to a distinction emphasised by Roger Crisp: a four-category classification of enumerative theories (about which items constitute (...) welfare), and a four-category classification of explanatory theories (about why these items constitute welfare). (shrink)

In this paper, I consider the role of perspective in Hegel’s metaphysics, and in particular the role that multiple perspectives play within the ultimate structure in Hegel’s metaphysics, which Hegel calls ‘the idea [die Idee].’ My (somewhat anachronistic) way into this topic will be to inquire about Hegel’s stance on what Adrian Moore has called ‘absolute representations.’ I argue for the claim that perspective is maintained, even in the absolute idea, which generates the task of understanding the nature of that (...) perspective and its compatibility with absoluteness. I attempt to accomplish this task by asking what a logical perspective could be, and how it might be related to visual perspective. Then I inquire into the relation that perspectives have to each other, i.e., to the system of perspectives. I construe those relations in reciprocal and dynamic terms, so that absoluteness takes the form of a structured round of perspectives rather than a relation to reality “once and for all”. (shrink)

Authentizitat ist ein in unserem kulturellen Raum allgegenwartiges Phanomen. Doch wem oder was begegnen wir, wenn wir meinen, uns selbst verwirklichen oder alternativ einfach uns selbst treu sein zu mussen? Christoph Wiesinger zeigt, dass wir auf ein Selbst geworfen werden, das zwar als homogener Nukleus der Person projiziert werden kann, sich aber bei genauerem Hinsehen als komplexe sozial verinnerlichte Struktur entpuppt. Das Selbst ist keineswegs objektiv zu fassen, sondern unterliegt sozialen Genesen und wird durch soziale Adressierung unterschiedlich formiert. Das Ereignis (...) von Authentizitat gibt somit Anlass zur Reflexion der Differenz zwischen Erwartung und Erfahrung. Christoph Wiesinger legt die Strukturen des Phanomens der Authentizitat frei, zeigt die theologischen Implikationen auf und diskutiert die praktisch-theologischen Konsequenzen. (shrink)

This chapter surveys hybrid theories of well-being. It also discusses some criticisms, and suggests some new directions that philosophical discussion of hybrid theories might take.

Group-based reasons are reasons to play one’s part in some pattern of action that the members of some group could perform, because of the good features of the pattern. This paper discusses three broad conceptions of such reasons. According to the agency-first conception, there are no group-based reasons in cases where the relevant group is not or would not be itself an agent. According to the behaviour-first conception, what matters is that the other members of the group would play their (...) parts in the relevant pattern, not whether they would have the cooperative intentional states constitutive of group agency in doing so. This paper argues against these conceptions and in favour of the powers-first conception, according to which what matters is that the members of the group have practically relevant powers. (shrink)

What makes philosophy on the continent of Europe so different and exciting? And why does it have such a reputation for being 'difficult'? Continental philosophy was initiated amid the revolutionary ferment of the 18th century, philosophers such as Kant and Hegel confronting the extremism of the time with theories that challenged the very formation of individual and social consciousness. Covering the great philosophers of the modern and postmodern eras – from Nietzsche, Heidegger, Derrida and Deleuze right to up Agamben and (...) Žižek – and philosophical movements from German idealism to deconstruction and feminism – Christopher Kul-Want and Piero brilliantly elucidate some of the most thrilling and powerful ideas ever to have been discussed. (shrink)

What does social justice require in contemporary societies? What are the requirements of social democracy? Who and where are the individuals and groups that can carry forward agendas for progressive social transformation? What are we to make of the so-called new social movements of the last thirty years? Is identity politics compatible with egalitarianism? Can cultural misrecognition and economic maldistribution be fought simultaneously? What of the heritage of Western Marxism is alive and dead? And how is current critical social theory (...) to approach these and other questions? Much of the most productive work done in recent social theory has revolved around such issues, in particular, around those concerning the relationship between the politics of recognition and the politics of distribution. After the intense theoretical focus over the last fifteen years or so on the issues of recognition politics—multiculturalism, multi-nationalism, identity politics, group-differentiated rights, the accommodation of difference, and so on—some social theorists have worried that attention has been diverted from important issues of distributive equality—systematic impoverishment, increasing material inequality, ‘structural’ unemployment, the growth of oligarchic power, global economic segmentation, and so on. While some critics seem to have adopted a blunt ‘it’s the economy, stupid’ line of criticism,1 others have attempted to develop an overarching, integrative theoretical framework adequate to the diverse issues concerning both economic and cultural justice. For example, Axel Honneth proposes that a suitably developed and normatively robust theory of intersubjective recognition can adequately integrate an analysis of apparently diverse contemporary struggles: those for a just division of labor and hence, a fair distribution of resources and opportunities, as well as those for a culture free of identity-deforming disrespect and denigration. (shrink)

Die Kernthese der Paracelsischen Naturphilosophie, die Ahnlichkeit von Mensch und Welt, festgelegt in der Analogie von Mikro- und Makrokosmos, enthullt einen -Code-, der als konstitutives Moment samtliche Aussagen auf einer prakonzeptionellen Ebene organisiert, samtliche Teilbereiche in ihrer funktionalen Bedeutung fur das -Ganze- markiert und schliesslich im Sinne Foucaults zu einer -diskursiven Formation- werden lasst. Die auf diese Weise vorgefuhrte Erfahrungsform von Welt und Natur steht zu dem neuzeitlich-technischen Verfugungswissen in einer historischen Diskontinuitat.".

Bernard Freydberg’s recent work is a careful and compact study of David Hume’s signature texts: An Enquiry Concerning Human Understanding (1748), An Enquiry Concerning Principles of Morals (1751), and “Of the Standard of Taste” (1757). Contrary to traditional epistemological readings that comfortably situate Hume as an empiricist naturalist, Freydberg argues that he is better understood as a profound thinker of imagination and Socratic ignorance. Hume’s figurative and Platonic argumentation varies in each text, but Freydberg makes a convincing case that his (...) theoretical, moral, and aesthetic philosophies share a proto-phenomenological center in the artistry of human nature and perception. (shrink)

This article proposes a way of understanding Kantianism, act-utilitarianism and some other important ethical theories according to which they are all versions of the same kind of theory, sharing a common structure. I argue that this is a profitable way to understand the theories discussed. It is charitable to the theories concerned; it emphasizes the common ground between them; it gives us insights into the differences between them; and it provides a method for generating new ethical theories worth studying. The (...) article briefly discusses the relationship between these ideas and some other recent proposals that emphasize the common ground between Kantianism and versions of consequentialism. (shrink)

This paper examines the idea of an extended unit of action, which is the idea that the reasons for or against an individual action can depend on the qualities of a larger pattern of action of which it is a part. One concept of joint action is that the unit of action can be extended in this sense. But the idea of an extended unit of action is surprisingly minimal in its commitments. The paper argues for this conclusion by examining (...) uses of the idea of an extended unit of action in four theoretical contexts. It also explains why the idea of an extended unit of action need not involve magical thinking, and discusses possible replies to an objection based on a worry about recklessness. (shrink)

Are we witnessing progress or regress in the recent increasing popularity and electoral success of populist politicians and parties in consolidated democratic nations? ... Is the innovative use of popular referendum in Great Britain to settle fundamental constitutional questions a progressive or regressive innovation? ... Similarly, is the increasing use of constituent assemblies to change constitutions across the world evidence of progress in democratic constitutionalism, or, a worryingly regressive change back toward unmediated popular majoritarianism? ... This paper reflects on some (...) of the perils and promise of framing such questions with the conceptual couplet of progress and regress. It considers four compelling critiques of the use of ‘progress’ and its cognates in sociopolitical theory, as well as arguing that such concepts are nevertheless ineliminable for our normative theories. The paper concludes by suggesting that we can avoid the most serious problems by employing only conceptions of political progress and regress that are piecemeal, pragmatic, and processual. (shrink)

Our reception of Hegel’s theory of action faces a fundamental difficulty: on the one hand, that theory is quite clearly embedded in a social theory of modern life, but on the other hand most of the features of the society that gave that embedding its specific content have become almost inscrutably strange to us (e.g., the estates and the monarchy). Thus we find ourselves in the awkward position of stressing the theory’s sociality even as we scramble backwards to distance ourselves (...) from the particular social institutions that gave conceptualized form to such sociality in Hegel’s own opinion. My attempt in this article is to make our position less awkward by giving us at least one social-ontological leg to stand on. Specifically, I want to defend a principled and conceptual pluralism as forming the heart of Hegel’s theory of action. If this view can be made out, then we will have a social-ontological structure that might be filled out in different ways in Hegel’s time and our own while simultaneously giving real teeth to the notion that Hegel’s theory of action is essentially social. (shrink)

Theorists of public reason such as John Rawls often idealize constitutional courts as exemplars of public reason. This paper raises questions about the seduction and limits of analogies between theorists’ account of public reason and actual constitutional jurisprudence. Examining the work product of the United States Supreme Court, the paper argues that while it does engage in reason-giving to support its decisions—as the public reason strategy suggests— those reasons are (largely) legalistic and specifically juristic reasons—not the theorists’ idealized moral-political reasons (...) on matters of fundamental principle. But if constitutional courts do not engage on matters of fundamental principle, then a public reason strategy for assuaging democratic worries about judicial review would no longer be open: prominent liberal and deliberative democratic theorists could no longer point to the alleged superiority of constitutional courts to speak in the name of, and for, the people’s shared political principles. The paper extends beyond the U.S. case study by pointing to three institutional factors explaining the disanalogy between what some constitutional courts do and what public reason theories require them to do. It concludes with considerations about whether the public reason strategy might be more successfully applied to international courts. (shrink)

We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...) of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable—and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines. (shrink)

Green bioethics is an area of research and scholarship that examines the impact of healthcare practices and policies on the environment and emphasises environmental values, such as ecological sustainability and stewardship. Some green bioethicists have argued that healthcare providers should inform patients about the environmental impacts of treatments and advocate for options that minimise adverse impacts. While disclosure of information pertaining to the environmental impacts of treatments could facilitate autonomous decision-making and strengthen the patient–provider relationship in situations where patients have (...) clearly expressed environmental concerns, it may have the opposite effect in other situations if makes patients feel like they are being judged or manipulated. We argue, therefore, that there is not a generalisable duty to disclose environmental impact information to all patients during the consent process. Providers who practice green bioethics should focus on advocating for system-level changes in healthcare financing, organisation and delivery and use discretion when bringing up environmental concerns in their encounters with patients. (shrink)

This paper connects two ideas. The first is that some common responses to ethical views are responses to their degrees of pragmatism, where a view’s degree of pragmatism is its sensitivity to ethically relevant changes in the actor’s circumstances. I claim that we feel the pull of opposing pro-pragmatic and antipragmatic intuitions in certain cases. This suggests a project, of searching for an ethical view capable of doing justice to these opposing intuitions in some way. The second central idea is (...) that a theory of pattern-based reasons looks more promising than the obvious alternatives to fulfil this role, amongst Teleological theories at least. Pattern-based reasons are reasons to perform some action because of the goodness or rightness of a larger pattern of action—such as a pattern that a group could perform or that the actor could perform over an extended period—of which the immediate action is a mere part. Existing theories of such reasons share two features that prevent them explaining the intuitions we wish to explain: they consider only one pattern at a time (they are monist), and they treat patterns as eligible only if the agents concerned are willing to realise them (they accept the Willingness Requirement). But we need not accept these doctrines. Moreover, a theory of patternbased reasons without them is able to explain the pro- and anti-pragmatic intuitions in an elegant way, and has other attractive features. (shrink)

There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific (...) literature, relating to desire, control, and emotion, respectively. We explain why the precise nature of the mechanism has important implications for the patient’s autonomy and personal identity. In the second part of the paper, we consider practical dimensions of offering DBS to patients with AN in certain cases. We first discuss some limited circumstances where the mere offering of the intervention might be perceived as exerting a degree of coercive pressure that could serve to undermine the validity of the patient’s consent. Finally, we consider the implications of potential effects of DBS for the authenticity of the patient’s choice to continue using stimulation to ameliorate their condition. (shrink)

One of the most important elements of Hegel’s philosophical anthropology is his moral psychology. In particular, his understanding of the relation between motivations and reason plays a crucial intermediate role in connecting his anthropological meditations on the complete nature of the human being with his political theory of actualized freedom. Whereas recent important work on Hegel’s moral psychology has detected a Kantian distinction between natural desires and the rational perspective, the activity of practical reason actually takes place within motivations themselves (...) on Hegel’s view. The exercise of the free, rational will is best understood in terms of its role in shaping the experience of malleable, indeterminate motivations. Rather than stepping back, the free agent on Hegel’s account delves further into the motivation, acting on it in the dual sense of being guided by and transforming it. This is what it means for Hegel to conceive of agency as self-expression while maintaining the centrality of reason for Free Will. Hegel says that when we go further into the motivations in this way, we should stop speaking of motivation in terms of drives and instead begin speaking of character. (shrink)

In the Gorgias, Plato explores the relationship between statesmanship and rhetoric. Socrates argues that the true statesman uses the true rhetoric in the attempt to make others better through speeches. In the conversation with Gorgias, Socrates forces him to see the potentially disastrous consequences of teaching a kind of rhetoric that is morally neutral, which suggests the need for an uncompromisingly true or just rhetoric. In the exchange with Polus, Socrates attempts the just reformation of rhetoric into true rhetoric to (...) counter the unjust rhetoric of Polus. In his discussion with Callicles, Socrates uses the true rhetoric to try to moderate him, but his failure reveals the limits of true statesmanship. By examining these three exchanges, I shed light on a unique and neglected paradox of the Gorgias. As clearly as the dialogue articulates what constitutes a true statesman, it challenges his own practice. Socrates, as the true statesman possessing the true rhetoric, is powerless to achieve his goals. However, a potential way to expand the success of the true statesman can be seen by going back to the discourse between Socrates and Gorgias and forging an alliance between them. (shrink)

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

Details the role that giants have played in the history of humankind. _...style is breezy and accessible...a pleasant browse._ --BOOKLIST.

This chapter discusses the analysis of Joseph Raz on coercion, trust, and citizenship. The chapter starts with a number of brief comments on some of his observations regarding the doctrine of liberty and the preference for minimum government. The chapter also includes one of Raz's arguments that states that some people favour non-perfectionist forms of government out of a misunderstanding of the implications of perfectionism for liberty.

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)

The author argues the following hypothesis: the medical clinic is an experimental practice, in the sense given to this term by Claude Bernard, and the clinic is its specific laboratory. Its object is not the disease, but the patient. Careful examination of the clinic attests to its very close proximity to the experimental method, and the comparison also raises a number of difficulties. The main obstacle arises from the specificity of medicine, which involves treating individual human subjects whose words cannot (...) be suppressed. Its main challenge is to combine a linguistic practice with an experimental method. (shrink)

At the end of 2015‘s The Witch, isolated and beaten protagonist, Thomasin, ultimately rejects her puritanical upbringing to become a witch, accepting the invitation of the Devil (in the guise of the family’s goat Black Philip). This essay will discuss Thomasin’s sexual deliverance in terms of her turning away from the authoritarian ‘Law of the Father’ towards female liberation that comes in the form of the Witch. Thomasin transitions from girl to woman, but does not want to do so in (...) the restrictive Puritan fashion where patriarchy and oppression rules. She becomes a woman by embracing her sexuality in the figure of the witch and Black Philip as the figure of lust helping her become free. Western folklore posits the goat as a symbol of fertility, independence, and lust; Black Philip is a figure who represents a connection to wild desires. Therefore, Black Philip becomes not only a physical representation of the devil, but also a symbolic representation of Thomasin’s sexual desire. Drawing on theories of the monstrous-feminine (Creed, Kristeva, Arnold), the symbolism of folklore and Freud’s Electra complex, this work argues that, despite its message of feminine empowerment, The Witch cannot fully reject or escape patriarchal discourse. (shrink)

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

Emerging reprogenetic technologies may enable the enhancement of our offspring's genes. Beyond raising ethical questions, these biotechnologies may change some aspects of future morality. In the reproductive field, biotechnological innovations may transform moral views about reproductive choices regarding what we consider to be just or even of equal standing.

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)